Educational resource development is important in the uptake of a Gluten Free Food Guide in children with Celiac Disease

Introduction: The gluten-free diet (GFD) is the main treatment of pediatric celiac disease (CD). The current Canadian Food Guide/plate model does not address the unique nutritional considerations of the GFD. A novel GF-food guide (GFFG) using a plate model for children with CD was recently developed to address this limitation. Uptake of food guide recommendations in youth is influenced by the feasibility of educational resources that support guideline content. The purpose of this study was to develop an evidenced-based GF-Cooking Resource to complement the GFFG content. Methods: An internet survey (via RedCap®) was disseminated to members of the community with CD (14 plus yrs.) via social media pages of national and local Celiac Association Chapters. The survey consists of 10 questions that addressed questions related to household demographics, ethnic cuisines consumed, meal and recipe suggestions/submissions. Recipes were reviewed for dietary evaluation for macronutrient, micronutrient, and gluten content using Food Processor Nutrition Analysis Software (SQL 11.0.124, ESHA Research, Salem, USA) and categorized according to meal or snack suggestions, nutrients of concern (e.g., high iron, high folate) according to validated methodologies. Representation of cooked recipes underwent stakeholder sensory evaluation by youth with CD and their parents for taste, smell, and appearance evaluation. Recipes that have an average score of 16/20 were included in the nutritional resource. The nutritional content of recipe content was translated to the GFFG plate model as an additional resource that will support current GFFG recommendations. Results: 253 responses (83=complete; 170=partial) from 8 different provinces and the US were completed between June-August 2022. About 66.4% of participants adopted at least one type of ethnic cuisine within their households. The most popular types of ethnic cuisines consumed within respondent households included 22.6% Italian cuisine, 13.7% Canadian Cuisine, and 13.7% participants consumed multiple ethnic cuisines. A total of 54 recipes were collected. Of these, 32 represented meals (breakfast, lunch, and dinner) 13 represented snack/dessert options, 4 soup-based options, and other suggestions. 26% of participants (n=66) reported challenges related to food preparation when following the gluten-free diet. These challenges included high cost of GF products, difficulties in baking with GF flour, and finding the right substitution of GF ingredients. Conclusions: This study conducted a pre-stakeholder evaluation related to the development of an evidenced-based GF cookbook for children and youth with CD. These resources will provide GF recipes, meal tips, and nutritional education that will support the GFFG recommendations representing a broad range of ethnic cuisines. Future studies including sensory taste evaluation will be conducted on youth with CD and their families to ensure that the cookbook content provided evidence-based recipes which children will enjoy and ensure optimal nutrient intake in children with CD.