Nutritional aspects of gluten-free products

Effect of dietary patterns and nutritional supplementation in the management of endometriosis: a review

Endometriosis is an estrogen-dependent chronic inflammatory disease which causes dysmenorrhea, chronic pelvic pain, and infertility in women of childbearing age, significantly impacting their quality of life and physical and mental health. The etiology of endometriosis remains unclear, with oxidative stress and inflammation currently thought to play pivotal roles in its pathophysiology. Epidemiological studies and clinical trials indicate that varying dietary patterns and specific nutrient supplementation can influence oxidative stress markers and levels of inflammatory factors and related pathways, potentially impacting the progression of endometriosis. In this review, we summarize the roles of oxidative stress and inflammation in endometriosis and thoroughly examine the current understanding of the effect of dietary patterns and nutrient supplementation in treating endometriosis. This study suggests that nutrients may prevent the occurrence of endometriosis by modulating levels of inflammatory factors, regulating angiogenesis, and influencing the metabolism of estrogen pathways. The findings might provide new insights into the treatment of endometriosis patients and the potential benefits of dietary patterns and nutrient supplementation in patients with endometriosis.

Determination and Comparison of Fat and Fibre Contents in Gluten-Free and Gluten-Containing Flours and Breads: Nutritional Implications

The absence of gluten is a technological challenge that requires the addition of components to replace the unique viscoelastic properties of gluten, thus altering the nutritional composition of gluten-free (GF) breads. Moreover, GF flours may have different compositions as compared to gluten-containing (GC) counterparts because of a different origin. This may impact the nutritional quality of GF diets. The aim of the study is to provide updated analytical data on moisture, fat, and fibre contents in GF flour and bread samples, and compare them with their GC counterparts, as well as to analyse ingredients and how they impact nutritional quality. A total of 30 different flours and 24 types of bread were analysed using AOAC methods. GF cereal flours contain more fat than GC flours (3.5 ± 2.1% vs. 2.5 ± 2.1%, p < 0.001), as well as GF flours from pseudocereals, except for wholemeal buckwheat (2.6 ± 0.1%). Fibre content is lower in GF flours (3.6 ± 3.1% vs. 7.1 ± 3.9%, p = 0.03), except for GF pseudocereal and legume flours. GF breads contain almost twice as much fat 6.6 ± 2.3% vs. 1.4 ± 0.2%, p < 0.001, and 4.2 ± 1.2%, p < 0.001) and fibre (7.3 ± 2.4% vs. 2.8 ± 0.5%, p < 0.001, and 4.9 ± 2.1%, p = 0.002) as GC breads. This is due to the raw materials themselves and to the addition of ingredients, such as regular and high oleic sunflower oil, and psyllium. Fibre ingredients and additives are more frequently used in ready-to-eat GF flours and breads, and more GF breads also contain fat-based ingredients, as compared to GC. Amaranth and chickpea flours are good alternatives to produce breads with better nutritional quality. Analysis of GF products for critical nutrients is peremptory because of continuing technological and nutritional innovation.

Short- and Long-Term Nutritional Status in Children and Adolescents with Celiac Disease Following a Gluten-Free Diet: A Systematic Review

BACKGROUND/OBJECTIVES

Numerous studies have highlighted the nutritional imbalances that are commonly observed in children and adolescents diagnosed with celiac disease (CD) who follow a gluten-free diet (GFD). However, the development and timeline of these nutritional deficiencies remain unclear. The aim of the present study is to investigate the short-term (≥6 months to <12 months) and long-term (≥12 months) association between adherence to a GFD and nutrient intake as well as micronutrient blood status in children and adolescents aged from 0 to 18 years with CD.

METHODS

A systematic review was conducted in PubMed and Scopus for observational studies published up to June 2024.

RESULTS

A total of 15 studies (case-control, cross-sectional, and prospective studies) with 2004 children and adolescents were included. Their quality was assessed using the ROBINS-E tool. Despite the lack of high-quality data and the heterogeneity of the methods used in the included studies, the results of the cross-sectional/case-control studies show that, in the short term, children and adolescents with CD consumed excessive amounts of protein and carbohydrates compared to controls. After long-term adherence to a GFD, significant changes in the diets of children and adolescents with CD persisted. Fat intake was higher, while protein intake remained excessive compared to controls. Based on prospective studies, vitamin C and iodine intake improved both in the short and long term after adherence to a GFD. However, most other nutrients either remain inadequate or continue to decline, indicating that it is difficult to meet nutrient requirements despite dietary adjustments.

CONCLUSIONS

Gaps in adherence to dietary recommendations appear to be widespread in children and adolescents with CD, emphasizing the need for improved diet quality and regular monitoring.

Starch and Protein Characteristics of Chestnut Flours and Their Applications in Gluten-Free Products

In the context of valorizing underutilized crops, this study investigated the starch and protein characteristics of chestnut varieties (Balestrera and Rossera) and their potential for use at 15% and 25% in reformulating gluten-free baked snacks and fresh pasta. Chestnut varieties differ in protein and starch content (Balestrera > Rossera), as well as in amylose, dietary fiber, and lipids (Balestrera < Rossera). Differences in starch and amylose content affected starch gelatinization (Balestrera < Rossera), pasting and retrogradation properties, and water absorption capacity at 90 °C (Balestrera > Rossera). No differences in water and oil absorption capacity and mixing properties were observed, neither in the protein profile nor in the nature of protein aggregates. Both varieties exhibited a good aptitude for producing gluten-free baked snacks and fresh pasta, even at enrichment levels of 25%. Overall, this study could provide valuable information for the development of gluten-free products using sustainable, underutilized crops.

