Introduction:
The gluten-free diet (GFD) is the only treatment for coeliac disease (CD), yet many patients experience persistent symptoms, ongoing gluten exposure, nutritional deficiencies, and reduced quality of life despite treatment. Although international guidelines recommend dietitian involvement, they provide limited guidance on the delivery of specialist dietetic care. We aimed to develop a national evidence-based protocol defining the role of specialist CD dietitians across the patient pathway.
Methods:
The Spanish Society for Coeliac Disease convened a multidisciplinary working group comprising five specialist dietitians with extensive clinical and research expertise in adult and paediatric CD. Representing clinical practice, academia, nutrition research, and specialist coeliac services in Spain and the United Kingdom, the group reviewed current evidence, international guidelines, and established care pathways to develop an evidence-based national protocol for specialist dietetic care.
Results:
The protocol provides the first structured framework defining specialist dietetic care before diagnosis, at diagnosis, and throughout long-term follow-up. It establishes specialist CD dietitians as core members of the multidisciplinary team and standardises nutritional, biochemical, dietary, symptom, and psychosocial assessment, implementation of a nutritionally adequate GFD, adherence monitoring, and management of non-responsive CD. It also defines referral criteria for complex clinical scenarios, including refractory CD, persistent symptoms, nutritional deficiencies, weight management concerns, transition from paediatric to adult care, and complex comorbidities. Structured group education and individual follow-up pathways are integrated throughout.
Conclusion:
This national expert protocol moves beyond existing guideline recommendations by translating evidence into practical clinical pathways for specialist dietetic care. It provides a scalable framework to standardise nutritional management, optimise adherence and nutritional adequacy, improve patient outcomes, and support integration of specialist dietitians within multidisciplinary coeliac services internationally.