Background and Objective: Nutritional management of celiac disease (CeD) varies across countries and cultures. Evidence-based international guidelines for gluten-free diet (GFD) education, notably regarding gluten cross-contact risks, are needed but have not been established. This study aimed to evaluate international dietitian practices for GFD patient education, with a focus on recommendations regarding gluten cross-contact.
Methods: A digital survey was developed by expert CeD dietitians and disseminated globally across six continents (Africa, Asia, Europe, the Americas, and Oceania) through professional dietetic listservs, gastroenterology networks, and clinical contacts. Survey questions assessed recommendations regarding cross-contact prevention in home and restaurant settings. Latent Class Analysis (LCA) was used to identify patterns of recommendation strictness among respondents.
Results: A total of 245 dietitians completed the survey, with 84% (n=194) actively seeing patients with CeD weekly or monthly and 16% (n=38) annually. While recruitment was international in scope, responses were concentrated in Europe (n=185, 76%) and North America (n=39, 16%), with additional representation from Oceania, Asia, South America, and Africa. Among participants with available LCA data (n=234, 95%), two distinct patterns of recommendations emerged. The more restrictive pattern (n=177, 76%) was characterized by stricter guidance on household food preparation, restaurant dining, cleaning, and sharing kitchen equipment; it was most common in the Americas and in Central/Southern Europe. The less restrictive pattern (n=57, 24%) was characterized by greater acceptance of shared kitchen equipment, less extensive cleaning practices, and greater flexibility when dining outside the home, and was most prevalent in Northern Europe and Oceania.
Conclusions: Dietetic practice regarding the strictness of GFD cross-contact recommendations varies substantially across regions worldwide, with differences primarily between US and European practice. Most respondents endorsed more restrictive approaches. Further research and evidence-based international guidelines are needed to standardize cross-contact education and determine how varying levels of dietary strictness affect patient outcomes.