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<p>The researchers carried out a systematic literature review searching electronic bibliographic databases Medline, Embase, the Cochrane Library and CINAHL, followed by hand searching of reference lists to identify relevant evidence. In addition, the researchers contacted the leading authors plus other key individuals and organisations in order to identify any relevant unpublished data. A list of inclusion and exclusion criteria was agreed and only papers including subjects with medically diagnosed coeliac disease following a gluten-free diet of six months or more were used. Scottish Intercollegiate Guidelines Network (SIGN) assessment checklists, were used to analyse the cohort studies and case control studies. Criteria used to assess the quality of studies differed for each study type. A data extraction tool was developed by the research team specific to the protocol for the systematic review taking into account the inclusion and exclusion criteria.</p>
<p>Background: Coeliac disease is a life-long autoimmune disease caused by intolerance to gluten, a protein found predominately in wheat, barley and rye cereals. In those affected by coeliac disease, consumption of gluten causes damage to the gut lining, resulting in a wide range of symptoms such as bloating, diarrhoea and nausea, as well as longer term health consequences if the disease is not managed. Management involves a strict gluten-free diet.</p>
<p>In the UK, people with medically diagnosed coeliac disease may access some of their gluten-free substitute foods on prescription but there are also a growing number of foods available that make "gluten-free" claims. There is no specific evidence base that compares the nutritional composition of gluten free foods to standard products and it is not well understood whether or not the diet of those following a gluten-free diet is nutritionally adequate. The Agency identified a policy need to identify, collate and review the existing scientific evidence on the nutritional adequacy of a typical gluten-free diet, with particular regard to the nutrients iron, calcium, folate, Vitamin D and the B Vitamins. The purpose of the research was to inform the Agency's understanding of whether the diet of UK consumers with coeliac disease, who are following a gluten-free diet, is nutritionally adequate. If not, there is a need for specific dietary advice or other strategies to ensure that these consumers can maintain a nutritionally adequate diet whilst avoiding gluten containing cereals.</p>