What is the impact of nutrition education on those who are diagnosed with celiac disease?

California State University Channel Islands

Lorayna Lucero

HLTH 309- Health Science Research Method

Dr. Lydia Dixon

May 18, 2022

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What is the impact of nutrition education on those who are diagnosed with celiac disease?

Introduction

Celiac disease is now becoming a more common disease these days. Celiac disease is an

autoimmune disorder that involves the immune system reacting to gluten. I chose this topic

because my mother was recently diagnosed with celiac disease, and so she had to learn all this

new information on the foods she can and can’t eat. She had to change her whole diet overnight,

and in solidarity, my entire family changed our diets as well. Women are mainly affected by

celiac disease, although men can be diagnosed as well, however, it is more severe for women.

Celiac disease can also affect children, and you can be diagnosed with celiac disease at any age.

Since, celiac disease can affect any person at any time in their life, analyzing articles (Akbari,

2022, Russo, 2020, Shepard, 2013, Suarez, 2021, and Wolf, 2020) about the impact of nutrition

education. In this literature review, I will examine articles about the effects of nutrition education

on those diagnosed with celiac disease in ways of symptoms and diet management. The

dependent variables are those diagnosed with celiac disease, women, men, or children, and how

they manage their celiac disease. The independent variable is nutrition education, for example,

education on a gluten-free diet.

Methods

My methods for conducting this review included using CSUChannel Islands library

academic search premier, and google scholar. Using one of the library databases, academic

search premier, using keywords such as nutrition education, celiac disease, and management.

Using these keywords only a few results came up, but one result was an article I was looking for.

Using google scholar, using keywords such as celiac disease, nutrition education, gluten-free

diet, and manage, thousands of results came through. I had to go to settings, in advance search,
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find articles with the exact phrase, time period, and peer-reviewed, and yet there were still

thousands of results. I just narrowed the results to find articles that fit best into my topic. I chose

articles that included qualitative and quantitative studies, mixed methods, and different groups of

participants ranging from children to adults.

Sampling Methods

The sample methods used in all five articles (Akbari, 2022, Russo, 2020, Shepard, 2013,

Suarez, 2021, and Wolf, 2020) include convenience sampling and purposive sampling. In four

out of the five articles (Akbari, 2022, Shepard, 2013, Suarez, 2021, and Wolf, 2020) convenience

sampling was used. The participants were recruited from flyers and registries from celiac

databases. Convenience sampling is used to gather initial data on a population sample, and

participants are the most accessible to the researchers. Once the researchers found the sample

size, participants had to undergo biopsies to prove the participant's celiac diagnosis. In one article

purposive sampling was used after participants were selected from initial flyers, and interviews

were conducted to hear how families with a child diagnosed with celiac disease coped and

managed their diets (Russo, 2020). Purposive sampling is where a researcher wants to gain

knowledge about a specific phenomenon. In all five articles, researchers recruited participants

via flyers from databases that had patients diagnosed with celiac disease. Participants were

recruited based on being recently diagnosed, their age, how long they have coped with celiac

disease, and how they managed a gluten-free diet. In all five articles (Akbari, 2022, Russo, 2020,

Shepard, 2013, Suarez, 2021, Wolf, 2020), convenience sampling was the best option because

researchers wanted to know more about a specific population, which was people diagnosed with

celiac disease and how nutrition education impacted their symptoms. The participants in all five
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articles gave their consent to participate in the research, and in a few articles, some incentives

were given out as a token.

