Elevated Poster Presentation International Celiac Disease Symposium 2026

The Recipe for Retention: Dietitian-Led Gluten-Free Diet Education as a Stronger Predictor of Pediatric Celiac Follow-Up Than Location, Insurance, or Comorbidities (146934)

Sadie Nagle 1 , Monique Germone 1 , Kaitlin Olson 2 , Marisa Stahl 1 , Edwin Liu 1 , Jocelyn Millican 3
  1. Children's Hopsital Colorado, Aurora, COLOARDO, United States
  2. Pediatric, University of Colorado, School of Medicine, Aurora, CO, United States
  3. Davidson College, Davidson, North Carolina, United States

 

Background: Celiac Disease (CeD) guidelines recommend multidisciplinary care, including expert CeD dietitian-led (RD) gluten-free diet (GFD) education and routine follow-up. This study examined factors associated with follow-up at a tertiary pediatric celiac center and evaluated the effectiveness of RD-led GFD education.

Method: Registry data from the Colorado Center for Celiac Disease was retrospectively analyzed (September 2023–June 2026; N=505; ages 0–19, median 11 years). Logistic regression evaluated RD-led education attendance, insurance type, distance from the center, and number of comorbidities as predictors of follow-up. Effectiveness of RD-led education was assessed by comparing GFD adherence (changes in repeat serology and Standard Dietitian Evaluation [SDE] scores) between education attendees and non-attendees.

Results: RD-led GFD education was utilized by 69.5% (n=351) of all newly diagnosed patients, but fewer patients returned for any follow-up visit (66.5%, nphysician=336; 51.7%, nRD=261). Distance and insurance did not significantly predict follow-up, though private insurance represented 61% (n=307) of the sample. Attendance at RD-led GFD education was the strongest predictor of any follow-up: attendees were 8.48 times as likely to follow up (95% CI 5.53–13.71, p<0.001), and each additional comorbidity increased odds of follow-up by a factor of 1.19 (95% CI 1.01–1.33, p=0.045). RD-led education also corresponded with excellent/good SDE scores, as patients who attended the RD-led education had 3.66 times the odds of having an SDE between “excellent” and “good” adherence, in comparison to patients who did not attend education (95% CI: 1.62, 8.16, p=0.002). Repeat serology (n=130) did not differ by attendance (p=0.377). 

Conclusion: RD-led GFD education strongly predicts follow-up and excellent/good SDE adherence scores, though serologic outcomes were similar regardless of education attendance. Attendance may serve as a proxy for patient-level facilitators and health engagement rather than a direct driver of dietary behavior alone. Future studies should address barriers to initial education access.