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Verma AK, Quattrini S, Serin Y, Monachesi C, Catassi GN, Gatti S, Makharia GK, Lionetti E, Catassi C. Unauthentic Information About Celiac Disease on Social Networking Pages: Is It a Matter of Concern in Celiac Disease Management? Dig Dis Sci 2024:10.1007/s10620-024-08486-7. [PMID: 38816597 DOI: 10.1007/s10620-024-08486-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 05/07/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Facebook (FB) is the most popular online networking platform. Many celiac disease Facebook (CD-FB) pages spread awareness about celiac disease (CD). To get the latest information, patients with CD frequently follow such pages. However, little is known about whether such pages provide authentic and reliable information. AIMS This study aims to investigate whether CD-FB pages spread misleading information to patients with CD. METHODS On the Facebook social networking platform, CD-FB pages created in three celiac-prevalent countries (Italy, the USA, and India) were explored using different combinations of keywords. The type/category of the CD-FB page, country of origin, purpose, page web link, and number of followers/members were documented in a Microsoft spreadsheet. All posts distributed on selected CD-FB pages in the last 3 years were thoroughly screened. RESULTS From August 2022 to March 2023, a total of 200 CD-FB pages from Italy, the USA, and India were explored. Out of these 200 pages, 155 CD-FB (Italy 70; the USA 46; India 39) were found eligible. Of them, 20 (13%) CD-FB pages (Italy 4; the USA 5; India 11) shared misleading information about CD. Surprisingly, 11 (8%) of these 20 pages (Italy 0; the USA 2; India 9) supported alternative treatment options for CD. CONCLUSIONS CD-FB pages are useful for disseminating celiac-disease-related information. While most such pages provide useful information, 13% of CD-FB pages allow misleading information. Patients with CD should consult their treating unit before following any uncertain information posted on CD-FB pages.
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Affiliation(s)
- Anil K Verma
- Department of Medicine Farncombe, Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada.
- Celiac Disease Research Laboratory, Polytechnic University of Marche, Ancona, Italy.
| | - Sara Quattrini
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, Ancona, Italy
| | - Yeliz Serin
- Department of Nutrition and Dietetics, Faculty of Health Science, Çukurova University, Adana, Turkey
| | - Chiara Monachesi
- Department of Medicine Farncombe, Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Giulia N Catassi
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, Ancona, Italy
| | - Simona Gatti
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, Ancona, Italy
| | - Govind K Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Elena Lionetti
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, Ancona, Italy
| | - Carlo Catassi
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, Ancona, Italy
- Center for Celiac Research and Treatment, Mass General Hospital for Children, Boston, USA
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Luque V, Crespo-Escobar P, Hård Af Segerstad EM, Koltai T, Norsa L, Roman E, Vreugdenhil A, Fueyo-Díaz R, Ribes-Koninckx C. Gluten-free diet for pediatric patients with coeliac disease: A position paper from the ESPGHAN gastroenterology committee, special interest group in coeliac disease. J Pediatr Gastroenterol Nutr 2024; 78:973-995. [PMID: 38291739 DOI: 10.1002/jpn3.12079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/10/2023] [Accepted: 08/20/2023] [Indexed: 02/01/2024]
Abstract
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.
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Affiliation(s)
- Veronica Luque
- Serra Húnter, Universitat Rovira i Virgili, Reus, Spain
- Paediatric Nutrition and Development Research Unit, IISPV, Reus, Spain
| | - Paula Crespo-Escobar
- Health Sciences Department, ADVISE Research Group, Miguel de Cervantes European University, Valladolid, Spain
- Nutrition and Dietetics Unit, Hospital Recoletas Campo Grande, Valladolid, Spain
| | - Elin M Hård Af Segerstad
- Paediatric Department, Skane University Hospital, Malmoe, Sweden
- Department of Clinical Sciences, Celiac Disease and Diabetes Unit, Faculty of Medicine, Lund University, Malmoe, Sweden
| | - Tunde Koltai
- Direction Board, Association of European Coeliac Societies, Brussels, Belgium
| | - Lorenzo Norsa
- Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Enriqueta Roman
- Paediatric Gastroenterology and Nutrition, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Anita Vreugdenhil
- Department of Pediatrics, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ricardo Fueyo-Díaz
- Department of Psychology and Sociology, Aragonese Primary Care Research Group (GAIAP, B21_20R), University of Zaragoza, Zaragoza, Spain
| | - Carmen Ribes-Koninckx
- Paediatric Gastroenterology, Hepatology and Nutrition, La Fe University Hospital & La Fe Research Institute, Valencia, Spain
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Verma AK, Monachesi C, Catassi GN, Franceschini E, Gatti S, Lionetti E, Catassi C. Performance assessment of a new G12/A1 antibody-based rapid ELISA using commercially available and gluten-spiked food samples. Eur J Gastroenterol Hepatol 2024; 36:416-422. [PMID: 38407849 DOI: 10.1097/meg.0000000000002739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
OBJECTIVE Food products with <20 mg/kg gluten can be labeled 'gluten-free' according to international regulations. Several antibodies-based ELISAs have been develop to track gluten traces in food products. Among them, R5 and G12 antibody-based ELISAs are the frequently used methods. However, these antibodies have certain limitations. We evaluated the accuracy of G12/A1 antibody-based 'Glutentox ELISA Rapid G12' and compared the results with the current reference method i.e., R5 antibody-based 'Ridascreen R5 ELISA'. METHODS In the first step, the performance of Glutentox ELISA Rapid G12 kit was inspected by determination of the threshold value i.e., > or <20 mg/kg gluten in different food products. In the second step, quantification accuracy was assessed by quantification of gluten in gluten-free food products spiked with gliadin reference material. RESULTS In total 47 food products (naturally and labeled gluten-free, and food with traces of gluten) were included. Of them, 29 products were quantified with <20 mg/kg, and 18 with a low level of gluten by both the kits. Six out of 29 gluten-free products were used for the recovery test at different spike levels. Gluten concentration and mean recovery rates of individual kits showed consistency. CONCLUSION GlutenTox Rapid G12 ELISA could be an appropriate choice for detecting gluten in food products but needs more in-house validation and collaborative tests.
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Affiliation(s)
- Anil K Verma
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Celiac Disease Research Laboratory, Polytechnic University of Marche, Ancona, Italy
| | - Chiara Monachesi
- Celiac Disease Research Laboratory, Polytechnic University of Marche, Ancona, Italy
| | - Giulia N Catassi
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, Ancona, Italy
| | - Elisa Franceschini
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, Ancona, Italy
| | - Simona Gatti
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, Ancona, Italy
| | - Elena Lionetti
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, Ancona, Italy
| | - Carlo Catassi
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, Ancona, Italy
- Mucosal Immunology and Biology Research Center, Division of Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital, Boston, USA
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Mazzola AM, Zammarchi I, Valerii MC, Spisni E, Saracino IM, Lanzarotto F, Ricci C. Gluten-Free Diet and Other Celiac Disease Therapies: Current Understanding and Emerging Strategies. Nutrients 2024; 16:1006. [PMID: 38613039 PMCID: PMC11013189 DOI: 10.3390/nu16071006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
A lifelong gluten-free diet (GFD) is the only treatment for celiac disease and other gluten-related disorders. Nevertheless, strict adherence to the GFD is often challenging due to concerns about social isolation, risk of gluten contaminations, high cost, poor quality and the taste of gluten-free products. Moreover, although the GFD is effective in achieving mucosal healing, it may lead to dietary imbalances due to nutrient deficiencies over a long period of time. To overcome these issues, several gluten-free wheat flours have been developed to create products that closely resemble their gluten-containing counterparts. Furthermore, given the critical importance of adhering to the GFD, it becomes essential to promote adherence and monitor possible voluntary or involuntary transgressions. Various methods, including clinical assessment, questionnaires, serology for celiac disease, duodenal biopsies and the detection of Gluten Immunogenic Peptides (GIPs) are employed for this purpose, but none are considered entirely satisfactory. Since adherence to the GFD poses challenges, alternative therapies should be implemented in the coming years to improve treatment efficacy and the quality of life of patients with celiac disease. The aim of this narrative review is to explore current knowledge of the GFD and investigate its future perspectives, focusing on technology advancements, follow-up strategies and insights into a rapidly changing future.
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Affiliation(s)
- Anna Maria Mazzola
- Gastroenterology Unit, Spedali Civili Hospital, 25123 Brescia, Italy; (A.M.M.); (I.Z.); (F.L.)
- Department of Internal Medicine and Medical Therapy, University of Pavia, 27100 Pavia, Italy
| | - Irene Zammarchi
- Gastroenterology Unit, Spedali Civili Hospital, 25123 Brescia, Italy; (A.M.M.); (I.Z.); (F.L.)
| | - Maria Chiara Valerii
- Unit of Translational Physiology and Nutrition, Department of Biological, Geological and Environmental Sciences, University of Bologna, 40126 Bologna, Italy; (M.C.V.); (E.S.)
| | - Enzo Spisni
- Unit of Translational Physiology and Nutrition, Department of Biological, Geological and Environmental Sciences, University of Bologna, 40126 Bologna, Italy; (M.C.V.); (E.S.)
| | - Ilaria Maria Saracino
- Microbiology Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy;
| | - Francesco Lanzarotto
- Gastroenterology Unit, Spedali Civili Hospital, 25123 Brescia, Italy; (A.M.M.); (I.Z.); (F.L.)
| | - Chiara Ricci
- Gastroenterology Unit, Spedali Civili Hospital, 25123 Brescia, Italy; (A.M.M.); (I.Z.); (F.L.)
- Department of Experimental and Clinical Science, University of Brescia, 25123 Brescia, Italy
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Rispo A, Guarino AD, Siniscalchi M, Imperatore N, Santonicola A, Ricciolino S, de Sire R, Toro B, Cantisani NM, Ciacci C. "The crackers challenge": A reassuring low-dose gluten challenge in adults on gluten-free diet without proper diagnosis of coeliac disease. Dig Liver Dis 2024:S1590-8658(24)00305-0. [PMID: 38521669 DOI: 10.1016/j.dld.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/09/2023] [Accepted: 03/01/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Gluten-free diet (GFD) is the one therapy in coeliac disease (CeD). Unfortunately, some patients adopt GFD before the diagnostic work-up. The guidelines suggest a 14-day gluten intake > 3 gr to get CeD diagnosis, although many subjects refuse this approach. Other evidence showed that the intake of 50 mg/day of gluten for 3 months could be useful for CeD diagnosis. AIMS We performed a dietary study, administering a low dose of gluten in form of "crackers" (about 60-120 mg of gluten/day) for 3 months, to get a final diagnosis of CeD in subjects already on GFD. METHODS We enrolled adult patients with a suspicion of CeD on self-prescribed GFD. All subjects performed the crackers challenge for 3 months. At the end, all patients were analysed for CeD serology and if positive underwent endoscopy/histology. Also, we recorded the grade of satisfaction for the gluten challenge and the onset of adverse events. RESULTS We enrolled 120 patients. All patients concluded the challenge without relevant adverse events. Serological positivity was detected in 54 patients (45%). Histology showed atrophy in 87% and Marsh 1-2 grade in 13% of patients. Ninety-nine patients (83%) were satisfied by this challenge. CONCLUSIONS The "crackers challenge" is a useful and safe diagnostic approach in people on self-administered GFD.