Gluten-containing flours and gluten-free flours as a source of calcium, magnesium, iron and zinc

Wheat flour is widely used in Poland for the preparation of bread, pasta and other foods. Due to the increasing number of people diagnosed with diet-related diseases, consumer awareness of health-promoting issues and interest in gluten-free products (GFP). There is a dynamic development of the market for these foods with high quality and nutritional value and minerals that benefit human health and prevent deficiencies in patients on a gluten-free diet. The aim of this study was to determine the content of minerals: Ca, Fe, Mg and Zn in flours using the ICP-OES method. The mineral composition of selected GF flours available on the Polish market was analysed. It was tested how they supplement the mineral requirements compared to gluten-containing flours. It was found that these products can be a valuable source of essential minerals, which are often in short supply, especially in patients with gastrointestinal disorders. As our study has shown, flours from the GFP group are a good source of essential minerals, especially in the case of chia and flax flours, as well as buckwheat, amaranth, quinoa, lupin or almonds flours.

Gluten-free foods are expensive and nutritionally imbalanced than their gluten-containing counterparts

OBJECTIVES

Nutritional quality of gluten-free (GF) food products is very important, as patients with celiac disease consume these products for lifelong. There is paucity of data on the nutritional content and cost of GF food products compared with their gluten-containing (GC) counterparts from India (Asia).

DESIGN

After a detailed market survey, packaged and labeled GF food products (n=485) and their packaged GC counterparts (n=790) from the supermarkets of Delhi (India) and e-commerce websites were included. Nutritional content and cost/100 g food (in US dollars) were calculated using the information on food label.

RESULTS

Gluten-free food products were 232% (range: 118% to 376%) more expensive than their GC counterparts. Energy content of all GF food products was similar to their GC counterparts, except cereal-based snacks (GF: 445 kcal vs. GC: 510 kcal, p<0.001). The protein content was significantly lower in GF pasta and macaroni products (single-grain: GF: 6.5 g vs. GC:11. 5 g, p-0.002; multigrain: GF:7.6 g vs. GC:11.5 g, p-0.027), cereal flours (single-grain: GF: 7.6 g vs. GC: 12.3 g, p<0.001; multigrain: GF:10.9 g vs. GC: 14.1 g, p-0.009) and nutritional bars (GF: 21.81 g vs. GC:26 g, p-0.028) than their GC counterparts. Similarly, the dietary-fiber content of GF pasta and macaroni products, cereal flours, cereal premix and nutritional bars of GF foods was significantly lower than their GC counterparts. Gluten-free bread and confectionary items, biscuits and cookies and snacks had higher total fats and trans-fat content than their GC counterparts. Gluten-free cereal-based snacks had higher sodium content than their GC counterparts (GF: 820 mg vs. GC:670 mg; p<0.001).

CONCLUSION

GF foods are significantly more expensive, contain less protein and dietary fiber and higher fat, trans-fat and sodium than their GC counterparts. Strategies must be developed to reduce the cost and improve the nutritional profile of GF foods.

Exploitation of Aureobasidium pullulans NRRL Y-2311-1 xylanase in mulberry and rice flours-based gluten-free cookie formulation: Effects on dough properties and cookie characteristics

Xylanases are mainly utilized in bakery industry for the hydrolysis of dietary fiber-based fractions. Their applications in gluten-free products have not been considered before. In the present study, the xylanase produced by Aureobasidium pullulans NRRL Y-2311-1 was utilized in a mulberry and rice flours-based gluten-free cookie formulation for the first time. Effects of various xylanase concentrations on gluten-free dough rheology and cookie characteristics were elucidated. Only rice flour-based cookie and only wheat flour-based cookie formulations were also prepared as comparison. Incorporation of xylanase into all cookie recipes resulted in softer cookie doughs with lower absolute stickiness. The hardness and absolute stickiness of the cookie doughs prepared by the mixture of mulberry and rice flours decreased by the addition of the enzyme into the formulation in a concentration-dependent manner. Enzyme concentrations above 100 U/100 g flour did not provide statistically significant further changes on gluten-free cookie doughs. Incorporation of xylanase into the cookie recipes resulted in increased baking loss and spread ratio in an enzyme concentration-dependent manner for all cookie types. Hardness values of both types of gluten-free cookies decreased by xylanase incorporation. Different effects on fracturability were observed depending on the cookie type and enzyme concentration. Enzyme concentration of 100 U/100 g flour provided mulberry and rice flours-based cookies with a more flexible and softer structure. No significant effects on color parameters of cookies were observed by xylanase incorporation.

