title: Is dietitian use associated with celiac disease outcomes?
abstract: A gluten-free diet (GFD) is the treatment for celiac disease (CD), but due to its complexity, dietitian referral is uniformly recommended. We surveyed patients with CD to determine if dietitian use is associated with quality of life, symptom severity, or GFD adherence. The survey utilized three validated CD-specific instruments: the CD quality of life (CD-QOL), CD symptom index (CSI) and CD adherence test (CDAT). Four hundred and thirteen patients with biopsy-proven CD were eligible for inclusion. The majority (77%) were female and mean BMI was 24.1. Over three-quarters of patients (326, 79%) had seen a dietitian, however, 161 (39%) had seen a dietitian only once. Age, sex, and education level were not associated with dietitian use; nor was BMI (24.6 vs. 24.0, p = 0.45). On multivariate analysis, adjusting for age gender, education, duration of disease, and body mass index, dietitian use was not associated with CD-QOL, CSI, or CDAT scores. Our survey did not show an association between dietitian use and symptom severity, adherence, or quality of life. Delay in diagnosis was associated with poorer outcomes. This is a preliminary study with several limitations, and further prospective analysis is needed to evaluate the benefits and cost-effectiveness of dietitian-referral in the care of celiac disease patients.
authors.affiliation: Celiac Disease Center, Columbia University College of Physicians and Surgeons, 180 Fort Washington Avenue, Suite 934, New York, NY 10032, USA. sm3455@columbia.edu
authors.forename: SriHari
authors.initials: S
authors.lastname: Mahadev
authors.forename: Suzanne
authors.initials: S
authors.lastname: Simpson
authors.forename: Benjamin
authors.initials: B
authors.lastname: Lebwohl
authors.forename: Suzanne K
authors.initials: SK
authors.lastname: Lewis
authors.forename: Christina A
authors.initials: CA
authors.lastname: Tennyson
authors.forename: Peter H R
authors.initials: PH
authors.lastname: Green
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis / Q000178:diet therapy*; D003695:Delivery of Health Care; D055050:Diet, Gluten-Free; D004046:Dietetics / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance; D011788:Quality of Life; D012017:Referral and Consultation; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult