An Evaluation of Nutritional Status and Problems with Dietary Compliance in Polish Patients with Celiac Disease

Assessment of Non-Cereal Products Gluten Cross-Contamination Exposure Risk in a Polish Female Population of Patients Diagnosed with Coeliac Disease

BACKGROUND/OBJECTIVES

Following gluten-free diet is challenging, due to risk of gluten cross-contamination. The study aimed to assess the non-cereal products gluten cross-contamination exposure risk in patients with coeliac disease.

METHODS

The study was conducted in a population of 699 Polish female members of the Polish Coeliac Society purchasing gluten-free products on-line (445 patients, 254 relatives). Participants were asked about frequency of buying and availability of gluten-free alternatives of non-cereal products characterized by the gluten cross-contamination risk ('hidden' gluten sources).

RESULTS

The most frequently bought non-cereal gluten-free alternatives of the 'hidden' gluten sources were baking powders, spices, side dishes, ice cream, chocolate and chocolate products, snack bars and candies. The caregivers often declared buying 'often' gluten-free baking powder, snack bars, chocolate and chocolate products, candies, ice cream, as well as often declared problems with the availability of gluten-free spices, chocolate and chocolate products, while patients often declared buying 'often' gluten-free beer, as well as often declared problems with its availability. The older respondents often declared buying 'often' gluten-free baking powder, while younger respondents often declared buying 'often' gluten-free chocolate and chocolate products, as well as often declared problems with the availability of gluten-free instant soups, and beer. The respondents living in small towns/villages often declared problems with the availability of gluten-free powder sauces. The respondents not purchasing in hypermarkets often declared buying 'often' gluten-free baking powder, spices, candies. The respondents who most often purchased gluten-free products often declared problems with the availability of gluten-free side dishes, chocolate and chocolate products.

CONCLUSIONS

The majority of patients diagnosed with coeliac disease do not buy a number of gluten-free alternatives of the 'hidden' gluten sources, so they may be prone to gluten exposure, due to non-cereal products' gluten cross-contamination risk.

Dietary assessments in individuals living with coeliac disease: key considerations

BACKGROUND

Coeliac disease (CeD) is a type of enteropathy characterised by an immune-mediated reaction to ingested gluten, resulting in impaired absorption of nutrients and symptoms such as bloating, abdominal cramping and diarrhoea. Currently, the only treatment for CeD is adherence to a gluten-free diet (GFD). The latest draft guidance from the US Food and Drug Administration recommends that dietitians experienced in CeD management evaluate patients during the screening and treatment period of CeD clinical trials to assess adherence to a GFD. However, there are currently no standardised guidelines on dietary assessment of patients with CeD on a GFD and there is a lack of widespread availability of expertise in this field.

METHODS

Based on the findings of a literature review conducted between April and September 2023, this article provides an overview of key points to consider in the nutritional and dietary assessment of patients with CeD who are following a GFD, with particular focus on the clinical trial setting.

RESULTS

Based on a consensus from dietitians and gastroenterologists experienced in treating patients with CeD, we present specific recommendations for registered dietitians who manage patients with CeD. We also describe the development of a simplified tool for assessment of adherence to a GFD, the Gluten-Free Adherence Survey, based on these recommendations.

CONCLUSIONS

These guidelines cover nutritional and dietary assessment of patients with CeD, physical assessments, intake of oats, environmental considerations and the disease burden.

Gluten Unraveled: Latest Insights on Terminology, Diagnosis, Pathophysiology, Dietary Strategies, and Intestinal Microbiota Modulations-A Decade in Review

A decade of research on gluten-related disorders (GRDs) is reviewed in this study, with a particular emphasis on celiac disease (CD) and non-celiac gluten sensitivity (NCGS). GRDs are triggered by the ingestion of gluten and gluten-like proteins found in wheat, barley, and rye. These proteins lead to intestinal damage in celiac disease, an autoimmune condition characterized by villous atrophy and a variety of gastrointestinal and extraintestinal symptoms. More enigmatic and less understood, NCGS involves symptoms similar to CD but without the immunological reaction or intestinal damage. Recent years have seen advances in the understanding of GRDs, particularly in connection to how intestinal microbiota influences disease progression and patient outcomes. The gluten-free diet (GFD) is still the standard therapy recommended for GRDs despite significant challenges, as discussed in this article. Precise diagnostic methods, patient education and dietary counseling are critical for improving patients' quality of life. The purpose of this review is to provide a more clear and up-to-date understanding of GRDs, and to help further research on this important topic.