Assessment of the social quality of life and the physical activity of adult celiac disease patients following a gluten-free diet in Lebanon

To date, the primary and only treatment recommended for effective management of celiac disease (CD) is adherence to a strict gluten-free diet (GFD) which entails a new approach to eating that affects the social quality of life (QoL) and physical activity (PA) of patients. This cross-sectional study aimed at assessing the social QoL and PA of adult Lebanese CD patients aged between 18 and 59 years old who are following a GFD. An online CD questionnaire was administered to 136 Lebanese celiac participants on a GFD. The findings of this study show a significant association between celiac patients following a GFD and their social QoL (P-value = 0.0001). The results also showed a significant association between the same population and their PA (p-value = 0.0001). Further awareness-raising and learning activities about gluten-free products are needed to improve the adherence to a strict GFD to facilitate its availability to the Lebanese population.

Gluten and Wheat in Women's Health: Beyond the Gut

Since the rise of awareness of gluten/wheat-related disorders in the academic and clinical field in the last few decades, misinformation regarding the gluten-free diet (GFD) and its impact on health has been spreading among the general population. Despite the established link between gluten and celiac disease (CD), where a GFD is mandatory to reach clinical and histological remission, things are more complicated when it comes to non-celiac gluten/wheat sensitivity (NCGWS) and other autoimmune/dysimmune disorders. In the last conditions, a beneficial effect of gluten withdrawal has not been properly assessed, but still is often suggested without strong supporting evidence. In this context, women have always been exposed, more than men, to higher social pressure related to nutritional behaviors and greater engagement in controlling body weight. With this narrative review, we aim to summarize current evidence on the adherence to a GFD, with particular attention to the impact on women's health.

Evaluation of the physicochemical and sensory characteristics of gluten-free cookies

The increasing prevalence of celiac disease and gluten intolerance has led to an increased demand for gluten-free food products in Peru. The research objective was to develop gluten-free cookies from substitute flours, evaluating their physicochemical and sensory parameters. Eight formulations were developed using 100% broad bean, chickpea, pea, kiwicha, quinoa, lentil, corn, and bean flour. One hundred consumers participated in this evaluation (59% women and 41% men). A completely randomized design (CRD) and a randomized complete block design (RCBD) were used for physicochemical analysis and acceptability, respectively. To describe the sensory characteristics of the cookies, Cochran's Q-test and correspondence analysis (CA) were performed. From the results obtained, the lentil cookie presented the highest amount of protein and fiber but lower fat and carbohydrate contents compared to the other samples. In terms of color, the corn cookie was the lightest, with greater luminosity (L*), less redness (a*), and greater yellowness (b*). Regarding the sensory analysis, the CATA questions allowed us to form six groups, and the samples with the greatest acceptability were the corn and chickpea cookies, which were rated as "I like them." Lentil flour crackers are a nutritionally adequate option, and corn flour crackers are highly sensorially acceptable, suggesting commercial opportunities for softer and more flavorful gluten-free products. However, it is crucial to continue researching and developing innovative products to meet changing market demands and offer healthier and more attractive options to consumers.

A chestnut-hemp type-II sourdough to improve technological, nutritional, and sensory properties of gluten-free bread

The nutritional quality of gluten-free (GF) products is usually improved by using flours derived from alternative grains (e.g., pseudocereals and legumes), additives and hydrolysates, leading to long ingredient lists in the labels, that conflict with current customer expectations. In this work, chestnut, carob, and hemp flours were used as mixed ingredients for making a gluten-free type-II sourdough. Three exopolysaccharides-producer lactic acid bacteria, belonging to Leuconostoc mesenteroides, Weissella cibaria, and Leuconostoc pseudomesenteroides, were used, and the fermentation processes (6 log10 cfu/g, 25 °C, 16 h) optimize to maximize the EPS synthesis (15.70 ± 2.1 mg/kg). The chestnut-hemp (70:30) type-II sourdough was included in a rice/corn gluten-free bread recipe also containing psyllium flour as structuring agent. Although the fortification with unfermented flours already led the achievement of 6 g/100 g of fiber (high fiber, Regulation EC n. 1924/2006) and content of magnesium higher than the daily reference intakes, the use of type-II sourdoughs led to a further structural, sensory, and nutritional improvements (e.g., decreasing the main anti-nutritional factor phytic acid). This work demonstrated that the use of ad-hoc selected ingredients and optimized protocol can be used to produce a GF and "clean label" bread with optimal nutritional features and appreciable sensory and structural properties.

Nutritional, textural and sensory properties of lasagna dough containing air yam, a non-conventional edible plant

The incorporation of non-conventional edible plants into gluten-free food products shows potential and the ability to increase nutritional properties. Therefore, the aim of this study was to develop a gluten-free air yam-based lasagna dough and to evaluate the nutritional, textural, and sensory properties. First, the air yam flour was obtained by drying the tubers at 55 °C for 16 h and then, mixed with the water and egg powder, it constituted the lasagna dough. The nutritional composition and bioaccessible mineral content of air yam flour and lasagna dough were evaluated, as well as the texture, microbiological and sensory properties of the lasagna dough. The results indicated that air yam flour and the lasagna dough had high dietary fiber contents, 17.1% and 9.4%, respectively. Additionally, the low-fat content found means that the lasagna dough can be considered both gluten-free and fat-free. The most bioaccessible mineral present was K in both air yam flour and lasagna dough. In sensory analysis, the lasagna dough containing air yam showed an intermediate acceptability in relation to two already commercialized lasagna doughs. This study shows an application to this group of plants that are still little explored, allowing the development to consumers and industries.

