Background: A gluten-free diet (GFD) is the only treatment for celiac disease (CeD), but processing required for gluten-free products may increase reliance on ultra-processed foods (UPF) and compromise diet quality. The Canadian Gluten-Free Food Guide (GFFG) promotes fruits, vegetables, protein-rich foods, and naturally gluten-free foods. A pilot trial found GFFG-based counseling improved dietary variety in children newly diagnosed with CeD. Whether similar education improves diet quality in U.S. children is unknown (1).
Objective: To assess the impact of a one-time nutrition intervention on fruit and vegetable intake and diet quality in children newly diagnosed with CeD in the US.
Methods: Children (2–17 years) with endoscopically confirmed CeD were randomized to GF-NOURISH or conventional GFD education and followed for 6 months. Both groups received education on gluten identification, label reading, and nutritional adequacy; GF-NOURISH additionally emphasized fruits, vegetables, plant proteins, and minimally processed foods using the GFFG. Dietary intake was assessed at baseline and 6 months and classified by NOVA. Analyses used repeated-measures ANOVA, t-tests, Wilcoxon tests, and Fisher’s exact tests as appropriate.
Results: Among 28 participants (GF-NOURISH n=11; Conventional n=17), mean age was 8.9±3.0 years; 70.4% were female and 57.7% had a family history of CeD. Total caloric and unprocessed/minimally processed food (NOVA 1) intake increased (GF-NOURISH p=0.0007; Conventional p=0.0035), while UPF intake did not change or differ between groups. Fruit intake increased in 70% of GF-NOURISH versus 40% of conventional participants (p=0.23); vegetable intake did not differ. Among GF-NOURISH participants, 82% rated the intervention very helpful. Despite less emphasis on gluten avoidance, GF-NOURISH did not increase reported gluten exposure (9.1% vs. 26.7%, p=0.36).
Conclusion: Minimally processed food intake increased in both groups, while GF-NOURISH showed a nonsignificant trend toward increased fruit intake. The intervention was well received, suggesting feasibility, though additional reinforcement may be needed to sustain dietary changes.