Methodological Approaches

Throughout the five articles, (Akbari, 2022, Russo, 2020, Shepard, 2013, Suarez, 2021,

and Wolf, 2020) a mixture of quantitative and qualitative approaches were used through the

process of surveys, and interviews. The quantitative approach was used to generalize people

diagnosed with celiac disease to explain the impact of nutrition education. For example, (Akabri,

2021, Suarez, 2021, Wolf, 2020) surveys and interviews were used to explore the participant's

symptoms of celiac disease, change of behavior before diagnosis and after diagnosis, and

nutrition intervention. In a qualitative approach (Russo, 2020), surveys and interviews were used

to look at an individual experience in managing celiac disease. All the five articles were

longitudinal studies, ranging from three months to a year (Akbari, 2022, Russo, 2020, Shepard,

2013, Suarez, 2021, Wolf, 2020). In Suarez, 2021, article, an experimental study was done to

assess a registered dietitian that was qualified for improving the eating habits of children

diagnosed with celiac disease. The use of a longitudinal study was to see how much nutrition

education has impacted a person with celiac disease, and what improvements can be made. One

weakness of a longitudinal study is the idea of participants quitting a study after a long period of

time because it takes too much time or participants just had enough.

Data Collection

Four out of five articles used surveys and interviews to collect their data (Akbari, 2022,

Russo, 2020, Shepard, 2013, Wolf, 2020). A positive of using the survey method is time

sensitivity, and little money is needed for this type of data collection. However, the downside of

using the survey methods is getting self-reported data. Self-reported answers should be taken
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with a grain of salt because participants may not understand a question or take a question the

wrong way. The interview styles that were used in the articles, were mainly semi-structured and

small focus groups. I think the best option for this type of research on how much of an impact

nutrition education can influence a person with celiac disease is through interviews. Interviews

allow the researcher to go in-depth with the participants and have follow-ups with how they are

doing. The weakness of having interviews is how much time and effort it takes, and the cost.

Keeping up with follow-up interviews will be costly. As I stated before, one of the articles was

an experimental study that was designed to examine a registered dietitian's knowledge to

improve the eating habits of children diagnosed with celiac disease (Suarez, 2021). However, in

the experimental study, there was no control group or experimental group, just one group where

parents and children were educated on a healthy diet for celiac disease. A strength of having an

experimental study is having variables you can control, and getting accurate results. A weakness

of having an experimental study is it is costly and has the risk of human error for results.

Analytical Techniques

In the five articles, many analytical techniques were used to analyze the findings (Akbari,

2022, Russo, 2020, Shepard, 2013, Suarez, 2021, Wolf, 2020). All five articles analyzed their

findings using means and standard deviation and paired t-tests (Akbari, 2022, Russo, 2021). The

use of means and standard deviation was to present continuous data frequencies and percentages

for categorical data. The paired t-test was used to assess differences in groups. Means and

standard deviation, and paired t-tests were not the only way the articles analyzed the findings,

they have also applied software (Akbari, 2022, Shepard, 2013, Suarez, 2021). A strength of using

means and standard deviation for analyzing data is getting precise measures of dispersions. A

weakness of using means and the standard deviation is that extreme numbers can affect the data.
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A strength of using paired t-test is testing an assumption of a given population, so in this case,

people diagnosed with celiac disease. A weakness of using a paired t-test for analyzing data is

the sample size range can vary from ten to hundreds. Every article used a different type of

software. In Akbari, 2022, the researchers used all used three methods to analyze its finding,

also including the Chi-square test. The Chi-square test was for analyzing nominal and categorical

variables. A strength of using the Chi-square test for analyzing data is seeing a difference

between two or more groups of participants. A weakness of using the Chi-square test is finding

no correlation between groups and sample size requirements. In Suarez, 2021, a software

program was applied for descriptive analysis, which provided relative and absolute frequency

distribution for qualitative results, and used position and dispersion for quantitative results. In

Shepard, 2013, a software called GRAPHAD PRISM was operated for statistical analysis, and

other methods of analyzing data were Pearson’s or Spearmen. The Pearson’s or Spearman’s test

was used for parametric or nonparametric data. Some strengths of using software for descriptive

analysis are getting real-time results, saving time, and it can deal with large amounts of data. A

weakness of using software for descriptive analysis is sampling error, for instance, if researchers

are collecting data there is a risk of human error. In all five articles, limitations still arose from

participants dropping out of the study, or from human error (Akbari, 2022, Russo, 2020, Shepard,

2013, Suarez, 2021, Wolf, 2020).