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Affiliation(s)
- Antonio Rispo
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, School of Medicine "Federico II" of Naples, Italy.
| | - Alessia Dalila Guarino
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, School of Medicine "Federico II" of Naples, Italy
| | - Monica Siniscalchi
- Department of Medicine, Surgery, and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, Italy; Gastroenterology Unit, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Nicola Imperatore
- Gastroenterology and Endoscopy Unit, P.O. Santa Maria Delle Grazie, Pozzuoli, Naples, Italy
| | - Antonella Santonicola
- Department of Medicine, Surgery, and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, Italy; Gastroenterology Unit, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Simona Ricciolino
- Gastroenterology and Endoscopy Unit, P.O. Santa Maria Delle Grazie, Pozzuoli, Naples, Italy
| | - Roberto de Sire
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, School of Medicine "Federico II" of Naples, Italy
| | - Benedetta Toro
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, School of Medicine "Federico II" of Naples, Italy
| | - Nicola Mattia Cantisani
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, School of Medicine "Federico II" of Naples, Italy
| | - Carolina Ciacci
- Department of Medicine, Surgery, and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, Italy; Gastroenterology Unit, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
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de Vargas FM, Cardoso LT, Didoné A, Lima JPM, Venzke JG, de Oliveira VR. Celiac Disease: Risks of Cross-Contamination and Strategies for Gluten Removal in Food Environments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:124. [PMID: 38397615 PMCID: PMC10888188 DOI: 10.3390/ijerph21020124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024]
Abstract
Celiac disease (CD) is the chronic immune-mediated enteropathy of the small bowel, manifesting when exposure to gluten occurs in genetically predisposed individuals. Nowadays, the only treatment considered safe for CD is a gluten-free diet (GFD). However, one of the problems faced by celiac patients is the cross-contamination of gluten-free food when preparing meals, in addition to utensils, surfaces and equipment. This study aimed to evaluate cross-contamination in gluten-free products and strategies for removing gluten from cross-contamination in cooking environments. The selection of papers for this integrative review was carried out by searching different databases. Gluten cross-contamination is a global concern for celiac patients in food environments. Although some practices are positive, such as gluten labeling on processed food in several countries, it is crucial to promote good practices in food services around the world. Only a few studies showed effective results in removing gluten from surfaces and utensils; furthermore, sampling was limited, making it difficult to identify appropriate procedures to reduce cross-contamination. The variation in contamination in different kitchen environments also highlighted that celiac patients must continue paying attention to the methods used to prepare gluten-free food. More research is needed, especially into methods of removing gluten from surfaces and utensils, to ensure food safety for celiac patients in many food environments.
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Affiliation(s)
- Fabiana Magnabosco de Vargas
- Postgraduate Program in Food, Nutrition, and Health (PPGANS), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, RS, Brazil;
| | - Louise Thomé Cardoso
- Postgraduate Program in Agricultural and Environmental Microbiology (PPGMAA), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, RS, Brazil;
| | - Amanda Didoné
- Nutrition Deparment, Faculty of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, RS, Brazil; (A.D.); (J.G.V.)
| | - João P. M. Lima
- Scientific-Pedagogical Unit of Dietetics and Nutrition, Coimbra Health School, Polytechnic University of Coimbra, 3046-854 Coimbra, Portugal;
| | - Janaína Guimarães Venzke
- Nutrition Deparment, Faculty of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, RS, Brazil; (A.D.); (J.G.V.)
| | - Viviani Ruffo de Oliveira
- Postgraduate Program in Food, Nutrition, and Health (PPGANS), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, RS, Brazil;
- Nutrition Deparment, Faculty of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, RS, Brazil; (A.D.); (J.G.V.)
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Brouns F, Van Haaps A, Keszthelyi D, Venema K, Bongers M, Maas J, Mijatovic V. Diet associations in endometriosis: a critical narrative assessment with special reference to gluten. Front Nutr 2023; 10:1166929. [PMID: 37731404 PMCID: PMC10507348 DOI: 10.3389/fnut.2023.1166929] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
Endometriosis is characterized by the presence of endometrium-like tissue outside the uterus. The etiology remains largely unknown. Despite adequate treatment, patients can still experience symptoms or side effects resulting in therapy incompliance and in self-management strategies such as dietary measures is increasing. A gluten free diet is thought to be contributory in reducing endometriosis-related pain, thereby optimizing quality of life. However, data is conflicting and currently provides no evidence for causality. This narrative review aims to put the effect of dietary self-management strategies on endometriosis in a balanced perspective, especially the effect of gluten and a gluten free diet. Several studies have found a strong overlap in symptoms, metabolic and immune responses associated with endometriosis and those associated with celiac disease, ulcerative colitis, Crohn's disease, irritable bowel syndrome and non-celiac wheat sensitivity. However, it remains unclear whether these diseases and/or disorders are causal to an increased risk of endometriosis. Some studies have found a positive effect on the risk of endometriosis, endometriosis-related symptoms and quality of life (QoL) when women either avoided certain nutrients or foods, or applied a specific nutrient supplementation. This includes the avoidance of red meat and omega-3, an increasing intake of foods rich in anti-oxidants, micronutrients and dietary fibers (e.g., fruit, vegetables) and the appliance of a gluten free diet. However, data from the available studies were generally graded of low quality and it was noted that placebo and/or nocebo effects influenced the reported positive effects. In addition, such effects were no longer seen when adjusting for confounders such as overweight, when a translation was made from in vitro to in vivo, or when the nutrients were not supplemented as isolated sources but as part of a mixed daily diet. Finally, some studies showed that long-term adherence to a gluten free diet is often associated with an impaired diet quality and nutrient intake, leading to negative health outcomes and reduced QoL. Concluding, scientific evidence on the efficacy of dietary interventions on well-defined clinical endpoints of endometriosis is lacking and recommending a gluten free diet to women solely diagnosed with endometriosis should therefore not be advised.
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Affiliation(s)
- Fred Brouns
- Department of Human Biology, School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Annelotte Van Haaps
- Endometriosis Center, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Daniel Keszthelyi
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Koen Venema
- Centre for Healthy Eating & Food Innovation (HEFI), Maastricht University, Maastricht, Netherlands
| | - Marlies Bongers
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, Netherlands
- Grow-School of Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
| | - Jacques Maas
- Grow-School of Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
- Department of Obstetrics and Gynaecology MUMC+, Maastricht, Netherlands
| | - Velja Mijatovic
- Endometriosis Center, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
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D’Amico V, Gänzle M, Call L, Zwirzitz B, Grausgruber H, D’Amico S, Brouns F. Does sourdough bread provide clinically relevant health benefits? Front Nutr 2023; 10:1230043. [PMID: 37545587 PMCID: PMC10399781 DOI: 10.3389/fnut.2023.1230043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 06/27/2023] [Indexed: 08/08/2023] Open
Abstract
During the last decade, scientific interest in and consumer attention to sourdough fermentation in bread making has increased. On the one hand, this technology may favorably impact product quality, including flavor and shelf-life of bakery products; on the other hand, some cereal components, especially in wheat and rye, which are known to cause adverse reactions in a small subset of the population, can be partially modified or degraded. The latter potentially reduces their harmful effects, but depends strongly on the composition of sourdough microbiota, processing conditions and the resulting acidification. Tolerability, nutritional composition, potential health effects and consumer acceptance of sourdough bread are often suggested to be superior compared to yeast-leavened bread. However, the advantages of sourdough fermentation claimed in many publications rely mostly on data from chemical and in vitro analyzes, which raises questions about the actual impact on human nutrition. This review focuses on grain components, which may cause adverse effects in humans and the effect of sourdough microbiota on their structure, quantity and biological properties. Furthermore, presumed benefits of secondary metabolites and reduction of contaminants are discussed. The benefits claimed deriving from in vitro and in vivo experiments will be evaluated across a broader spectrum in terms of clinically relevant effects on human health. Accordingly, this critical review aims to contribute to a better understanding of the extent to which sourdough bread may result in measurable health benefits in humans.
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Affiliation(s)
- Vera D’Amico
- Department of Food Science and Technology, BOKU–University of Natural Resources and Life Sciences, Vienna, Austria
| | - Michael Gänzle
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Lisa Call
- Department of Crop Sciences, BOKU–University of Natural Resources and Life Sciences, Tulln, Austria
| | - Benjamin Zwirzitz
- Department of Food Science and Technology, BOKU–University of Natural Resources and Life Sciences, Vienna, Austria
| | - Heinrich Grausgruber
- Department of Crop Sciences, BOKU–University of Natural Resources and Life Sciences, Tulln, Austria
| | - Stefano D’Amico
- Institute for Animal Nutrition and Feed, AGES–Austrian Agency for Health and Food Safety, Vienna, Austria
| | - Fred Brouns
- Department of Human Biology, School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
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Systematic Review and Dose-Response Meta-Analysis on the Relationship between Different Gluten Doses and Risk of Coeliac Disease Relapse. Nutrients 2023; 15:nu15061390. [PMID: 36986121 PMCID: PMC10057462 DOI: 10.3390/nu15061390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/27/2023] [Accepted: 03/08/2023] [Indexed: 03/15/2023] Open
Abstract
Gluten proteins are known as immunological triggers for inflammation resulting in mucosal lesions in patients with coeliac disease (CD). Adherence to a strict gluten-free diet (GFD) is currently known as the only effective treatment for CD. In this study, we performed a systematic review and dose-response meta-analysis on data from previous studies to investigate the association between different gluten doses administered and the risk of CD relapse. Electronic databases were systematically searched to retrieve studies that investigated the response of CD patients to different amounts of gluten intake and evaluated the clinical, serologic, and/or histologic evidence to recognize disease relapse. Study-specific relative risks (RRs) were combined using a random effects model. A total of 440 identified published papers were screened, of which 7 records were selected following full-text reviewing and eligibility assessment for dose-response meta-analysis. According to our analysis, the risk of CD relapse is estimated to be 0.2% (RR: 1.002; 95% CI: 1.001 to 1.004) following the consumption of 6 mg gluten/day, which was increased to 7% (RR: 1.07; 95% CI: 1.03 to 1.10), 50% (RR: 1.50; 95% CI: 1.23 to 1.82), 80% (RR: 1.80; 95% CI: 1.36 to 2.38), and 100% (RR: 2.00; 95% CI: 1.43 to 2.78) by the daily intake of 150, 881, 1276, and 1505 mg gluten, respectively. Although good adherence to a GFD can adequately control CD-related symptoms, disease relapse might happen even with a very low dose of gluten, and the duration of exposure to gluten is also an important matter. The current literature has substantial limitations, such as relying on the data from just a few countries that were different in terms of the amount of gluten administered, the duration of the challenge, etc. Therefore, more randomized clinical trials using a standardized gluten challenge protocol are needed to confirm the findings of the present study.
