Nutrition Assessment and Management in Celiac Disease

Impact of tailored dietary interventions on suspected carbohydrate intolerance patients based on genetic testing

BACKGROUND

carbohydrate intolerance presents a complex scenario where symptoms arise following the consumption of specific substrate and alleviate upon their elimination from the diet. Lactose Intolerance is one of the most prevalent types of food intolerance. Primary lactose intolerance is linked to genetic factors, Lactase Non-Persistence phenotype, while secondary lactose intolerance might be a temporary condition resulting from intestinal damage and loss of disaccharidase activity. Fructose absorption is an energy-independent process, leading to limited and variable absorption. Fructose undergoes quick absorption into the bloodstream through active transporters, specifically GLUT-5 and GLUT-2, found in the initial segment of the small intestine. The management of carbohydrate intolerance requires precise testing methods, accurate diagnostics, and customized dietary interventions. Genetic testing plays a crucial role in determining an individual's genetic profile, helping decide whether permanent restrictions on specific nutrients, such as lactose, are necessary.

OBJECTIVE

this research aims to understand the origin of suspected carbohydrate intolerance, combining genetic testing with breath tests to enhance the efficacy of treatment plans, as customized dietary interventions will be based on the patient's genetic profile and carbohydrate absorption capacity.

MATERIAL AND METHODS

a combination of genetic testing (lactase non-persistence and celiac disease risk) and breath test for lactose and fructose were performed. Recommendations such as low lactose, low fructose or gluten-free diets; or a combination of them were provided based on each patient's testing profile results.

RESULTS

after the nutritional intervention, a significant improvement was noted in all gastrointestinal symptoms, except for reflux and nausea, and in all of the extraintestinal symptoms.

CONCLUSIONS

designing dietary interventions based on primary and secondary causes for carbohydrate intolerance can avoid unnecessary food restrictions; improving patients' quality of life and treatment effectiveness through tailored dietary interventions.

The Strategies of Picture Books as a Mode of Health Communication for Young Children with Coeliac Disease

Background/Objectives: Coeliac disease, a chronic and lifelong health condition, is one of the most common autoimmune diseases. However, it is also one of the most under-recognised conditions, and emotionally and cognitively appropriate materials are especially lacking for young children and their families who are coping with this disease. Effective health communication is essential for educating and supporting children living with coeliac disease as well as their families and communities. Picture books can serve as useful and accessible educational and health promotion tools, promoting adaptive coping strategies for dealing with a potentially traumatic condition. Methods: This study aimed to fill a critical gap in the literature by examining a range of picture books (n = 9) aimed at children three to eight years of age diagnosed with coeliac disease. Reflective thematic and structural narrative analyses were applied to explore strategies and themes used in these books and how they align with the current literature on developing coping through children's narratives. Results: Four themes were developed and measured against an existing model of coping narratives to find a more specific model that recognises the specific concerns of coeliac disease. The four themes found were Information Provision; Promotion of CD Management; Anxiety and Hypervigilance Reduction, with two subthemes of Validating Feelings and Reducing Concerns; and Community and Connection. Conclusions: The findings have likely implications for the following applications: incorporation into clinician training (as a therapeutic and health promotion intervention), support within schools, authors of similar books for children coping with chronic illness, and coping approaches for individuals/families to promote health literacy/support regarding living with coeliac disease.

The Amelioration of Methionine Restriction on the Celiac Toxic Effects of p31-43 Gliadin Peptide Is Disrupted by S-Adenosyl-Methionine

Methionine restriction (MR) has been found to alleviate the progression of diseases such as cognitive disorders and cancer, but it is not clear whether regulating methionine availability can have a beneficial effect on wheat gluten-induced celiac disease. We aimed to excavate the effects of MR on the celiac toxic effects of p31-43 gliadin peptide. In this study, we systematically investigated the effects of MR on p31-43 gliadin peptide-induced oxidative damage, the elevation of tissue transglutaminase enzyme activity, the overexpression of inflammatory factors, the increase of permeability, and T-lymphocyte dysfunction by utilizing Caco-2 epithelial cells and lymphocytes derived from mouse mesenteric lymph nodes to elucidate the effectiveness of MR. Moreover, the potential mechanism of MR on innate and adaptive immune regulation was explored with the help of S-adenosyl-methionine (SAM), a critical metabolic intermediate in methionine cycle. We discovered that MR effectively suppressed the celiac toxic effects of p31-43 gliadin peptide. Furthermore, we illustrated the controlling role of SAM in MR to regulate the toxic effects of gliadin in terms of both gliadin-induced innate and adaptive immune responses and found that SAM could directly affect the effectiveness of MR. This study might offer novel insights for the utilization of MR in celiac disease (such as MR interventions or gluten-free diets with specific methionine content) as well as the roles of SAM in MR.

Celiac Disease: Beyond Diet and Food Awareness

Celiac disease is attributable to a combination of genetic predisposition and exposure to dietary gluten, with immune system involvement. The incidence is increasing globally, and the societal economic burden of celiac disease stretches beyond the cost of gluten-free food. This enteropathy that affects the small intestine has been related to different disorders and comorbidities. Thus, the implications of suffering from this disease are multidimensional and need further consideration. Celiac disease is a serious condition that remains under-recognized, resulting in an increased need for programs for better management. This review aims to summarize the current evidence regarding celiac diseases, with special emphasis on clinical implications, diagnosis, dietary management, socioeconomical aspects, and future perspectives.

Assessing the Impact of Early Nutritional Intervention on Pediatric Celiac Disease Management: A Prospective Cohort Study

BACKGROUND

Celiac disease is a chronic autoimmune condition requiring lifelong adherence to a gluten-free diet, particularly in children, to prevent nutritional deficiencies and developmental delays.

OBJECTIVE

The objective of study was to evaluate the effects of early nutritional intervention on the management and health outcomes of children diagnosed with celiac disease.

METHODOLOGY

A prospective, longitudinal cohort study was conducted over two years (July 2019-July 2021). A customized gluten-free meal plan and any necessary dietary supplements were given to the participants. Baseline evaluations and six-monthly follow-ups were used to gather data on growth, nutritional status, and dietary compliance. SPSS was used for the statistical analysis, and a significance threshold of p<0.05 was established.

RESULTS

Significant improvements were observed in growth metrics, with mean height increasing from 145.67 cm to 157.48 cm and weight from 36.29 kg to 46.24 kg over 24 months (p < 0.001). Nutritional status also improved, with serum iron levels rising from 45.19 µg/dL to 76.89 µg/dL and vitamin D from 20.14 ng/mL to 44.22 ng/mL (p < 0.001). Dietary adherence increased from 84.37% to 94.62%.

CONCLUSION

Growth and nutritional results in children with celiac disease are greatly improved with nutritional intervention.