Conclusion

In all five articles, a positive outcome showed nutrition education impacts symptoms and

diet management for a person diagnosed with celiac disease (Akbari, 2022, Russo, 2020,

Shepard, 2013, Suarez, 2021, Wolf, 2020). In one study, in particular, a result of education based

on nutrition showed significant improvement in gastrointestinal symptoms (Akabri, 2022). In

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two articles, nutrition education promoted improvement in eating patterns in children diagnosed

with celiac disease (Russo, 2020, Suarez, 2013). However, in one study a negative outcome was

brought up about participants' gluten-free diet. The results showed a risk of nutritional

inadequacies, meaning that gluten-free diets showed low levels of thiamin, riboflavin, and niacin

(Shepard, 2013). The last article, mentions that a cooking-based intervention was acceptable to

improve the quality of life of celiac disease patients, and was an alternate strategy for gluten-free

diet management (Wolf, 2020). Throughout the five articles, the results mention that more

research needs to be done and follow-ups should be done with longer durations of

disease-specific questionnaires.

The method that was used by all five articles was convenience sampling because it was

targeting a certain population, for instance, people diagnosed with celiac disease. One article also

used purposive sampling, to find out more about a specific phenomenon, in this case, a cooking

intervention on a small sample of people diagnosed with celiac disease. In all five articles, the

use of interviews, surveys, and questionnaires was used for data collection, along with one

experimental study. I do think the best way to collect data for this type of research is through

interviews and small focus groups. Having either a structured interview or semi-structured

interview would allow the researchers to go more in-depth with participants and overall get a

better understanding of what the participants are going through. The only weakness of the

interview method is its time consumption and how costly it is. Quantitative and qualitative

approaches were used throughout all the five articles, I determined there was no best option

because the approaches seemed to fit in with the research. To close it out, nutrition education has

impacted people diagnosed with celiac disease, through managing symptoms and diets. Although

further research needs to be done for follow-ups.

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References:

Akbari Namvar, Z., Mahdavi, R., Shirmohammadi, M., & Nikniaz, Z. (2022). The effect of
group-based education on gastrointestinal symptoms and quality of life in patients with celiac
disease: Randomized controlled clinical trial. BMC Gastroenterology, 22(1).
https://doi.org/10.1186/s12876-022-02096-1

Russo, C., Wolf, R. L., Leichter, H. J., Lee, A. R., Reilly, N. R., Zybert, P., Green, P. H., &
Lebwohl, B. (2020). Impact of a child’s celiac disease diagnosis and management on the family.
Digestive Diseases and Sciences, 65(10), 2959–2969.
https://doi.org/10.1007/s10620-020-06316-0

Shepherd, S. J., & Gibson, P. R. (2013). Nutritional inadequacies of the gluten-free diet in both
recently-diagnosed and long-term patients with coeliac disease. Journal of Human Nutrition &
Dietetics, 26(4), 349–358. https://doi-org.ezproxy.csuci.edu/10.1111/jhn.12018

Suárez-González, M., Bousoño-García, C., Jiménez-Treviño, S., & Díaz-Martín, J. J. (2021).

Gluten-free diet: Nutritional strategies to improve eating habits in children with celiac disease: A
prospective, single-arm intervention study. Nutrients, 13(4), 1108.
https://doi.org/10.3390/nu13041108

Wolf, R. L., Morawetz, M., Lee, A. R., Koch, P. A., Contento, I. R., Zybert, P., Green, P., &
Lebwohl, B. (2020). A Cooking-Based Intervention Promotes Gluten-Free Diet Adherence and
Quality of Life for Adults with Celiac Disease. Clinical gastroenterology and hepatology: the
official clinical practice journal of the American Gastroenterological Association, 18(11),
2625–2627. https://doi.org/10.1016/j.cgh.2019.09.019