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Benítez M, Zubiate P, Socorro-Leránoz A, Matías I. Lossy mode resonance-based optical immunosensor towards detecting gliadin in aqueous solutions. Food Control 2023. [DOI: 10.1016/j.foodcont.2023.109624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Catassi C, Verdu EF, Bai JC, Lionetti E. Coeliac disease. Lancet 2022; 399:2413-2426. [PMID: 35691302 DOI: 10.1016/s0140-6736(22)00794-2] [Citation(s) in RCA: 105] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/05/2022] [Accepted: 04/13/2022] [Indexed: 12/14/2022]
Abstract
Coeliac disease is an autoimmune disorder that primarily affects the small intestine, and is caused by the ingestion of gluten in genetically susceptible individuals. Prevalence in the general population ranges from 0·5% to 2%, with an average of about 1%. The development of the coeliac enteropathy depends on a complex immune response to gluten proteins, including both adaptive and innate mechanisms. Clinical presentation of coeliac disease is highly variable and includes classical and non-classical gastrointestinal symptoms, extraintestinal manifestations, and subclinical cases. The disease is associated with a risk of complications, such as osteoporosis and intestinal lymphoma. Diagnosis of coeliac disease requires a positive serology (IgA anti-transglutaminase 2 and anti-endomysial antibodies) and villous atrophy on small-intestinal biopsy. Treatment involves a gluten-free diet; however, owing to the high psychosocial burden of such a diet, research into alternative pharmacological treatments is currently very active.
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Affiliation(s)
- Carlo Catassi
- Department of Specialized Clinical Sciences and Odontostomatology, Polytechnic University of Marche, Ancona, Italy; Celiac Center and Mucosal Immunology and Biology Research, MassGeneral Hospital for Children-Harvard Medical School, Boston, MA, USA.
| | - Elena F Verdu
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Julio Cesar Bai
- Department of Medicine, Dr C Bonorino Udaondo Gastroenterology Hospital, Buenos Aires, Argentina; Research Institutes, Universidad del Salvador, Buenos Aires, Argentina
| | - Elena Lionetti
- Department of Specialized Clinical Sciences and Odontostomatology, Polytechnic University of Marche, Ancona, Italy
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12
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Gluten contamination in labelled gluten-free, naturally gluten-free and meals in food services in low-, middle- and high-income countries: a systematic review and meta-analysis. Br J Nutr 2022; 127:1528-1542. [PMID: 34753529 DOI: 10.1017/s0007114521002488] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The gluten-free diet is based on the consumption of foods without gluten, which aims to manage celiac disease. The concern of celiac patients is that these foods should be safe. However, gluten contamination can affect these foods. The objectives of this review and meta-analysis were first, to identify articles that detected gluten contamination in gluten-free foods using validated methods. Second, to quantify the overall prevalence of gluten contamination of naturally gluten-free foods, labelled gluten-free products, and meals prepared in food services. Third, to highlight the influence of the country's income and the period of study on this prevalence. The studies were identified in Scopus, Science Direct, Web of Science, PubMed, and Google Scholar. Forty articles were included according to PRISMA guidelines. The statistical meta-analysis was performed using MedCalc 19 software. The results show that in the gluten-free foods analysed, the overall prevalence of gluten contamination was estimated at 15.12% (95% CI: 9.56%-21.70%), with more than 20 mg/kg of gluten. Naturally gluten-free foods were significantly more contaminated than labelled gluten-free products and than meals in food services (28.32%; 9.52%; 4.66% respectively; p < 0.001). Moreover, it was noticed that oats were the most contaminated food. In addition, the prevalence of gluten contamination has significantly decreased over time. The majority of the studies were carried out in upper-middle-income and high-income countries, while only one study was conducted in lower-middle income countries. Therefore, it is necessary to implement preventive actions to reduce gluten contamination, ensuring safe gluten-free foods for celiac patients, including low-income countries.
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13
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Felber J, Bläker H, Fischbach W, Koletzko S, Laaß M, Lachmann N, Lorenz P, Lynen P, Reese I, Scherf K, Schuppan D, Schumann M, Aust D, Baas S, Beisel S, de Laffolie J, Duba E, Holtmeier W, Lange L, Loddenkemper C, Moog G, Rath T, Roeb E, Rubin D, Stein J, Török H, Zopf Y. Aktualisierte S2k-Leitlinie Zöliakie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS). ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022; 60:790-856. [PMID: 35545109 DOI: 10.1055/a-1741-5946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jörg Felber
- Medizinische Klinik II - Gastroenterologie, Hepatologie, Endokrinologie, Hämatologie und Onkologie, RoMed Klinikum Rosenheim, Rosenheim, Deutschland
| | - Hendrik Bläker
- Institut für Pathologie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland
| | | | - Sibylle Koletzko
- Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, LMU-Klinikum München, München, Deutschland.,Department of Pediatrics, Gastroenterology and Nutrition, School of Medicine Collegium Medicum University of Warmia and Mazury, 10-719 Olsztyn, Polen
| | - Martin Laaß
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | - Nils Lachmann
- Institut für Transfusionsmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Pia Lorenz
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Berlin, Deutschland
| | - Petra Lynen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Berlin, Deutschland
| | - Imke Reese
- Ernährungsberatung und -therapie Allergologie, München, Deutschland
| | - Katharina Scherf
- Institute of Applied Biosciences Department of Bioactive and Functional Food Chemistry, Karlsruhe Institute of Technology (KIT), Karlsruhe, Deutschland
| | - Detlef Schuppan
- Institut für Translationale Immunologie, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland.,Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Michael Schumann
- Medizinische Klinik I für Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Deutschland
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14
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Detection of gluten content in both naturally and labelled gluten-free products available in Morocco. J Verbrauch Lebensm 2022. [DOI: 10.1007/s00003-022-01374-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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15
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The global burden of coeliac disease: opportunities and challenges. Nat Rev Gastroenterol Hepatol 2022; 19:313-327. [PMID: 34980921 DOI: 10.1038/s41575-021-00552-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 02/06/2023]
Abstract
Coeliac disease is a systemic disorder characterized by immune-mediated enteropathy, which is caused by gluten ingestion in genetically susceptible individuals. The clinical presentation of coeliac disease is highly variable and ranges from malabsorption through solely extra-intestinal manifestations to asymptomatic. As a result, the majority of patients with coeliac disease remain undiagnosed, misdiagnosed or experience a substantial delay in diagnosis. Coeliac disease is diagnosed by a combination of serological findings of disease-related antibodies and histological evidence of villous abnormalities in duodenal biopsy samples. However, variability in histological grading and in the diagnostic performance of some commercially available serological tests remains unacceptably high and confirmatory assays are not readily available in many parts of the world. Currently, the only effective treatment for coeliac disease is a lifelong, strict, gluten-free diet. However, many barriers impede patients' adherence to this diet, including lack of widespread availability, high cost, cross-contamination and its overall restrictive nature. Routine follow-up is necessary to ensure adherence to a gluten-free diet but considerable variation is evident in follow-up protocols and the optimal disease management strategy is not clear. However, these challenges in the diagnosis and management of coeliac disease suggest opportunities for future research.
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16
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Gluten-Free Cereal Products and Beverages: A Review of Their Health Benefits in the Last Five Years. Foods 2021; 10:foods10112523. [PMID: 34828804 PMCID: PMC8618534 DOI: 10.3390/foods10112523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 01/09/2023] Open
Abstract
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.
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Verma AK, Mandal S, Tiwari A, Monachesi C, Catassi GN, Srivastava A, Gatti S, Lionetti E, Catassi C. Current Status and Perspectives on the Application of CRISPR/Cas9 Gene-Editing System to Develop a Low-Gluten, Non-Transgenic Wheat Variety. Foods 2021; 10:foods10102351. [PMID: 34681400 PMCID: PMC8534962 DOI: 10.3390/foods10102351] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/10/2021] [Accepted: 09/28/2021] [Indexed: 12/23/2022] Open
Abstract
Wheat gluten contains epitopes that trigger celiac disease (CD). A life-long strict gluten-free diet is the only treatment accepted for CD. However, very low-gluten wheat may provide an alternative treatment to CD. Conventional plant breeding methods have not been sufficient to produce celiac-safe wheat. RNA interference technology, to some extent, has succeeded in the development of safer wheat varieties. However, these varieties have multiple challenges in terms of their implementation. Clustered Regularly Interspaced Short Palindromic Repeats-associated nuclease 9 (CRISPR/Cas9) is a versatile gene-editing tool that has the ability to edit immunogenic gluten genes. So far, only a few studies have applied CRISPR/Cas9 to modify the wheat genome. In this article, we reviewed the published literature that applied CRISPR/Cas9 in wheat genome editing to investigate the current status of the CRISPR/Cas9 system to produce a low-immunogenic wheat variety. We found that in recent years, the CRISPR/Cas9 system has been continuously improved to edit the complex hexaploid wheat genome. Although some reduced immunogenic wheat varieties have been reported, CRISPR/Cas9 has still not been fully explored in terms of editing the wheat genome. We conclude that further studies are required to apply the CRISPR/Cas9 gene-editing system efficiently for the development of a celiac-safe wheat variety and to establish it as a "tool to celiac safe wheat".