Graphical abstract

Assessment of Nutritional Value and Maillard Reaction in Different Gluten-Free Pasta

Evaluating the nutritional quality and thermal damage effects of gluten-free foods is essential to ensure that people with gluten intolerance or celiac disease can safely meet their needs. In this work, fifteen different commercial gluten-free pasta samples made from cereals, pseudocereals, and pulses, alone or in mixed combinations, were analyzed to assess their nutritional value, essential amino acids composition, and protein chemical score. The occurrence of the Maillard reaction was investigated, and the levels of heat treatment markers (furosine, maltulose, hydroxymethylfurfural, and glucosylisomaltol) were determined. Analysis of the furosine values showed that pasta made with the same raw materials can have different degrees of thermal damage. There was no evidence of the Maillard reaction progressing in the advanced phase in any of the samples tested. Finally, the correlation between maltulose and furosine levels demonstrated the usefulness of combining the two markers to assess the extent of thermal damage.

Effect of soy protein isolate on physical properties of quinoa dough and gluten-free bread quality characteristics

BACKGROUND

Quinoa is a good gluten-free resource for food processing, especially bread making, and can improve and prevent the development of complications associated with celiac disease (CD). However, lack of gluten affects quinoa bread quality. Previous research showed that soy protein isolate (SPI) could improve gluten-free bread quality to some extent. Therefore, this study investigated the effects of SPI on the physical properties of quinoa dough and gluten-free bread quality characteristics.

RESULTS

Results showed that, with appropriate SPI substitution, the farinograph properties of quinoa flour significantly improved (P < 0.05). The sample with 8% SPI substitution showed a better development time (DT, 3.30 ± 0.20 min), stability time (ST, 8.80 ± 0.10 min) and softening degree (SD, 8.80 ± 0.10 FU), which were close to those of wheat flour, although more water absorption (WA, 76.40 ± 2.10%) was needed than for wheat flour (66.30 ± 3.10%). The extensograph properties of quinoa flour also significantly improved after 8% SPI substitution (P < 0.05). Furthermore, SPI substitution increased G' moduli of quinoa dough and decreased tan δ to some extent, providing better rheological properties closer to those of wheat dough. SPI substitution also improved the quality and texture of quinoa bread and reduced the gap with wheat bread. When SPI substitution was 8%, the specific volume, hardness and springiness of quinoa bread were 2.29 ± 0.05 mL g^-1 , 1496.47 ± 85.21 g and 0.71 ± 0.03%, respectively.

CONCLUSION

These results suggested that SPI substitution would be an effective way to develop higher-quality gluten-free bread. © 2022 Society of Chemical Industry.

Effect of enrichment of rice snacks with pulse seed coats on phenolic compound content, product features and consumer hedonic response

This study investigated the impact of seed coats from peas (PC) and chickpeas (CC) (at 15 % and 30 % levels) on rice-based co-extruded snacks. Using PC and CC reduced the content of soluble (29 %) and cell-wall bound phenolic acids (21 %), but it enhanced the amount and the profile of flavonoids of rice-based snacks (up to 16 times with PC), resulting in significantly higher antioxidant activity (134 %). Snacks with 15 % CC showed a higher section area (about 335 versus 191 mm2) and a lower average pore radius (20.1 versus 23.9 mm) than PC-snacks; however, such features did not affect either texture or porosity. At 30 % level, PC resulted in a more porous structure (porosity: 73.1 versus 66.7 %) with smaller pores (17.2 versus 27.3 mm) and high firmness (55.9 versus 40.1 N). Consumers' acceptability evaluation revealed that samples containing pulse seed coat were comparable and preferred to the control (i.e., 100 % polished rice).

Nutritional Quality of Gluten-Free Bakery Products Labeled Ketogenic and/or Low-Carb Sold in the Global Market

Gluten-free and ketogenic bakery products are gaining momentum. This study aims to develop a better understanding of the nutritional quality of gluten-free bakery products labeled ketogenic and/or low-carb. For this reason, the products available on the global market that were labeled ketogenic and/or low-carb (n = 757) were retrieved and compared to standard gluten-free products (n = 509). Overall, nutritionally, no significant differences were found among ketogenic and/or low-carb products due the high intra-variability of each type, but they differed from standard products. Compared to standard products, all ketogenic and/or low carb, irrespective of categories, showed lower carbohydrates that derived chiefly from fibers and, to a lesser extent, from sugars. They also had higher protein contents (p < 0.05) compared to standard products. Fats was higher (p < 0.05) in ketogenic and/or low-carb baking mixes, savory biscuits, and sweet biscuits than in their standard counterparts. Saturated fats were higher (p < 0.05) in low-carb savory biscuits and breads, as well as in ketogenic sweet biscuits than in the same standard products. Overall, median values of the nutrients align with the definition of the ketogenic diet. Nevertheless, several products did not align with any of the ketogenic definitions. Therefore, consumers need to carefully read the nutritional facts and not rely on mentions such as low-cab and ketogenic to make their decision of purchase/consumption.

