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: n 20) or the intervention (INT: standard of care + GFFG; n 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) v. 3 months: 10 (10–10); P = 0·01) and in higher variety scores than CON at 3 months (P < 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) % v. 3 months: 12·4 (sd 6·7) %; P = 0·01) and unsweetened milk (BL: 2·5 (sd 2·2) % v. 3 months: 4·7 (sd 3·0) %; P = 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 v. 3 months: 5/19; P = 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.

There are currently no universal evidence-based nutrition guidelines that address the gluten-free (GF) diet for children/youth (4–18 years). A GF food guide was created to help children/youth with coeliac disease (CD) and their families navigate the complexities of following a GF diet. Guide formation was based on pre-guide stakeholder consultations and an evaluation of nutrient intake and dietary patterns. The study objective was to conduct an evaluation on guide content, layout, feasibility and dissemination strategies from end-stakeholder users (children/youth with CD, parents/caregivers and health care professionals). This is a cross-sectional study using a multi-method approach of virtual focus groups and an online survey to conduct stakeholder evaluations. Stakeholders included children/youth (4–18 years), their parents/caregivers in the coeliac community (n 273) and health care professionals (n 80) with both paediatric and CD experience from across Canada. Thematic analysis was performed on focus group responses and open-ended survey questions until thematic saturation was achieved. χ2 and Fisher’s exact statistical analyses were performed on demographic and close-ended survey questions. Stakeholders positively perceived the guide for content, layout, feasibility, ethnicity and usability. Stakeholders found the material visually appealing and engaging with belief that it could effectively be used in multi-ethnic community and clinical-based settings. Guide revisions were made in response to stakeholder consultations to improve food selection (e.g. child-friendly foods), language (e.g. clarity) and layout (e.g. organisation). The evaluation by end-stakeholders provided practical and patient-focused feedback on the guide to enable successful uptake in community and clinical-based settings.

The gluten-free (GF) diet is the only treatment for coeliac disease (CD). While the GF diet can be nutritious, increased reliance on processed and packaged GF foods can result in higher fat/sugar and lower micronutrient intake in children with CD. Currently, there are no evidence-based nutrition guidelines that address the GF diet. The objective of this cross-sectional study was to describe the methodological considerations in forming a GF food guide for Canadian children and youth (4–18 years) with CD. Food guide development occurred in three phases: (1) evaluation of nutrient intake and dietary patterns of children on the GF diet, (2) pre-guide stakeholder consultations with 151 health care professionals and 383 community end users and (3) development of 1260 GF diet simulations that addressed cultural preferences and food traditions, diet patterns and diet quality. Stakeholder feedback identified nutrient intake and food literacy as important topics for guide content. Except for vitamin D, the diet simulations met 100 % macronutrient and micronutrient requirements for age–sex. The paediatric GF plate model recommends intake of >50 % fruits and vegetables (FV), <25 % grains and 25 % protein foods with a stronger emphasis on plant-based sources. Vitamin D-fortified fluid milk/unsweetened plant-based alternatives and other rich sources are important to optimise vitamin D intake. The GF food guide can help children consume a nutritiously adequate GF diet and inform policy makers regarding the need for nutrition guidelines in paediatric CD.