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Affiliation(s)
- Anil K. Verma
- Celiac Disease Research Laboratory, Polytechnic University of Marche, 60123 Ancona, Italy;
- Correspondence: or ; Tel.: +39-0715962834
| | - Sayanti Mandal
- Institute of Bioinformatics and Biotechnology, Savitribai Phule Pune University, Ganeshkhind Road, Pune 411007, Maharashtra, India;
| | - Aadhya Tiwari
- Department of System Biology, MD Anderson Cancer Center, Houston, TX 77030, USA;
- Laboratory of Cell Biology, Department of Orthopaedic Surgery, University Hospital of Tübingen, Waldhörnlestraße 22, D-72072 Tübingen, Germany
| | - Chiara Monachesi
- Celiac Disease Research Laboratory, Polytechnic University of Marche, 60123 Ancona, Italy;
| | - Giulia N. Catassi
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, 60123 Ancona, Italy; (G.N.C.); (S.G.); (E.L.); (C.C.)
| | - Akash Srivastava
- Department of Molecular Biology, Cell Biology and Biochemistry, Brown University, Providence, RI 02906, USA;
| | - Simona Gatti
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, 60123 Ancona, Italy; (G.N.C.); (S.G.); (E.L.); (C.C.)
| | - Elena Lionetti
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, 60123 Ancona, Italy; (G.N.C.); (S.G.); (E.L.); (C.C.)
| | - Carlo Catassi
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, 60123 Ancona, Italy; (G.N.C.); (S.G.); (E.L.); (C.C.)
- Mucosal Immunology and Biology Research Center, Division of Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital, Boston, MA 02114, USA
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18
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Sajid Mushtaq B, Zhang W, Al-Ansi W, Ul Haq F, Rehman A, Omer R, Mahmood Khan I, Niazi S, Ahmad A, Ali Mahdi A, Al-Maqtari QA, Walayat N, Wang L. A Critical Review on the Development, Physicochemical Variations and Technical Concerns of Gluten Free Extrudates in Food Systems. FOOD REVIEWS INTERNATIONAL 2021. [DOI: 10.1080/87559129.2021.1976793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Bilal Sajid Mushtaq
- School of Food Science and Technology, State Key Laboratory of Food Science and Technology, National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, China
| | - Wenhui Zhang
- Institute of Food Science, Tibet Academy of Agriculture and Animal Husbandry Sciences, Lhasa, Tibet, China
| | - Waleed Al-Ansi
- School of Food Science and Technology, State Key Laboratory of Food Science and Technology, National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, China
| | - Faizan Ul Haq
- School of Food Science and Technology, State Key Laboratory of Food Science and Technology, National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, China
| | - Abdur Rehman
- School of Food Science and Technology, State Key Laboratory of Food Science and Technology, National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, China
| | - Rabia Omer
- State Key Laboratory of Bioreactor Engineering, East China University of Science and Technology, Shanghai, China
| | - Imran Mahmood Khan
- School of Food Science and Technology, State Key Laboratory of Food Science and Technology, National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, China
| | - Sobia Niazi
- School of Food Science and Technology, State Key Laboratory of Food Science and Technology, National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, China
| | - Aqsa Ahmad
- School of Biotechnology, Jiangnan University, Wuxi, China
| | - Amer Ali Mahdi
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang, China
| | - Qais Ali Al-Maqtari
- School of Food Science and Technology, State Key Laboratory of Food Science and Technology, National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, China
| | - Noman Walayat
- Department of Food Science and Engineering, College of Ocean, Zhejiang University of Technology, Hangzhou, China
| | - Li Wang
- School of Food Science and Technology, State Key Laboratory of Food Science and Technology, National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, China
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19
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Food Safety and Cross-Contamination of Gluten-Free Products: A Narrative Review. Nutrients 2021; 13:nu13072244. [PMID: 34210037 PMCID: PMC8308338 DOI: 10.3390/nu13072244] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/23/2021] [Accepted: 06/26/2021] [Indexed: 02/06/2023] Open
Abstract
A gluten-free diet (GFD) is currently the only effective treatment for celiac disease (CD); an individual’s daily intake of gluten should not exceed 10 mg. However, it is difficult to maintain a strict oral diet for life and at least one-third of patients with CD are exposed to gluten, despite their best efforts at dietary modifications. It has been demonstrated that both natural and certified gluten-free foods can be heavily contaminated with gluten well above the commonly accepted threshold of 20 mg/kg. Moreover, meals from food services such as restaurants, workplaces, and schools remain a significant risk for inadvertent gluten exposure. Other possible sources of gluten are non-certified oat products, numerous composite foods, medications, and cosmetics that unexpectedly contain “hidden” vital gluten, a proteinaceous by-product of wheat starch production. A number of immunochemical assays are commercially available worldwide to detect gluten. Each method has specific features, such as format, sample extraction buffers, extraction time and temperature, characteristics of the antibodies, recognition epitope, and the reference material used for calibration. Due to these differences and a lack of official reference material, the results of gluten quantitation may deviate systematically. In conclusion, incorrect gluten quantitation, improper product labeling, and poor consumer awareness, which results in the inadvertent intake of relatively high amounts of gluten, can be factors that compromise the health of patients with CD.
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Calderón de la Barca AM, Luna-Alcocer V, Valenzuela-Miranda JR, Mejía-León ME. Gluten-Free Labeling Is Misused Frequently in Foods Marketed in Northwestern Mexico. Front Nutr 2021; 8:687843. [PMID: 34249997 PMCID: PMC8267002 DOI: 10.3389/fnut.2021.687843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/21/2021] [Indexed: 01/12/2023] Open
Abstract
Background: Patients with celiac disease (CD) require a gluten-free (GF) diet, including industrialized products containing ≤ 20 mg gluten/kg. The market status of GF food products is almost unknown in Mexico. Therefore, we studied the GF-labeled products on the northwestern Mexican market and analyzed their gluten content. Methods: We searched for GF type of foods in three different supermarkets of each chain in Mexicali Baja California and Hermosillo Sonora and corroborated the price, origin, and GF certification of each item using internet sites. We quantified the gluten in the foods using the sandwich R5-enzyme-linked immunosorbent assay (ELISA) and detected their immune-reactivity for IgA from patients with CD. Results: The study included >263 different GF-labeled foodstuffs, and 55% of them were made in Mexico. The Mexican items were principally flours, sausages, bread and bakery, milk-type products, and tortillas, while pasta, snacks, and breakfast cereals were mainly imported. The cost ratio of GF products to the conventional mean was 3.5, ranging principally from 1 to 13. The most common GF-labeled foods were flours and pasta (34), cookies and snacks (32), breakfast cereals, sausages, and milk-type products (18-20). Although 36% of the products were certified, 17.4% of the analyzed samples contained >20 mg gluten/kg, mainly the non-certified ones and those made in Mexico. IgA from patients with CD reacted in vitro against gluten proteins from the contaminated GF-labeled products. Conclusion: The accessibility of GF products in the northwestern Mexican market is wide; however, such products are expensive, and some could be risky for patients with CD because they contain gluten, which is recognized by the immune systems of these patients.
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Affiliation(s)
- Ana M Calderón de la Barca
- Depto. Nutrición y Metabolismo, Centro de Investigación en Alimentación y Desarrollo, A.C. Hermosillo, Sonora, Mexico
| | - Valeria Luna-Alcocer
- Depto. Nutrición y Metabolismo, Centro de Investigación en Alimentación y Desarrollo, A.C. Hermosillo, Sonora, Mexico
| | - José R Valenzuela-Miranda
- Depto. Nutrición y Metabolismo, Centro de Investigación en Alimentación y Desarrollo, A.C. Hermosillo, Sonora, Mexico
| | - Maria E Mejía-León
- Facultad de Medicina Mexicali, Universidad Autónoma de Baja California, Mexicali, Mexico
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21
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Aneja A, Lal SB, Sharma AK, Rawat A, Singh S. Clinical Characteristics of Children With Celiac Disease Not Responding to Hepatitis B Vaccination in India. JPGN REPORTS 2021; 2:e046. [PMID: 37206938 PMCID: PMC10191543 DOI: 10.1097/pg9.0000000000000046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/15/2020] [Indexed: 05/21/2023]
Abstract
The immunological response to hepatitis B virus (HBV) vaccine may be suboptimal in children with celiac disease (CD), but the reasons for this are not well defined. Objectives This study was undertaken to assess the immune response to HBV vaccine in CD children and to explore the possible factors affecting the immune response. Methods The study population consisted of 3 groups-50 newly diagnosed CD children (group 1), 50 previously diagnosed CD children who were on gluten free diet (GFD) >3 months (group 2), and 100 age and gender matched healthy controls (group 3). The patient characteristics were recorded, and the blood samples were analyzed for HBsAg and anti-HBs titers. The nonresponders were given a booster dose of HBV vaccine and reevaluated after 6 weeks. Results Positive anti-HBs response was found in 46% in newly diagnosed CD children, 60% in CD children on GFD, and 83% in healthy controls (P < 0.001). The immune response to HBV vaccine in CD children was inferior to that in healthy children (53% vs 83%, P < 0.001). The immune response was found to be significantly affected by age at diagnosis, delay in diagnosis, type of presentation, and compliance to GFD. 44 out of 45 (97.77%) nonresponders from CD group seroconverted after a single booster dose. Conclusion Early diagnosis and good compliance to GFD may improve the immune response to HBV vaccine in CD children. Single additional booster dose is sufficient to attain optimal immune response.
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Affiliation(s)
- Aradhana Aneja
- From the Division of Paediatric Gastroenterology, Hepatology & Nutrition
| | - Sadhna B. Lal
- From the Division of Paediatric Gastroenterology, Hepatology & Nutrition
| | | | - Amit Rawat
- Division of Paediatric Immunology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Surjit Singh
- Division of Paediatric Immunology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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22
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Gluten content in labeled and unlabeled gluten-free food products used by patients with celiac disease. Eur J Clin Nutr 2021; 75:1245-1253. [PMID: 33462461 DOI: 10.1038/s41430-020-00854-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/12/2020] [Accepted: 12/17/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Gluten-free (GF) diet is the only reliable treatment for patients with celiac disease (CeD), but data on the extent of gluten contamination in GF food available in India is scanty. We evaluated gluten content in labeled, imported, and non-labeled GF food products currently available in the Indian market. METHODS Overall, 794 processed and commercially available packaged GF products (labeled GF (n = 360), imported GF (n = 80), and non-labeled/naturally GF (n = 354)) were collected from supermarkets of National Capital Region of India. Those unavailable in stores were purchased from e-commerce sites or directly from the manufacturers. Gluten level in them was determined by Ridascreen Gliadin sandwich R5 enzyme-linked immunosorbent assay (R-Biopharm AG, Germany). As per Codex Alimentarius and Food Safety and Standard Authority of India, "gluten free" labeled products must not contain > 20 mg/kg of gluten. RESULTS Overall, 10.1% of 794 GF products including 38 (10.8%) of 360 labeled and 42 (11.8%) of 354 non-labeled/naturally GF food products had gluten content > 20 mg/kg (range: 24.43-355 and 23.2-463.8 mg/kg, respectively). None of the imported GF products had gluten more than the recommended limits. Contaminated products most commonly belonged to cereal and their products (flours, coarse grains, pasta/macaroni, snack foods) pulse flours, spices, and bakery items. CONCLUSIONS A substantial proportion (10.1%) of GF food products (both labeled and non-labeled) available in India have gluten content greater than the prescribed limits of <20 mg/kg. Physicians, dietitians, support group, and patients with CeD should be made aware of this fact and regulatory bodies should ensure quality assurance.
