Development of the Standardized Dietitian Integrated Evaluation Tool for Gluten-Free Diets (DIET-GFD): 2016 ACG Presidential Poster Award
Bibliographic record
Abstract
Introduction: Celiac disease is a chronic immune disorder which is treated with a gluten-free diet. Dietitian assessment of dietary adherence is the best available non-invasive way to monitor patients with celiac disease, yet neither the process nor content of this assessment has been defined. AIMS: To develop a standardized reporting tool for dietitians evaluating gluten-free diet adherence by patients with celiac disease. Methods: A literature review guided initial content for the scale, with consideration of the elements required to evaluate adherence to gluten-free diet as a behavior as well as an outcome. Using a consensus process, an expert panel composed of gastroenterologists, dietitians with expertise in monitoring patients on gluten-free diets, psychologists and persons with celiac disease developed a ten-point ordinal descriptive scale for dietary adherence. Registered dietitians (KG, DW) performed duplicate assessments of 10 patients. The scale was revised further during panel review of cases where dietitian scores were discordant or there was uncertainty which score to apply. The same dietitians used the revised scale for duplicate assessments of 23 additional patients which were used to determine the intraclass correlation coefficient. Results: The Dietitian Integrated Evaluation Tool for Gluten-Free Diets (DIET-GFD) includes features related to frequency and quantity of gluten ingestion based on self-report and food frequency evaluation, shopping and dining habits, how food is prepared and consumed, eating behaviors, locations where food is prepared and consumed, and label reading skills. For example a score of 1 was assigned if there was gluten in the kitchen and no precaution with food preparation, or >5 gluten containing foods on food frequency questionnaire, or consuming gluten as a major ingredient >1/week and consuming gluten when eating out. The assigned global scores ranged from 1-10 (mean 7.2, SD 1.7; median 8, IQR 7-8). The interrater agreement was good with a weighted kappa of 0.804. Conclusion: The DIET-GFD is a descriptive reporting tool for dietitian assessment of patient adherence to a gluten-free diet. The level of agreement between two expert dietitians was good. Use of a standardized tool facilitates comparison of scores by different dietitians and serial scores in a single individual over time. Further studies will evaluate reliability and validity and determine how this scale can be applied across institutions and cultures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.039 | 0.049 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".