Unlocking the Potential of Teff for Sustainable, Gluten-Free Diets and Unravelling Its Production Challenges to Address Global Food and Nutrition Security: A Review

Sustainable diets, as defined by the Food and Agriculture Organisation, aim to be nutritionally adequate, safe, and healthy, while optimising natural and human resources. Teff (Eragrostis tef), a gluten-free grain primarily grown in Ethiopia, has emerged as a key contender in this context. Widely regarded as a "supergrain", teff offers an outstanding nutrition profile, making it an excellent choice for people with gluten-related disorders. Rich with protein, essential amino acids, polyunsaturated fats, and fibre, and abundant in minerals like calcium and iron, teff rivals other popular grains like quinoa and durum wheat in promoting human health. Beyond its nutritional benefits, teff is a hardy crop that thrives in diverse climates, tolerating both drought and waterlogged conditions. Due to its resilience and rich nutrient content, teff holds the potential to address nine of the 17 United Nations' Sustainable Development Goals (SDGs), including SDG 1 (no poverty), SDG 2 (zero hunger), and SDG 3 (good health and wellbeing), which are tied to improving food and nutrition security. However, teff production in Ethiopia faces significant issues. Traditional farming practices, insufficient storage infrastructure, and food safety challenges, including adulteration, hinder teff's full potential. This review explores teff's dual role as a nutritious, sustainable food source and outlines the key challenges in its production to conclude on what needs to be done for its adoption as a golden crop to address global food and nutrition security.

Nutrition Assessment and Management in Celiac Disease

Celiac disease (CeD) is the most common immune condition affecting the gastrointestinal tract; it is triggered by gluten and the only available treatment is a strict gluten-free diet (GFD). Therefore, for patients with CeD, adopting a GFD is not a lifestyle choice. The major problem is that a GFD is restrictive and, like all restrictive diets, it has the potential for adverse nutritional outcomes, especially if adopted for a long term. It is well known that GFD can be nutritionally inadequate and is frequently associated with vitamin and mineral deficiencies; it is also associated with excessive sugar and fat intake, particularly when gluten-free substitutes are consumed. Consequently, people with CeD are affected by higher rates of overweight and obesity and metabolic complications, such as fatty liver and cardiovascular disease. Therefore, assessment of nutritional status and diet quality at diagnosis and while on a long-term GFD is key in the management of CeD. This narrative review addresses nutritional considerations in CeD and management of common challenges associated with a GFD.

Gluten-free diet for pediatric patients with coeliac disease: A position paper from the ESPGHAN gastroenterology committee, special interest group in coeliac disease

BACKGROUND AND OBJECTIVE

Coeliac disease is a chronic, immune-mediated disorder for which the only treatment consists of lifelong strict adherence to gluten-free diet (GFD). However, there is a lack of evidence-based guidelines on the GFD dietary management of coeliac disease. This position paper, led by the Special Interest Group in coeliac disease of the European Society of Pediatric, Gastroenterology Hepatology, and Nutrition, supported by the Nutrition Committee and the Allied Health Professionals Committee, aims to present evidence-based recommendations on the GFD as well as how to support dietary adherence.

METHODS

A wide literature search was performed using the MeSH Terms: "diet, gluten free," "gluten-free diet," "diets, gluten-free," "gluten free diet," and "coeliac disease" in Pubmed until November 8th, 2022.

RESULTS

The manuscript provides an overview of the definition of the GFD, regulations as basis to define the term "gluten-free," which foods are naturally gluten-free and gluten-containing. Moreover, it provides recommendations and educational tips and infographics on suitable food substitutes, the importance of reading food labels, risk of gluten cross-contact at home and in public settings, nutritional considerations as well as factors associated to dietary adherence based on available evidence, or otherwise clinical expertise.

CONCLUSIONS

This position paper provides guidance and recommendations to support children with coeliac disease to safely adhere to a GFD.