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Quantification of Accidental Gluten Contamination in the Diet of Children with Treated Celiac Disease. Nutrients 2021; 13:nu13010190. [PMID: 33435453 PMCID: PMC7827942 DOI: 10.3390/nu13010190] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 12/31/2020] [Accepted: 01/07/2021] [Indexed: 11/16/2022] Open
Abstract
A strict gluten-free diet is extremely difficult to maintain. Protracted ingestion of gluten traces (>10 mg/day) is sufficient to cause significant damage in the architecture of the small intestinal mucosa in patients on treatment for celiac disease. The aim of this study was to directly measure the level of contaminating gluten in the daily diet of celiac children following a gluten-free diet. From April 2019 to December 2019, celiac disease children (2-18 years old) on a gluten-free diet for ≥6 months were offered to participate in this prospective-observational study. Patients and their caregivers were invited to provide a representative portion (about 10 g) of all meals consumed during a 24-h period. Participants were requested to weigh all ingested food and report items in a 24-h food diary. The gluten content was quantified by the R5 sandwich enzyme-linked immunosorbent assay method. Sixty-nine children completed the protocol. Overall, 12/448 (2.7%) food samples contained detectable amounts of gluten; of them, 11 contained 5-20 ppm and 1 >20 ppm. The 12 contaminated food samples belonged to 5/69 enrolled patients. In these 5 children, the daily gluten intake was well below the safety threshold of 10 mg/day. The present findings suggest that in a country characterized by high celiac disease awareness, the daily unintended exposure to gluten of treated celiac children on regular follow-up is very low; reassuringly, the presence of gluten traces did not lead to exceed the tolerable threshold of 10 mg/day of gluten intake in the gluten-free diet.
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Analyzing Gluten Content in Various Food Products Using Different Types of ELISA Test Kits. Foods 2021; 10:foods10010108. [PMID: 33419186 PMCID: PMC7825509 DOI: 10.3390/foods10010108] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/24/2020] [Accepted: 12/26/2020] [Indexed: 11/17/2022] Open
Abstract
Gluten is an insoluble protein produced when glutelins and prolamins, which are found in grains such as wheat, barley, and oats, combine to form an elastic thin film. This dietary gluten can cause severe contraction of the intestinal mucous membrane in some people, preventing nutrient absorption. This condition, called celiac disease (CD), affects approximately 1% of the world's population. The only current treatment for patients with CD and similar diseases is lifelong avoidance of gluten. To analyze the gluten content in food, various enzyme-linked immunosorbent assay (ELISA) tests are currently used. In this study, the gluten content in various food products was analyzed using different kinds of ELISA test kits. For gluten-free food, three different ELISA test kits mostly yielded values below the limit of detection. However, gluten was detected at 24.0-40.2 g/kg in bread, 6.5-72.6 g/kg in noodles, and 23.0-86.9 g/kg in different powder food samples. A significant difference (p < 0.05) in gluten content was observed for these gluten-containing food products. Reproducibility issues suggest that it is necessary to use several ELISA kits for the accurate detection and quantification of gluten in various food products rather than using one ELISA kit.
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Kosendiak A, Stanikowski P, Domagała D, Gustaw W. Gluten-Free Diet in Prisons in Poland: Nutrient Contents and Implementation of Dietary Reference Intake Standards. Nutrients 2020; 12:E2829. [PMID: 32947787 PMCID: PMC7551281 DOI: 10.3390/nu12092829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/11/2020] [Accepted: 09/12/2020] [Indexed: 12/16/2022] Open
Abstract
The gluten-free diet (GFD) requires special attention from nutritionists due to the potential risk of nutrient deficiencies in its users. This risk may be greater when this type of nutrition is implemented in prisons due to the limited possibilities of external control, a low catering budget for meals, and insufficiently defined recommendations regulating nutrition for prisoners. The aim of the present study was to assess the nutritional value of GFD and regular diet meals served in some Polish prisons and to compare the values to the dietary reference intake (DRI) standards. Using a specialized computer program, 7-day menus of both types of diet provided in 10 prisons were analyzed. The percentage coverage of the DRI was calculated based on the recommendations of the Polish National Food and Nutrition Institute. GFD was characterized by lower average contents of energy and 11 out of 14 essential nutrients, i.e., protein, carbohydrates, dietary fiber, starch, ash, sodium, calcium, iron, zinc, folate, and vitamin B12. The average content of phosphorus, niacin, and riboflavin in the gluten-free diet was higher than that in the regular diet. It was shown that the meals in GFD and the regular diet did not provide the recommended amounts of calcium (38 and 44% DRI, respectively), vitamin D (29 and 30% DRI), vitamin C (86 and 76% DRI), and folate (51 and 56% DRI). In turn, the supply of sodium, phosphorus, copper, and vitamins A and B6 substantially exceeded the recommended levels. The results indicate a need for greater quality control of GFD meals served in catering facilities. It is also necessary to develop legal provisions that will regulate more specifically the nutrition for prisoners in terms of an adequate supply of minerals and vitamins.
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Affiliation(s)
- Aureliusz Kosendiak
- Study of Physical Education and Sport, Wroclaw Medical University, 51-601 Wroclaw, Poland;
| | - Piotr Stanikowski
- Department of Plant Food Technology and Gastronomy, Faculty of Food Science and Biotechnology, University of Life Sciences in Lublin, 20-704 Lublin, Poland;
| | - Dorota Domagała
- Department of Applied Mathematics and Computer Science, Faculty of Production Engineering, University of Life Sciences in Lublin, 20-612 Lublin, Poland;
| | - Waldemar Gustaw
- Department of Plant Food Technology and Gastronomy, Faculty of Food Science and Biotechnology, University of Life Sciences in Lublin, 20-704 Lublin, Poland;
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Atasoy G, Ulutas B, Turhan M. Potential ways for gluten contamination of gluten-free grain and gluten-free foods: the buckwheat case. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2020; 37:1591-1600. [PMID: 32805193 DOI: 10.1080/19440049.2020.1787529] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Buckwheat has been reported to be responsible for gluten contamination in manufactured gluten-free foods (mGFFs) although it is inherently gluten-free (GF). It could happen through buckwheat grains contacting gluten-containing (GC) grains and surfaces contacted by GC grains during pre-manufacturing practices. To simulate grain contact, whole and broken GC grains (wheat, rye, barley, and oat) were mixed into buckwheat grains at the ratio of 2.5-10.0%. Grains were agitated in vessels with inner surfaces covered with buckwheat grain. Gluten was not detected in buckwheat grains contacting whole GC grains at all mixing ratios. It was not detected in the case of broken GC grains at the mixing ratio of 2.5% and oat grains at all mixing ratios. Gluten concentration increased with the increasing mixing ratio and the natural gluten concentration of broken GC grains. To simulate surface contact, GC grains were first agitated in galvanised steel vessels and then buckwheat grains were agitated together under the same conditions. Gluten was detected on galvanised steel surfaces contacted by whole and broken GC grains. It was not detected in buckwheat grains contacting the surfaces contaminated by whole GC grains. Gluten was detected in buckwheat grain in the case of the broken GC grains except for oats. Gluten concentrations increased with increasing natural gluten concentration of GC grains. Contamination of mGFFs could be linked to potential contact with buckwheat grain. This contamination issue could be resolved through regulations mandating the proof of being GF for ingredients used in the production of mGFFs.
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Affiliation(s)
- Guler Atasoy
- Department of Food Engineering, University of Mersin , Mersin, Turkey
| | - Bilge Ulutas
- Department of Food Engineering, University of Mersin , Mersin, Turkey
| | - Mahir Turhan
- Department of Food Engineering, University of Mersin , Mersin, Turkey
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Osorio CE, Wen N, Mejías JH, Mitchell S, von Wettstein D, Rustgi S. Directed-Mutagenesis of Flavobacterium meningosepticum Prolyl-Oligopeptidase and a Glutamine-Specific Endopeptidase From Barley. Front Nutr 2020; 7:11. [PMID: 32133368 PMCID: PMC7040222 DOI: 10.3389/fnut.2020.00011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/28/2020] [Indexed: 12/12/2022] Open
Abstract
Wheat gluten proteins are the known cause of celiac disease. The repetitive tracts of proline and glutamine residues in these proteins make them exceptionally resilient to digestion in the gastrointestinal tract. These indigested peptides trigger immune reactions in susceptible individuals, which could be either an allergic reaction or celiac disease. Gluten exclusion diet is the only approved remedy for such disorders. Recently, a combination of a glutamine specific endoprotease from barley (EP-B2), and a prolyl endopeptidase from Flavobacterium meningosepticum (Fm-PEP), when expressed in the wheat endosperm, were shown to reasonably detoxify immunogenic gluten peptides under simulated gastrointestinal conditions. However useful, these "glutenases" are limited in application due to their denaturation at high temperatures, which most of the food processes require. Variants of these enzymes from thermophilic organisms exist, but cannot be applied directly due to their optimum activity at temperatures higher than 37°C. Though, these enzymes can serve as a reference to guide the evolution of peptidases of mesophilic origin toward thermostability. Therefore, a sequence guided site-saturation mutagenesis approach was used here to introduce mutations in the genes encoding Fm-PEP and EP-B2. A thermostable variant of Fm-PEP capable of surviving temperatures up to 90°C and EP-B2 variant with a thermostability of up 60°C were identified using this approach. However, the level of thermostability achieved is not sufficient; the present study has provided evidence that the thermostability of glutenases can be improved. And this pilot study has paved the way for more detailed structural studies in the future to obtain variants of Fm-PEP and EP-B2 that can survive temperatures ~100°C to allow their packing in grains and use of such grains in the food industry.