Gluten-Free Product Contribution to Energy and Macronutrient Intakes in Spanish Children and Adolescents with Celiac Disease

Gluten-free products (GFP) are a good choice for the replacement of cereals when following a gluten-free diet due to celiac disease (CD). However, commercial GFP are made with highly refined flours and may contain more fat, sugar, and salt, and less fiber and micronutrients than gluten-containing analogues, thus challenging the nutritional adequacy of the diet. The aim of this study is to assess the contribution of GFP to the diets of children and adolescents with CD. Food intakes were assessed in a cross-sectional study on 70 children and adolescents with CD (aged four to 18, 50% females), using three 24-h dietary records. GFP consumption reached 165 g a day and comprised mostly bread and fine bakery ware, followed by pasta. GFP contributed with a high percentage (>25%) to total energy, carbohydrates, fiber, and salt daily intakes and, to a lesser extent (<20%), to fat (including saturated fat), sugars and protein. Contribution of homemade products was testimonial. GFP contribution to total energy intake is significant and, consequently, relevant to the nutritional adequacy of the diet. Children and adolescents with CD could benefit from fat, saturated fat, and salt reduction, and fiber enrichment of processed GFP.

Glycaemic Index of Gluten-Free Biscuits with Resistant Starch and Sucrose Replacers: An In Vivo and In Vitro Comparative Study

The glycaemic index (GI) is used to demonstrate the tendency of foods to increase blood glucose and is thus an important characteristic of newly formulated foods to tackle the rising prevalence of diabetics and associated diseases. The GI of gluten-free biscuits formulated with alternate flours, resistant starch and sucrose replacers was determined using in vivo methods with human subjects. The relationship between in vivo GI values and the predicted glycaemic index (pGI) from the in vitro digestibility-based protocols, generally used by researchers, was established. The in vivo data showed a gradual reduction in GI with increased levels of sucrose substitution by maltitol and inulin with biscuits where sucrose was fully replaced, showing the lowest GI of 33. The correlation between the GI and pGI was food formulation-dependent, even though GI values were lower than the reported pGI. Applying a correction factor to pGI tend to close the gap between the GI and pGI for some formulations but also causes an underestimation of GI for other samples. The results thus suggest that it may not be appropriate to use pGI data to classify food products according to their GI.

The Efficacy of Plant Enzymes Bromelain and Papain as a Tool for Reducing Gluten Immunogenicity from Wheat Bran

Gluten-free products made from naturally gluten-free raw materials have an inferior taste and can cause deficiencies in various nutrients, especially non-starch polysaccharides. To address this problem, scientists are searching for new strategies to eliminate harmful gluten from wheat, rye, and barley and to produce balanced products with good organoleptic properties. This study evaluated the possibility of hydrolysing gluten in wheat bran, a by-product obtained after the dry fractionation of wheat, using plant enzymes. The gluten content of wheat bran after treatment with papain, bromelain, and their combination under different hydrolysis conditions was investigated. The amount of gluten was determined using an enzyme-linked immunosorbent assay ELISA R5 and the reduction in immunogenic gliadins was analysed using high-performance reverse phase liquid chromatography. The results of the study showed that 4 h hydrolysis with bromelain and papain reduced the levels of gluten immunogenic compounds in bran from 58,650.00 to 2588.20–3544.50 mg/kg; however, they did not reach the gluten-free limit. A higher hydrolysis efficiency of 95.59% was observed after treatment with papain, while the combination of both enzymes and bromelain alone were less effective. The results presented in this article will be helpful to other researchers and manufacturers of wheat-based products when selecting methods to reduce gluten immunogenicity and contribute to the development of sustainable technologies.

Evaluation of a paediatric gluten-free food guide by children and youth with coeliac disease, their parents and health care professionals

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 Effect of Foliar Fungicide and Insecticide Application on the Contamination of Fumonisins, Moniliformin and Deoxynivalenol in Maize Used for Food Purposes

The fungal ear rot of maize cultivated in temperate areas is mainly due to the Fusarium species. The use of insecticides against European Corn Borer (ECB) reduces the severity of fungal ear rot as well as the fumonisin (FB) and moniliformin (MON) levels in maize kernels at harvest, which in turn results in a lowering of their effect on deoxynivalenol (DON) control. However, the direct fungicidal control of ear rot has rarely been implemented for maize, and the first studies reported conflicting results on the reduction of mycotoxins. In the present experiment, field trials were carried out in North Italy over three growing seasons to study the effect of fungicide application timings on maize to control mycotoxins, considering the interaction of the application with the insecticide treatment, according to a full factorial split plot design. The mycotoxin content was determined through LC-MS/MS analysis. The field trials showed a significant reduction in ECB severity (75%), fungal ear rot severity (68%), Fusarium Liseola section infection (46%), FBs (75%) and MON (79%) as a result of the insecticide application for all the years, while the DON content increased by 60%. On the other hand, a fungicide application alone or applied in plots protected by an insecticide was never effective for the fungal symptoms, infection or mycotoxin content. The results confirm that a correct insecticide application to control ECB damage is the most effective agrochemical solution for the control of fungal ear rot, FBs and MON.

