A Gluten-Free Food Guide used in diet education to improve diet quality in children with newly diagnosed celiac disease: a pilot randomised control trial

Children with coeliac disease (CD) on a gluten-free diet (GFD) often have poor dietary quality (DQ). A Gluten-Free Food Guide (GFFG) was developed to address this. This pilot randomised controlled trial evaluated the impact of GFFG dietary counselling on DQ and ultra-processed food (UPF) intake in newly diagnosed CD children. Child-parent pairs were randomised to the standard of care only (CON: <i>n</i> 20) or the intervention (INT: standard of care + GFFG; <i>n</i> 20). Primary outcomes included DQ (Healthy Eating Index-Canadian) and UPF intake (NOVA classification), assessed at baseline (BL), 3 and 6 months. In INT, dietary variety scores, a subcomponent of DQ, increased between BL and 3 months (BL: 6·7 (3·3-6·7) <i>v</i>. 3 months: 10 (10-10); <i>P</i> = 0·01) and in higher variety scores than CON at 3 months (<i>P</i> < 0·01). Total DQ and UPF intake remained unchanged. Increased dietary variety in INT was associated with increases in dairy products (BL: 7·5 (sd 3·6) % <i>v</i>. 3 months: 12·4 (sd 6·7) %; <i>P</i> = 0·01) and unsweetened milk (BL: 2·5 (sd 2·2) % <i>v</i>. 3 months: 4·7 (sd 3·0) %; <i>P</i> = 0·01) servings, consumed as a percentage of the total food group servings. These improvements were not observed at 6 months. A greater number of INT children met the GFFG protein recommendation at 3 months (BL: 0/19 <i>v</i>. 3 months: 5/19; <i>P</i> = 0·01), with no change in CON. A single GFFG session improved short-term dietary variety and unsweetened milk intake. Ongoing work addressing the GF food environment, dietitian access and policies to improve DQ are needed.