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Affiliation(s)
- Claudia E. Osorio
- Department of Crop and Soil Sciences, Washington State University, Pullman, WA, United States
- Agriaquaculture Nutritional Genomic Center, Temuco, Chile
| | - Nuan Wen
- Department of Crop and Soil Sciences, Washington State University, Pullman, WA, United States
| | - Jaime H. Mejías
- Centro Regional de Investigación Carillanca, Instituto de Investigaciones Agropecuarias INIA, Temuco, Chile
| | - Shannon Mitchell
- Department of Biological Systems Engineering, Washington State University, Pullman, WA, United States
| | - Diter von Wettstein
- Department of Crop and Soil Sciences, Washington State University, Pullman, WA, United States
| | - Sachin Rustgi
- Department of Crop and Soil Sciences, Washington State University, Pullman, WA, United States
- Department of Plant and Environmental Sciences, Clemson University Pee Dee Research and Education Center, Florence, SC, United States
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Raju N, Joshi AKR, Vahini R, Deepika T, Bhaskarachari K, Devindra S. Gluten contamination in labelled and naturally gluten-free grain products in southern India. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2020; 37:531-538. [PMID: 32011974 DOI: 10.1080/19440049.2020.1711970] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Consumption of a gluten-free diet or avoiding exposure to gluten is the only feasible and effective treatment available for coeliac patients to date. Although many grains and their products are naturally gluten-free, the possibility of gluten cross-contamination must be considered. Since such data are not available for Indian markets, we carried out this pilot study (n = 160) to assess gluten contamination in various grain-based food products from the category of breakfast products, flours, and batters made from grain that are naturally gluten free. The gluten was extracted from samples using 60% ethanol and gluten analysis was carried out using a commercially available competitive ELISA, which utilises a monoclonal antibody. Nearly 9.8% of the products labelled as gluten-free and 36.7% of the products made from naturally gluten-free grain were found to contain gluten above 20 mg/kg. Among products made from naturally gluten-free grain, 35.9% of the flour samples and 85% of the oat samples (11.67-1830 mg/kg) were contaminated with gluten. In the case of flours, unbranded samples collected from local markets (70%) and directly from local mills (30%) showed gluten content above Codex safety levels (20-400 mg/kg). Among products labelled as gluten free (n = 51), only 5 samples showed gluten contamination above 20 mg/kg although levels were well within 100 mg/kg (32.5 ± 5.8). Our study suggests that there is a likelihood of gluten contamination in products that are sourced from local retailers and millers.
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Affiliation(s)
- Nagaraju Raju
- Department of Dietetics, National Institute of Nutrition (ICMR), Hyderabad, India
| | - Apurva Kumar R Joshi
- Department of Dietetics, National Institute of Nutrition (ICMR), Hyderabad, India
| | - Raidu Vahini
- Department of Dietetics, National Institute of Nutrition (ICMR), Hyderabad, India
| | - Thappatla Deepika
- Department of Dietetics, National Institute of Nutrition (ICMR), Hyderabad, India
| | | | - S Devindra
- Department of Dietetics, National Institute of Nutrition (ICMR), Hyderabad, India
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Atasoy G, Kurt Gokhisar O, Turhan M. Gluten contamination in manufactured gluten-free foods in Turkey. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2019; 37:363-373. [PMID: 31825749 DOI: 10.1080/19440049.2019.1696021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Gluten contamination in manufactured gluten-free foods (mGFFs) is a major health, well-being and economic issue worldwide for both mandatory and voluntary GFF-consumers. Although scarce, a number of surveys have shown that up to 21.5 % of mGFFs in circulation in the market are contaminated with gluten. However, at the present time there is no published work reporting gluten contamination in mGFFs produced in Turkey. In this paper miscellaneous mGFFs produced in Turkey were analysed for gluten concentration (G) to fill this knowledge gap, and to compare the situation in Turkey with worldwide efforts on this issue. A total of 200 mGFFs from 8 product categories (snack, pasta, bread, cookie, cracker, farina, traditional and others), and manufactured using 7 main ingredients (cereal mixture, buckwheat, corn, rice, locust bean, potato, and others) were analysed. A significant portion of mGFFs (17.5 %) were contaminated with gluten and therefore unacceptable as being GFF. The results point to buckwheat as the main cause of this contamination. If buckwheat is excluded, the ratio of unacceptable mGFFs dramatically decreases to 6.3 % and probably to 1.8 %, which are comparable figures to those reported for other countries. Almost all countries are subjected to the same regulations on GFFs, and the problem of gluten contamination could readily be solved to a great extent if pre-market measures are mandated. Enforcing mGFF-producers to screen their raw materials and final products to detect the presence of gluten, and preventing the release of contaminated mGFFs into the market would be a practical measure in favour of all stakeholders involved in GFF-consumption.
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Affiliation(s)
- Guler Atasoy
- Department of Food Engineering, University of Mersin, Mersin, Turkey
| | | | - Mahir Turhan
- Department of Food Engineering, University of Mersin, Mersin, Turkey
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Osorio CE, Mejías JH, Rustgi S. Gluten Detection Methods and Their Critical Role in Assuring Safe Diets for Celiac Patients. Nutrients 2019; 11:E2920. [PMID: 31810336 PMCID: PMC6949940 DOI: 10.3390/nu11122920] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 11/20/2019] [Accepted: 11/26/2019] [Indexed: 12/16/2022] Open
Abstract
Celiac disease, wheat sensitivity, and allergy represent three different reactions, which may occur in genetically predisposed individuals on the ingestion of wheat and derived products with various manifestations. Improvements in the disease diagnostics and understanding of disease etiology unveiled that these disorders are widespread around the globe affecting about 7% of the population. The only known treatment so far is a life-long gluten-free diet, which is almost impossible to follow because of the contamination of allegedly "gluten-free" products. Accidental contamination of inherently gluten-free products could take place at any level from field to shelf because of the ubiquity of these proteins/grains. Gluten contamination of allegedly "gluten-free" products is a constant threat to celiac patients and a major health concern. Several detection procedures have been proposed to determine the level of contamination in products for celiac patients. The present article aims to review the advantages and disadvantages of different gluten detection methods, with emphasis on the recent technology that allows identification of the immunogenic-gluten peptides without the use of antibodies. The possibility to detect gluten contamination by different approaches with similar or better detection efficiency in different raw and processed foods will guarantee the safety of the foods for celiac patients.
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Affiliation(s)
- Claudia E. Osorio
- Agriaquaculture Nutritional Genomic Center, CGNA, Las Heras 350, Temuco 4781158, Chile
| | - Jaime H. Mejías
- Centro Regional de Investigación Carillanca, Instituto de Investigaciones Agropecuarias INIA, Temuco 4880000, Chile
| | - Sachin Rustgi
- Department of Crop and Soil Sciences, Washington State University, Pullman, WA 99164, USA
- Department of Plant and Environmental Sciences, School of Health Research, Clemson University Pee Dee Research and Education Center, Florence, SC 29506, USA
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Farage P, Zandonadi RP, Gandolfi L, Pratesi R, Falcomer AL, Araújo LS, Nakano EY, Ginani VC. Accidental Gluten Contamination in Traditional Lunch Meals from Food Services in Brasilia, Brazil. Nutrients 2019; 11:nu11081924. [PMID: 31426287 PMCID: PMC6723046 DOI: 10.3390/nu11081924] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 01/04/2023] Open
Abstract
This study aimed to evaluate the occurrence of gluten contamination in naturally gluten-free meals from food services in the Federal District, Brazil. This is an exploratory cross-sectional quantitative study in which a total of 180 samples of naturally gluten-free dishes were collected from 60 food services in Brazil. The enzyme-linked immunosorbent assay was used for the quantification of gluten. As established by the Codex Alimentarius, the threshold of 20 ppm of gluten was considered as the accepted upper gluten level for gluten-free food. A total of 2.8% (95% CI: 0.3-5.2%) gluten contamination was found in the samples. Among the 60 food services, 6.7% (95% CI: 2.7-10.6%) displayed at least one contaminated food in our sample. The occurrence of gluten contamination in naturally gluten-free preparations was uncommon and low on a quantitative basis.
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Affiliation(s)
- Priscila Farage
- Faculty of Nutrition, Federal University of Goiás (UFG), Campus Colemar Natal e Silva, Rua 227 qd.68 s/n, Setor Leste Universitário, Goiânia 74605-080, Brazil.
| | - Renata Puppin Zandonadi
- Department of Nutrition, Faculty of Health Sciences, University of Brasilia (UnB), Campus Darcy Ribeiro, Asa Norte, Brasilia 70910-900, Brazil.
| | - Lenora Gandolfi
- Faculty of Medicine, University of Brasilia (UnB), Campus Darcy Ribeiro, Asa Norte, Brasilia 70910-900, Brazil
| | - Riccardo Pratesi
- Faculty of Medicine, University of Brasilia (UnB), Campus Darcy Ribeiro, Asa Norte, Brasilia 70910-900, Brazil
| | - Ana Luísa Falcomer
- Department of Nutrition, Faculty of Health Sciences, University of Brasilia (UnB), Campus Darcy Ribeiro, Asa Norte, Brasilia 70910-900, Brazil
| | - Letícia Santos Araújo
- Department of Nutrition, Faculty of Health Sciences, University of Brasilia (UnB), Campus Darcy Ribeiro, Asa Norte, Brasilia 70910-900, Brazil
| | - Eduardo Yoshio Nakano
- Department of Statistics, Central Institute of Sciences, University of Brasilia (UnB), Campus Darcy Ribeiro, Asa Norte, Brasilia 70910-900, Brazil
| | - Verônica Cortez Ginani
- Department of Nutrition, Faculty of Health Sciences, University of Brasilia (UnB), Campus Darcy Ribeiro, Asa Norte, Brasilia 70910-900, Brazil
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Food Neophobia in Celiac Disease and Other Gluten-Free Diet Individuals. Nutrients 2019; 11:nu11081762. [PMID: 31370243 PMCID: PMC6722680 DOI: 10.3390/nu11081762] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/24/2019] [Accepted: 07/29/2019] [Indexed: 12/21/2022] Open
Abstract
The only treatment currently available to combat celiac disease (CD) is strict adherence to a gluten-free diet (GFD), but there may be various determinants of its adherence, including food neophobia (FN), that is associated with sensory aversions, or fears of negative consequences of eating specific food products, that may be crucial for CD patients following a GFD. The aim of the present study was to analyze food neophobia levels and its determinants in CD patients in comparison with other individuals who follow a GFD based on their own decision. The study was conducted in two independent groups of individuals following a GFD: those diagnosed with CD (n = 101) and those following a GFD based on their own decision (n = 124). Each group was recruited with cooperation from the local CD and GFD societies located in Poland. The FN was assessed using the Food Neophobia Scale (FNS) and compared between groups, as well as the influence of gender, age, body mass index, educational level, place of residence and employment status was assessed. It was stated, that for the individuals following a GFD, CD was the major determinant of FN. The FNS score values were higher (indicating higher food neophobia) for CD individuals (39.4 ± 9.2), than for those following a GFD based on their own decision (33.6 ± 8.7; p < 0.0001) and it was observed both for general group and for sub-groups stratified by assessed variables. Moreover, the indicated variables did not influence the FNS in any of the analyzed groups. The influence of CD with no influence of other variables was confirmed in the regression analysis. It may be concluded that CD is a major contributor to FN, which can be attributed to fear of developing adverse reactions to gluten-contaminated food products, which is more pronounced in CD patients compared to non-CD patients following a GFD based on their own decision.