Personalized Nutrition in the Management of Female Infertility: New Insights on Chronic Low-Grade Inflammation

Increasing evidence on the significance of nutrition in reproduction is emerging from both animal and human studies, suggesting a mutual association between nutrition and female fertility. Different “fertile” dietary patterns have been studied; however, in humans, conflicting results or weak correlations are often reported, probably because of the individual variations in genome, proteome, metabolome, and microbiome and the extent of exposure to different environmental conditions. In this scenario, “precision nutrition”, namely personalized dietary patterns based on deep phenotyping and on metabolomics, microbiome, and nutrigenetics of each case, might be more efficient for infertile patients than applying a generic nutritional approach. In this review, we report on new insights into the nutritional management of infertile patients, discussing the main nutrigenetic, nutrigenomic, and microbiomic aspects that should be investigated to achieve effective personalized nutritional interventions. Specifically, we will focus on the management of low-grade chronic inflammation, which is associated with several infertility-related diseases.

Potential use of plant-based by-products and waste to improve the quality of gluten-free foods

The food industry generates a large amount of waste and by-products, the disposal of which has a negative impact on the environment and the economy. Plant-based waste and by-products are rich in bioactive compounds such as dietary fiber, proteins, essential fatty acids, antioxidant compounds, vitamin, and minerals, which can be exploited to reduce the nutritional deficiencies of gluten-free products. The latter are known to be rich in fats and carbohydrates but lacking in bioactive compounds; the absence of gluten also has a negative effect on textural and sensory properties. Several attempts have been made to improve the quality of gluten-free products using alternative flours and additives, or by adopting innovative technologies. The exploitation of plant-based by-products would represent a chance to improve both the nutritional profile and the overall quality of gluten-free foods by further enhancing the sustainability of the agri-food system. After examining in detail the composition of plant-based by-products and waste, the objective of this review was to provide an overview of the effects of their inclusion on the quality of gluten-free products (bread, pasta, cake/muffins, biscuits and snacks). The advantages and drawbacks regarding the physical, sensory, and nutritional properties were critically evaluated. © 2021 Society of Chemical Industry.

The Effectiveness of Extruded-Cooked Lentil Flour in Preparing a Gluten-Free Pizza with Improved Nutritional Features and a Good Sensory Quality

Extruded-cooked lentil (ECL) flour was used to fortify (10/100 g dough) gluten-free pizza, which was compared with rice/corn-based pizza (control), and with pizza containing native lentil (NL) flour. Viscoamylograph and Mixolab data evidenced the hydrocolloid properties of ECL flour (initial viscosity = 69.3 BU), which contained pregelatinized starch. The use of ECL flour made it possible to eliminate hydroxymethylcellulose (E464), obtaining a clean label product. Both NL and ECL pizzas showed significantly (p < 0.05) higher contents of proteins (7.4 and 7.3/100 g, respectively) than the control pizza (4.4/100 g) and could be labelled as "source of proteins" according to the Regulation (EC) No. 1924/2006. In addition, NL and ECL pizzas were characterized by higher contents of bioactive compounds, including anthocyanins, and by higher in vitro antioxidant activity (1.42 and 1.35 µmol Trolox/g d.m., respectively) than the control pizza (1.07 µmol Trolox/g d.m.). However, NL and ECL pizzas also contained small amounts of undigestible oligosaccharides, typically present in lentils (verbascose = 0.92-0.98 mg/g d.m.; stachyose = 4.04-5.55 mg/g d.m.; and raffinose = 1.98-2.05 mg/g d.m.). No significant differences were observed in the liking level expressed by consumers between ECL and control pizzas.

Nutritional Deficiencies in Vegetarian, Gluten-Free, and Ketogenic Diets

Previously, medical diets, including the ketogenic and gluten-free diets, were rare outside of their target population. Subspecialists more familiar with risks and benefits often managed nutrition and any associated shortcomings. With more patients electively following a gluten-free or ketogenic diet for nonmedical needs, as well as the increasing prevalence of vegetarian diets, general pediatricians are seeing more followers of restrictive diets with general well-child care. Increasingly, general pediatricians can be the first provider to witness presenting signs or symptoms of associated nutritional deficiencies. This article reviews signs and symptoms of possible nutrient deficiencies seen with the vegetarian, ketogenic, and gluten-free diets.

Delving into the Role of Dietary Fiber in Gluten-Free Bread Formulations: Integrating Fundamental Rheological, Technological, Sensory, and Nutritional Aspects

The evidenced relevance of dietary fibers (DF) as functional ingredients shifted the research focus towards their incorporation into gluten-free (GF) bread, aiming to attain the DF contents required for the manifestation of health benefits. Numerous studies addressing the inclusion of DF from diverse sources rendered useful information regarding the role of DF in GF batter’s rheological properties, as well as the end product’s technological and nutritional qualities. The presented comprehensive review aspires to provide insight into the changes in fiber-enriched GF batter’s fundamental rheological properties, and technological, sensory, and nutritional GF bread quality from the insoluble and soluble DF (IDF and SDF) perspective. Different mechanisms for understanding IDF and SDF action on GF batter and bread were discussed. In general, IDF and SDF can enhance, but also diminish, the properties of GF batter and bread, depending on their addition level and the presence of available water in the GF system. However, it was seen that SDF addition provides a more homogenous GF batter structure, leading to bread with higher volumes and softer crumb, compared to IDF. The sensory properties of fiber-enriched GF breads were acceptable in most cases when the inclusion level was up to 7 g/100 g, regardless of the fiber type, enabling the labeling of the bread as a source of fiber.

