Country – Argentina
From the Argentinean Association of Dietitians and Nutritionist - Dietitians (Asociación Argentina de Dietistas y Nutricionistas Dietistas - AADYND) we would like to share recent advances on Celiac Disease (CD) legislation in Argentina. CD is the most frequent chronic intestinal disease and is estimated that affects one in 100 Argentineans. Since the only known effective treatment is a lifetime gluten-free diet, the role of dietitians is essential in all aspects of the disease.
CD regulatory framework in Argentina
The National Department of Health has issued the Resolution 1560/2007 to create the National Program for Detection and Control of Celiac Disease (Programa Nacional de Detección y Control de la Enfermedad Celiaca). The main goals of the program are:
To promote knowledge and massive dissemination of information about CD. For example, development and distribution of educational tools like pamphlets for the community and brochures for schools (Find printable version here: http://www.msal.gov.ar/celiacos/pdf/guia-escuelas-web.pdf).
Contribute to the early detection of the disease, by distributing serologic screening kits.
Support continuing education of health care team members. For example, the national meeting of dietitians held in 2011.
Encourage scientific research.
Organize a National Registry for CD.
Clinical Practice Guidelines
A workgroup of experts in CD, and within the National Program for Health Care Quality, developed the Clinical Practice Guidelines for Diagnosis and Treatment of CD along with two educational pieces, one for professionals and one for patients. These guidelines were approved in May of 2011 under the resolution 561/2011 from the National Department of Health. The purpose of these guidelines is to create evidence based recommendations aimed to standardize and optimize the screening, diagnosis and treatment of CD in primary health. Access to the Guidelines here: http://www.msal.gov.ar/celiacos/pdf/guia-enfermedad-celiaca-v54.pdf
The National Law for Celiac Disease and other regulations
The national law for CD (law no. 26588) was sanctioned and enacted in 2009 and implemented in 2011. It contains 18 articles and declares the diagnosis and treatment of CD of National interest as well as its clinical and epidemiologic research and professional training in early detection. Over the year 2011, several other achievements have been made:
The detection of CD was incorporated into the Obligatory Medical Plan (Plan Medico Obligatorio)
A resolution modified the Article no. 1383 of the Argentinean Food Code: gluten free foods are defined as those containing less than 10 mg gluten/kg (down from 20 mg/kg).
A national logo was created for labeling of gluten free foods (the inscription Sin T.A.C.C. means with no wheat, oat, barley and rye)
The National Program of Food Control (Programa Federal de Control de los Alimentos) was created.
Food industry is now exempt to pay a fee when registering gluten free foods at the Instituto Nacional de Alimentos (National Institute of Food).
Health care insurance companies must cover the cost of alternative flours and gluten-free premixes according to Article no. 9 of the CD law.
More information about current legislation, CD facts and resources for patients and families can be found in: http://www.msal.gov.ar/celiacos/
The Celiac Community has achieved fundamental rights like medical coverage of diagnosis and treatment, as well as recognition of the gluten-free diet as its treatment. It is yet too early to measure outcomes of these new regulations and there is some uncertainty between patients regarding the way they will be implemented by health insurance. Professional continuing education and training, and research activities are essential to integrate and support these achievements.
Author: Andrea F. González, Licentiate in Nutrition. Chief of Dietetics Department, Hospital of Gastroenterology “Dr. C. Bonorino Udaondo”. Member of AADYND and Coordinator of AADYND Celiac Disease Workgroup . Member of the National Advisory Commission of Celiac Disease, Member of the Advisory Commission on Celiac Disease of Buenos Aires Government, Professor and researcher in Celiac Disease.
Translation and text adaptation: Romina Barritta de Defranchi, Licentiate in Nutrition. Member of AADYND. Argentina ICDA Representative.