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Pei J, Wei S, Pei Y, Wu H, Wang D. Role of Dietary Gluten in Development of Celiac Disease and Type I Diabetes: Management Beyond Gluten-Free Diet. Curr Med Chem 2019; 27:3555-3576. [PMID: 30963964 DOI: 10.2174/0929867326666190409120716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 03/25/2019] [Accepted: 04/03/2019] [Indexed: 11/22/2022]
Abstract
Gluten triggers Celiac Disease (CD) and type I diabetes in genetically predisposed population of human leukocyte antigen DQ2/DQ8+ and associates with disorders such as schizophrenia and autism. Application of a strict gluten-free diet is the only well-established treatment for patients with CD, whereas the treatment for patients with celiac type I diabetes may be depend on the timing and frequency of the diet. The application of a gluten-free diet in patients with CD may contribute to the development of metabolic syndrome and nonalcoholic fatty liver disease and may also lead to a high glycemic index, low fiber diet and micronutrient deficiencies. The alteration of copper bioavailability (deficient, excess or aberrant coordination) may contribute to the onset and progress of related pathologies. Therefore, nutrient intake of patients on a gluten-free diet should be the focus of future researches. Other gluten-based therapies have been rising with interest such as enzymatic pretreatment of gluten, oral enzyme supplements to digest dietary gluten, gluten removal by breeding wheat varieties with reduced or deleted gluten toxicity, the development of polymeric binders to suppress gluten induced pathology.
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Affiliation(s)
- Jinli Pei
- Hainan Province Key Laboratory for Sustainable Utilization of Tropical Bioresources, Hainan University, Hainan, 570228, China.,Laboratory of Biotechnology and Molecular Pharmacology, School of Life and Pharmaceutical Sciences, Hainan University, Hainan 570228, China
| | - Shuangshuang Wei
- Hainan Province Key Laboratory for Sustainable Utilization of Tropical Bioresources, Hainan University, Hainan, 570228, China.,Laboratory of Biotechnology and Molecular Pharmacology, School of Life and Pharmaceutical Sciences, Hainan University, Hainan 570228, China
| | - Yechun Pei
- Hainan Province Key Laboratory for Sustainable Utilization of Tropical Bioresources, Hainan University, Hainan, 570228, China.,Laboratory of Biotechnology and Molecular Pharmacology, School of Life and Pharmaceutical Sciences, Hainan University, Hainan 570228, China
| | - Hao Wu
- Hainan Province Key Laboratory for Sustainable Utilization of Tropical Bioresources, Hainan University, Hainan, 570228, China.,Laboratory of Biotechnology and Molecular Pharmacology, School of Life and Pharmaceutical Sciences, Hainan University, Hainan 570228, China
| | - Dayong Wang
- Hainan Province Key Laboratory for Sustainable Utilization of Tropical Bioresources, Hainan University, Hainan, 570228, China.,Laboratory of Biotechnology and Molecular Pharmacology, School of Life and Pharmaceutical Sciences, Hainan University, Hainan 570228, China
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Szakács Z, Csiszár B, Kenyeres P, Sarlós P, Erőss B, Hussain A, Nagy Á, Kőszegi B, Veczák I, Farkas N, Bódis E, Márta K, Szentesi A, Tőkés-Füzesi M, Berki T, Vincze Á, Tóth K, Hegyi P, Bajor J. Haemorheological and haemostatic alterations in coeliac disease and inflammatory bowel disease in comparison with non-coeliac, non-IBD subjects (HERMES): a case-control study protocol. BMJ Open 2019; 9:e026315. [PMID: 30904871 PMCID: PMC6475350 DOI: 10.1136/bmjopen-2018-026315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Haemorheological and haemostatic changes predispose to the development of arterial and venous thrombotic events; however, limited information is available on the status of these changes in coeliac disease (CeD) and inflammatory bowel disease (IBD). In this study, we aim to describe the haemorheological and haemostatic profiles of CeD and IBD patients in a Hungarian cohort of patients to investigate whether any alterations contribute to elevated thrombotic risk. METHODS AND ANALYSIS This is a case-control study involving newly diagnosed and followed CeD and IBD patients with age-matched and sex-matched non-CeD, non-IBD subjects with an allocation ratio of 1:1:1.After informed consent is obtained, a detailed medical history will be collected, including venous and arterial thrombotic risk factors and medications. Symptoms in CeD patients will be assessed with the Gastrointestinal Symptoms Rating Scale, and disease activity in IBD patients will be determined by disease-specific scores. Dietary adherence will be assessed among CeD patients with a thorough interview together with a measurement of self-reported adherence, dietary knowledge and urine analysis (detection of gluten immunogenic peptides). In addition to routine laboratory parameters, haemorheological (ie, erythrocyte deformability and aggregation, viscosity of whole blood and plasma) and haemostatic parameters (eg, protein C, protein S and antithrombin) with immunological indicators (ie, coeliac-specific serology and antiphospholipid antibodies) will be measured from venous blood for every participant.Primary and secondary outcomes will be haemorheological and haemostatic parameters, respectively. Univariate and multivariate statistics will be used to compare CeD and IBD patients to control subjects. Subgroup analysis will be performed by disease type in IBD, (Crohn's disease and ulcerose colitis), dietary adherence in CeD, and disease activity in IBD and CeD. ETHICS AND DISSEMINATION The study was approved by the Regional and Local Research Ethics Committee, University of Pécs (Ref. No. 6917). Findings will be disseminated at research conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN49677481.
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Affiliation(s)
- Zsolt Szakács
- János Szentágothai Research Center, University of Pécs, Pécs, Hungary
- Clinical Medicine Doctoral School, University of Szeged, Szeged, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Beáta Csiszár
- János Szentágothai Research Center, University of Pécs, Pécs, Hungary
- Division of Cardiology and Angiology, First Department of Medicine, University of Pécs, Pécs, Hungary
| | - Péter Kenyeres
- János Szentágothai Research Center, University of Pécs, Pécs, Hungary
- Division of Cardiology and Angiology, First Department of Medicine, University of Pécs, Pécs, Hungary
| | - Patrícia Sarlós
- János Szentágothai Research Center, University of Pécs, Pécs, Hungary
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Alizadeh Hussain
- János Szentágothai Research Center, University of Pécs, Pécs, Hungary
- Division of Hematology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Ágnes Nagy
- Division of Hematology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Balázs Kőszegi
- Department of Biochemistry and Medical Chemistry, Medical School, University of Pécs, Pécs, Hungary
| | - Ibolya Veczák
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Nelli Farkas
- Institute of Bioanalysis, Medical School, University of Pécs, Pécs, Hungary
| | - Emőke Bódis
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Katalin Márta
- János Szentágothai Research Center, University of Pécs, Pécs, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Andrea Szentesi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Margit Tőkés-Füzesi
- Department of Laboratory Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Tímea Berki
- Department of Immunology and Biotechnology, Medical School, University of Pécs, Pécs, Hungary
| | - Áron Vincze
- János Szentágothai Research Center, University of Pécs, Pécs, Hungary
- Clinical Medicine Doctoral School, University of Szeged, Szeged, Hungary
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Kálmán Tóth
- János Szentágothai Research Center, University of Pécs, Pécs, Hungary
- Division of Cardiology and Angiology, First Department of Medicine, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- János Szentágothai Research Center, University of Pécs, Pécs, Hungary
- Clinical Medicine Doctoral School, University of Szeged, Szeged, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Judit Bajor
- Clinical Medicine Doctoral School, University of Szeged, Szeged, Hungary
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
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Zysk W, Głąbska D, Guzek D. Role of Front-of-Package Gluten-Free Product Labeling in a Pair-Matched Study in Women with and without Celiac Disease on a Gluten-Free Diet. Nutrients 2019; 11:nu11020398. [PMID: 30769829 PMCID: PMC6412319 DOI: 10.3390/nu11020398] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/11/2019] [Accepted: 02/11/2019] [Indexed: 12/16/2022] Open
Abstract
Gluten-free (GF) product labeling is one of the most important determinants of food product choices by patients with celiac disease, due to the need for following a GF diet. The aim of this study was to assess the role of front-of-package GF product labeling in pair-matched celiac and non-celiac women on a GF diet in a choice experiment (CE). In subgroups of celiac (n = 77) and non-celiac pair-matched respondents on a GF diet, but with no gluten-related diseases diagnosed (n = 77), the influence of front-of package labeling of GF bread on the choice of products was assessed. The labeling assessed in a CE included for all the products crossed grain logotype and additional logotypes of European Union (EU) organic production, “dairy-free” product, wheat starch-free product, quality and vegan product, as well as additional “gluten-free” written information. It was stated that the frequency of selection of products with “gluten-free” written information did not differ between subgroups of celiac and non-celiac respondents, as well as in subgroups stratified by age, body mass index (BMI), place of residence, and economic status. The frequency of selection of products with “vegan” logotype was higher for non-celiac respondents than for celiac ones (p = 0.0011). The frequency of selection of a product with additional logotypes was influenced by BMI and place of residence, but not by age and economic status of assessed women.
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Affiliation(s)
- Wioleta Zysk
- Department of Organization and Consumption Economics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences (SGGW⁻WULS), 159C Nowoursynowska Street, 02⁻776 Warsaw, Poland.
| | - Dominika Głąbska
- Department of Dietetics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences (SGGW⁻WULS), 159C Nowoursynowska Street, 02⁻776 Warsaw, Poland.
| | - Dominika Guzek
- Department of Organization and Consumption Economics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences (SGGW⁻WULS), 159C Nowoursynowska Street, 02⁻776 Warsaw, Poland.