Gluten-Free Cereal Products and Beverages: A Review of Their Health Benefits in the Last Five Years

In the past decades, food products and beverages made from gluten-free cereals were initially created for certain groups of people who experience gluten-related disorders such as wheat allergies, gluten ataxia, non-celiac gluten sensitivity, and the most well-known, celiac disease. Nowadays, the consumption of gluten-free products is not only restricted to targeted groups, but it has become a food trend for normal consumers, especially in countries such as the UK, the US, and some European countries, who believe that consuming a gluten-free product is a healthier choice compared to normal gluten-containing products. However, some research studies have disapproved of this claim because the currently available gluten-free products in the market are generally known to be lower in proteins, vitamins, and minerals and to contain higher lipids, sugar, and salt compared to their gluten-containing counterparts. The use of other gluten-free cereals such as sorghum, millet, and teff as well as pseudo cereals such as buckwheat and quinoa has gained significant interest in research in terms of their various potential health benefits. Hence, this review highlights the potential health benefits of some gluten-free cereals and pseudo cereals apart from corn and rice in the last decade. The potential health benefits of gluten-free products such as bread, pasta, crackers, and cookies and the health benefits of some other non-alcoholic beverages made from gluten-free cereals and pseudo cereals are reported.

Nutritional implications of dietary gluten avoidance among Canadians: results from the 2015 Canadian Community Health Survey

Adherence to a gluten-free diet (GFD) is the only available treatment for gluten-related disorders, although a GFD may also be followed for discretionary reasons. The main objectives of the present study were to (1) describe and test for differences in key nutrient intakes among Canadians who follow a GFD compared with Canadians with no dietary exclusions and (2) describe additional dietary avoidances adhered to by Canadians who avoid gluten. We conducted a secondary analysis of the cross-sectional 2015 Canadian Community Health Survey-Nutrition Survey, which included a general health survey and 24-h dietary recall (n 20 487). Participants were categorised as those who avoid dietary gluten and those who reported no avoidances. Key nutrient intakes were assessed, as a percentage of Dietary Recommended Intakes, including fibre, B vitamins, vitamin D, Ca, Fe, Na and Zn, and compared between the two groups using t tests. Canadians who avoided gluten had significantly lower intakes of folate, vitamin B12, vitamin D, Fe, Na and Ca compared with those who did not avoid any food groups. However, Canadians who reported following a GFD were significantly more likely to use vitamin or mineral supplements in the past 30 d. More than 20 % of those who avoided gluten also avoided dairy products. Findings suggest that following a GFD places Canadians at risk for nutrient inadequacies, particularly folate, Ca and vitamin D. Further research is required to further examine how multiple dietary avoidances among those who avoid gluten may contribute to dietary inadequacies.

Pasta from yellow lentils: How process affects starch features and pasta quality

The effects of conventional extrusion (CV) and extrusion-cooking (EC) were investigated on 100% yellow lentils (YL). Both the extrusion processes led to pasta with good cooking quality (cooking loss: 7.0-7.1 g/100 g, firmness: 530-608 N), even in overcooking (cooking loss: 7.7-7.9 g/100 g, firmness: 418-513 N). Contrary to what is known for gluten-free cereals, CV is effective in producing pasta from native YL with no need for a pre-gelatinization step. However, pasta from EC showed a higher compression energy (2898 versus 2448 N*mm). In this sample, starch presented a higher degree of gelatinization (75.5 versus 57.6 g/100 g) and lower enthalpy (0.97 versus 1.07 J/g). At the same time, EC promoted a more compact structure that required higher temperature for melting (66.49 versus 63.16 °C) and showing pasting properties (79.1 versus 74.7 °C). Thus, by selecting suitable extrusion conditions it is possible to improve the cooking behavior of 100% pulse pasta.

Amorphophallus konjac: A Novel Alternative Flour on Gluten-Free Bread

The demand for gluten-free products is rising, but their production with similar quality as their gluten counterparts is challenging. This study aimed to develop gluten-free bread samples using different concentrations of Amorphophallus konjac flour (0%, 12.5%, 25%, 37.5%, and 50% of the total flour content) and to evaluate their nutritional and physicochemical properties. Proteins, lipids, carbohydrates, moisture, ash content, fibers, resistant starch, firmness, specific volume, and color were evaluated using official methods. Protein varied from 2.95% to 4.94%, the energy value from 347.93 to 133.55 kcal/100 g, dietary fiber from 8.19 to 17.90%, and resistant starch from 0.67% to 0.75% on wet basis. The addition of konjac flour positively influenced the specific volume. Higher concentrations of konjac flour in the formulations led to lower calories of the bread due to the significant addition of water to the dough. The bread samples with konjac showed high fiber content due to the composition of the flour. They had lower levels of carbohydrates, which can positively influence the glycemic index. Konjac flour provided dough mold, growth, and better texture for gluten-free bread. The best formulations were prepared in concentrations up to 37.5% konjac. The 50% konjac bread showed slightly reduced specific volume and pale color.