Association between frailty and chronic constipation and chronic diarrhea among American older adults: National Health and Nutrition Examination Survey

BACKGROUND

This study was to explore the relationship between chronic constipation, chronic diarrhea, and frailty in older Americans.

METHODS

This cross-sectional study selected a total of 4241 community-dwelling individuals aged 60 years and older from the 2005-2010 National Health and Nutrition Examination Survey. Frailty was measured using a 49-item frailty index, and a frailty index > 0.21 was defined as a frail status. Chronic constipation and chronic diarrhea were defined as the "usual or most common type of stool" by the Bristol Stool Form Scale (BSFS) Types 1 and 2 and BSFS Types 6 and 7, respectively. Weighted logistic regression analysis was used to examine the relationship between gut health and frailty status. Restricted cubic spline (RCS) curves were built to assess the association between frailty index and stool frequency.

RESULTS

Frailty status was associated with higher odds of constipation in an unadjusted model; however, after further adjusting for confounding variables, the relationship between frailty status and constipation was not statistically significant. We discovered a positive correlation between the frailty status and diarrhea after adjustment for all variables. The frailty index showed a U-shaped relationship with stool frequency, and the frailty index was the smallest at a frequency of 10 stools/week.

CONCLUSION

Negative associations were observed between frailty status and chronic constipation and diarrhea among older adults. Older adults who have a bowel movement frequency of about 10 times per week are the least frail. Future studies are warranted to confirm the causal relationship in this association.

Assessment of Nutritional Status by Bioelectrical Impedance in Adult Patients with Celiac Disease: A Prospective Single-Center Study

The gluten-free diet [GFD] has been linked to an increased risk of weight gain and the development of metabolic disorders. Most of the studies have focused on the effect of GFD on the Body Mass Index [BMI]. We aimed to evaluate the nutritional status using specific nutritional parameters in patients with celiac disease [CeD] at diagnosis and on a GFD compared to healthy controls. We recruited subjects at our outpatient clinic at the University of Padua. We collected demographic and clinical data and values obtained with bioelectrical impedance analysis. A total of 24 CeD patients and 28 healthy controls were enrolled. CeD patients at diagnosis had a lower body cell mass index [BCMI, p = 0.006], fat-free mass index [FFMI, p = 0.02], appendicular skeletal muscle index [ASMI, p = 0.02], and phase angle [PA] [p < 0.001] compared to controls. Their percentage of extracellular water [ECW] was also higher [p < 0.001]. Considering CeD patients after GFD, nutritional status significantly improved after 6 months of GFD. We did not observe differences in BMI among groups [p = ns]. CeD patients at diagnosis were found to have a poorer nutritional status than healthy controls, with a positive effect of the GFD on their nutritional status, underlining the inefficacy of evaluating this aspect through only BMI evaluation.

Determinants of Adherence to a Gluten-Free Diet in Children with Celiac Disease and the Influence of the Methods Used to Assess It

Lifelong adherence to a gluten-free diet (GFD) is the cornerstone of management of celiac disease (CD), but adhering to a GFD can be hard. Although several factors are positively associated with adherence of pediatric CD patients to a GFD, it is unknown whether these are influenced by variability caused by the specific tool used to assess adherence to a GFD. Here, we aimed to evaluate how individual patient characteristics and dietary counselling by a trained dietitian influence adherence to a GFD in children with CD, as assessed by two validated questionnaires: the Biagi questionnaire and the Leffler short questionnaire adapted for pediatric patients. Some 139 children and adolescents were recruited in a cross-sectional, multicenter study. Concordance between the two questionnaires in defining adherence was fair (weighted Cohen's kappa coefficient 0.39, 95%CI 0.19-0.60). Upon regression analysis, having a cohabiting family member with CD, being of Italian origin, and receiving specialized dietary counselling during follow-up were found to positively influence stricter adherence to a GFD for children with CD. Neither questionnaire detected a significant relationship between adherence to a GFD and the presence of symptoms after gluten ingestion. This study provides important new data on the factors influencing GFD adherence in the pediatric population, and highlights the importance of dietician input and overcoming language and cultural barriers when educating patients.