Nutritional inadequacies of the gluten-free diet in both recently-diagnosed and long-term patients with coeliac disease

J Hum Nutr Diet. 2013 Aug;26(4):349-58. doi: 10.1111/jhn.12018. Epub 2012 Nov 30.


Background: Life-long gluten-free diet (GFD) is the only recognised treatment for coeliac disease (CD). The present study aimed to determine the nutritional adequacy of the 'no detectable gluten' diet.

Methods: Seven-day prospective food intake was assessed in 55 patients who were adherent to a GFD for more than 2 years and in 50 newly-diagnosed age- and sex-matched patients (18-71 years, 24% male) studied prospectively over 12 months on GFD. Historical precoeliac intake was also assessed in the latter group. Intake was compared with Australian Nutritional Recommendations and the Australian population data.

Results: Nutritional intake was similar between groups. Of macronutrients, only starch intake fell over 12 months (26% to 23%, P = 0.04). Fibre intake was inadequate for all except in diet-experienced men. More than one in 10 of both newly-diagnosed and experienced women had inadequate thiamin, folate, vitamin A, magnesium, calcium and iron intakes. More than one in 10 newly-diagnosed men had inadequate thiamin, folate, magnesium, calcium and zinc intakes. Inadequate intake did not relate to nutrient density of the GFD. Inadequacies of folate, calcium, iron and zinc occurred more frequently than in the Australian population. The frequency of inadequacies was similar pre- and post-diagnosis, except for thiamin and vitamin A, where inadequacies were more common after GFD implementation.

Conclusions: Dietary intake patterns at 12 months on a GFD are similar to longer-term intake. Dietary inadequacies are common and may relate to habitual poor food choices in addition to inherent deficiencies in the GFD. Dietary education should also address the achievement of adequate micronutrient intake. Fortification of GF foods also need to be considered.

Keywords: coeliac disease; dietary assessment; gluten-free diet; nutritional adequacy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Australia / epidemiology
  • Celiac Disease / diagnosis
  • Celiac Disease / diet therapy*
  • Deficiency Diseases* / epidemiology
  • Deficiency Diseases* / etiology
  • Diet Records
  • Diet, Gluten-Free*
  • Energy Intake*
  • Feeding Behavior
  • Female
  • Humans
  • Male
  • Micronutrients / administration & dosage*
  • Middle Aged
  • Nutrition Assessment*
  • Nutritional Requirements*
  • Patient Compliance
  • Prospective Studies
  • Thiamine / administration & dosage
  • Vitamin A / administration & dosage
  • Young Adult


  • Micronutrients
  • Vitamin A
  • thiamine bromide
  • Thiamine