Small and Large Intestine (I): Malabsorption of Nutrients

Numerous disorders can alter the physiological mechanisms that guarantee proper digestion and absorption of nutrients (macro- and micronutrients), leading to a wide variety of symptoms and nutritional consequences. Malabsorption can be caused by many diseases of the small intestine, as well as by diseases of the pancreas, liver, biliary tract, and stomach. This article provides an overview of pathophysiologic mechanisms that lead to symptoms or complications of maldigestion (defined as the defective intraluminal hydrolysis of nutrients) or malabsorption (defined as defective mucosal absorption), as well as its clinical consequences, including both gastrointestinal symptoms and extraintestinal manifestations and/or laboratory abnormalities. The normal uptake of nutrients, vitamins, and minerals by the gastrointestinal tract (GI) requires several steps, each of which can be compromised in disease. This article will first describe the mechanisms that lead to poor assimilation of nutrients, and secondly discuss the symptoms and nutritional consequences of each specific disorder. The clinician must be aware that many malabsorptive disorders are manifested by subtle disorders, even without gastrointestinal symptoms (for example, anemia, osteoporosis, or infertility in celiac disease), so the index of suspicion must be high to recognize the underlying diseases in time.

A Systematic Review on Gluten-Free Bread Formulations Using Specific Volume as a Quality Indicator

This study aimed to perform a systematic review on gluten-free bread formulations using specific volumes as a quality indicator. In this systematic review, we identified 259 studies that met inclusion criteria. From these studies, 43 met the requirements of having gluten-free bread with a specific volume greater than or equal to 3.5 cm³/g. Other parameters such as the texture profile, color (crumb and crust), and sensory analysis examined in these studies were presented. The formulations that best compensated the lack of the gluten-network were based on the combination of rice flour, rice flour with low amylose content, maize flour, rice starch, corn starch, potato starch, starch with proteins and added with transglutaminase (TGase), and hydrocolloids like hydroxypropylmethylcellulose (HPMC). Of the 43 studies, three did not present risk of bias, and the only parameter evaluated in common in the studies was the specific volume. However, it is necessary to jointly analyze other parameters that contribute to the quality, such as texture profile, external and internal characteristics, acceptability, and useful life of the bread, especially since it is a product obtained through raw materials and unconventional ingredients.

High-amylose corn in gluten-free pasta: Strategies to deliver nutritional benefits ensuring the overall quality

High-amylose corn alone or in combination (25% and 50%) with conventional corn was used to produce gluten-free pasta. Flour pre-gelatinization in a tank (process A) or on a conveyor belt (process B) were tested. Resistant starch (RS), soluble (SPAs) and cell-wall bound phenolic acids (CWBPAs) and antioxidant capacity were significantly higher in high-amylose corn pasta. Cooked pasta from process B showed a higher SPA concentration, likely due to the lower cooking loss. The structure of pasta prepared with process B was more homogeneous, whereas it was more compact in the case of process A, as shown by a lower starch susceptibility to α-amylase hydrolysis, higher beginning of gelatinization temperature and lower water absorption. 25% HA represents a good compromise between high RS (4.2%) and good cooking behavior. At higher HA levels, process B is more suitable to obtain pasta with a better cooking quality.

All Things Gluten: A Review

Gluten is a common dietary component with a complex protein structure. It forms incomplete products of digestion, which have the potential to mount an immune response in genetically predisposed individuals, resulting in celiac disease. It also has been linked with nonceliac gluten sensitivity and irritable bowel syndrome due to wheat allergy. A gluten-free diet is an effective treatment of these conditions; however, it can lead to micronutrient and mineral deficiencies and a macronutrient imbalance with higher sugar and lipid intake. Recent popularity has led to greater availability, but increasing cost, of commercially available gluten-free products.

Glycemic Index of Gluten-Free Bread and Their Main Ingredients: A Systematic Review and Meta-Analysis

This study aimed to perform a systematic review and meta-analysis of the glycemic index (GI) of gluten-free bread (GFB) and its main ingredients. The systematic review followed PRISMA guidelines, using seven electronic databases (PubMed, EMBASE, Scopus, Science Direct, Web of Science, gray literature research with Google Scholar, and patents with Google Patent tool), from inception to November 2020. Eighteen studies met the inclusion criteria evaluating 132 GFB samples. Five articles tested GI in vivo, eleven in vitro; and two studies tested both methods. The analysis showed that 60.7% (95% CI: 40.2-78.1%) of the samples presented high glycemic indexes, evidencing a high glycemic profile for GFB. Only 18.2% (95% CI: 11.7-27.2%) of the bread samples presented in the studies were classified as a low GI. Meta-analysis presented moderate/low heterogenicity between studies (I2 = 61% and <1% for both high and low GIs) and reinforced the proportion of high GIs. Lower GIs were found in formulations based on Colocasia esculenta flour or enriched with fiber, yogurt and curd cheese, sourdough, psyllium, hydrocolloids, enzymes, fructans, and resistant starch, highlighting the efficacy of these ingredients to lower GFBs' GI. GFB tends to present high GI, impacting the development of chronic diseases when consumed.