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Grabowicz A, Czaja-Bulsa G. Misleading labelling of gluten-free products in the light of EU regulations: time for a change? J Verbrauch Lebensm 2019. [DOI: 10.1007/s00003-019-01208-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Paul SP, Stanton LK, Adams HL, Basude D. Coeliac disease in children: the need to improve awareness in resource-limited settings. Sudan J Paediatr 2019; 19:6-13. [PMID: 31384082 DOI: 10.24911/sjp.106-1549488256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Coeliac disease (CD) is an immune-mediated systemic disorder caused by the ingestion of gluten. In children, it may present with intestinal or extra-intestinal manifestations such as diarrhoea, weight loss, iron deficiency anaemia or faltering growth. Diagnosis is confirmed by small bowel biopsies showing histological changes consistent with enteropathy. In 2012, the European Society for Paediatric Gastroenterology, Hepatology and Nutrition revised the CD guidelines and suggested that, in a selective group of symptomatic children, CD can be diagnosed without the need for small-bowel biopsies. Management of CD is through strict adherence to a life-long gluten-free diet (GFD). CD is of great public health significance as its prevalence in developing countries has been found to be similar to that in developed countries. Early recognition and treatment improves prognosis. Patients and families require long term support to enable effective adherence to a GFD lifestyle. This alone can be challenging, but through support of health professionals and dietitians, can improve patient outcomes. In resource-limited settings medical professionals need to be creative in formulating cheaper and locally sourced gluten free options in close cooperation with the dietitians thereby ensuring availability of gluten free food items at affordable prices. In this paper, we gave an overview of the subject followed by authors' view to emphasize the need for improved awareness in resource-limited settings.
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Affiliation(s)
| | | | | | - Dharamveer Basude
- Paediatric Gastroenterology, Bristol Royal Hospital of Children, Bristol, UK
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Contribution of Oral Hygiene and Cosmetics on Contamination of Gluten-free Diet: Do Celiac Customers Need to Worry About? J Pediatr Gastroenterol Nutr 2019; 68:26-29. [PMID: 30119098 DOI: 10.1097/mpg.0000000000002129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The only available treatment for celiac disease (CD) is the gluten-free diet. It is unclear whether the presence of gluten in oral hygiene products and cosmetics that are applied on the mouth is a reason of concern for CD patients. The aim of this study was to test the level of gluten contamination in oral hygiene and cosmetic products available in the Italian market. METHODS A total of 66 products (toothpastes = 37; dental tablets = 2; mouthwashes = 5; lip-balms = 10; lipsticks = 12) labelled gluten-free or with unknown gluten content were randomly collected from different supermarkets and pharmacies. The gluten quantification was determined by the R5 ELISA method approved by EU regulations. RESULTS Out of 66 oral hygiene and cosmetics, 62 products (94%) were found to be gluten-free (gluten level <20 ppm), while 4 (6%) (toothpastes = 3; lipsticks = 1) showed a gluten level >20 ppm (toothpastes: 20.7, 31.4, and 35 ppm; lipstick: 27.4 ppm). None of the selected products had ingredient derived from wheat, barley, or rye. CONCLUSIONS Gluten contamination is currently not an issue in a wide array of cosmetic and oral hygiene products that are commonly in the market.
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Falcomer AL, Santos Araújo L, Farage P, Santos Monteiro J, Yoshio Nakano E, Puppin Zandonadi R. Gluten contamination in food services and industry: A systematic review. Crit Rev Food Sci Nutr 2018; 60:479-493. [PMID: 30582343 DOI: 10.1080/10408398.2018.1541864] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Gluten-related disorders (GRD) affects approximately 10% of the general population. The only treatment for GRD is still so far is the lifelong complete exclusion of gluten from the daily diet. The correct information about the presence/absence of gluten in food is very important to this group. The present study aimed to evaluate the prevalence of gluten contamination in gluten-free industrial and non-industrial products. In this systematic review, 24 cross-sectional studies were analyzed. The authors developed specific search strategies for Science Direct, Scopus, Web of Science, Google Scholar and ProQuest Dissertations & Theses Global. The authors evaluated the methodological quality of the included studies using criteria from Meta-analysis of Statistics Assessment and Review Instrument (MASTARI). We performed the statistical meta-analysis by metafor package of R program. 95.83% (n = 23) of the studies presented positive results for contamination (over 20 ppm). In industrial food products, studies showed a contamination prevalence of 13.2% (95% CI: 10.8%-15.7%). In non-industrial food products, studies showed a contamination prevalence of 41.5% (95% CI: 16.6%-66.4%). Despite the non-industrial products presented higher contamination prevalence than the industrial products, the difference was not significant (p = 0.072). The findings indicate cross-contamination in industrialized and non-industrialized products. As expected, industrial products labeled as gluten-free showed a lower percentage of gluten-contamination than non-industrialized. Despite that, any contaminated sample found in this group present greater relevance than non-labeled foods. It indicates that foods labeled as "gluten-free" should not be considered safe for patients with GRD since information on the label regarding the presence/absence of gluten is unreliable. Therefore, any gluten-contamination in products labeled as gluten-free is a serious problem to whom present GRD. Further studies are needed to estimate gluten cross-contamination in food service meals and industry better.
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Affiliation(s)
- Ana Luísa Falcomer
- Department of Nutrition, Faculty of Health Sciences, Campus Universitário Darcy, Ribeiro, University of Brasília, Distrito Federal, Brazil
| | - Letícia Santos Araújo
- Department of Nutrition, Faculty of Health Sciences, Campus Universitário Darcy, Ribeiro, University of Brasília, Distrito Federal, Brazil
| | - Priscila Farage
- Department of Nutrition, Faculty of Health Sciences, Campus Universitário Darcy, Ribeiro, University of Brasília, Distrito Federal, Brazil
| | - Jordanna Santos Monteiro
- Department of Nutrition, Faculty of Health Sciences, Campus Universitário Darcy, Ribeiro, University of Brasília, Distrito Federal, Brazil
| | - Eduardo Yoshio Nakano
- Department of Statistics, Campus Universitário Darcy Ribeiro, University of Brasília, Distrito Federal, Brazil
| | - Renata Puppin Zandonadi
- Department of Nutrition, Faculty of Health Sciences, Campus Universitário Darcy, Ribeiro, University of Brasília, Distrito Federal, Brazil
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Abstract
Gluten is among the 14 major food allergens officially recognized by Regulation (EU) No. 1169/2011. The risk to coeliac patients from gluten presence in the food products they consume is likely due to the unintentional contamination of naturally gluten-free (GF) and GF-labelled products, or to hidden sources of gluten in processed GF products. The aim of this paper is to provide a snapshot of gluten risk analysis, with emphasis on immunological methods currently used in gluten detection. The study highlights that immunoassays have some advantages over other analytical methods in gluten determination and are suitable for routine tests. However, some factors (e.g., complexity of the food matrix, type of the applied antibody, gluten extraction procedures and lack of reference material) affect the reliability of obtained results. Hence, efforts are required at an analytical level to overcome the drawbacks of the immunological methods currently available. Harmonization is necessary, so as to assist both consumers in making safe food choices, and the food industry in gluten risk assessment, management and communication.
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Analysis of Gluten Content in Gluten-Free Pizza from Certified Take-Away Pizza Restaurants. Foods 2018; 7:foods7110180. [PMID: 30384457 PMCID: PMC6262390 DOI: 10.3390/foods7110180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 10/24/2018] [Accepted: 10/29/2018] [Indexed: 12/04/2022] Open
Abstract
Currently, a strict gluten-free diet is the only treatment for celiac disease. In Italy, food service establishments and restaurants can be certified for providing gluten-free foods, including pizza restaurants that make both gluten-free pizza and traditional wheat-based pizza. With this study we analyzed the gluten content in samples of gluten-free pizza prepared and purchased at certified restaurants in the Turin metropolitan area. All samples, from 28 pizzas and 28 cooked dough bases, produced results below the test limit of detection, except for one sample of cooked dough, that tested positive for gluten but still below the warning level for celiac consumers (<20 ppm). Gluten-free pizza, as advertised in the restaurants surveyed, can be considered a safe option for gluten-free consumption. Attention to and compliance with good manufacturing practices, a requisite for obtaining gluten-free certification for restaurants, were noted to have a positive effect on the final product.
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Garcia-Mazcorro JF, Noratto G, Remes-Troche JM. The Effect of Gluten-Free Diet on Health and the Gut Microbiota Cannot Be Extrapolated from One Population to Others. Nutrients 2018; 10:E1421. [PMID: 30287726 PMCID: PMC6212913 DOI: 10.3390/nu10101421] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 09/25/2018] [Accepted: 10/01/2018] [Indexed: 02/07/2023] Open
Abstract
Gluten-related disorders (GRD) affect millions of people worldwide and have been related to the composition and metabolism of the gut microbiota. These disorders present differently in each patient and the only treatment available is a strict life-long gluten-free diet (GFD). Several studies have investigated the effect of a GFD on the gut microbiota of patients afflicted with GRD as well as healthy people. The purpose of this review is to persuade the biomedical community to think that, while useful, the results from the effect of GFD on health and the gut microbiota cannot be extrapolated from one population to others. This argument is primarily based on the highly individualized pattern of gut microbial composition and metabolic activity in each person, the variability of the gut microbiota over time and the plethora of factors associated with this variation. In addition, there is wide variation in the composition, economic viability, and possible deleterious effects to health among different GFD, both within and among countries. Overall, this paper encourages the conception of more collaborative efforts to study local populations in an effort to reach biologically and medically useful conclusions that truly contribute to improve health in patients afflicted with GRD.
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Affiliation(s)
- Jose F Garcia-Mazcorro
- Instituto de Investigaciones Medico Biológicas, Universidad Veracruzana, Calle Agustín de Iturbide, Salvador Díaz Mirón, Veracruz 91700, Mexico.
| | - Giuliana Noratto
- Department of Nutrition and Food Science, Texas A&M University, 2253 TAMU, College Station, TX 77843, USA.
| | - Jose M Remes-Troche
- Instituto de Investigaciones Medico Biológicas, Universidad Veracruzana, Calle Agustín de Iturbide, Salvador Díaz Mirón, Veracruz 91700, Mexico.
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Evans S, Cecere J. Celiac Disease Awareness: Unraveling the Secrets of Celiac Disease. NASN Sch Nurse 2018; 34:90-94. [PMID: 30270716 DOI: 10.1177/1942602x18802344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
School nurses play a major role in the care of students with food-related diversities balancing responsibilities such as providing a safe environment, encouraging leadership and community outreach, giving guidance to family and peers with care coordination, and providing needed accommodations so that all students may thrive in the school setting. It is essential that school nurses share their understanding of what it is like to live with the serious genetic autoimmune disorder known as celiac disease. With improved knowledge, the school education team, nutritional staff, and guidance counselors will have a better understanding of what the student is facing and the unique challenges it presents, because celiac disease is not a food allergy, but much more.
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Farage P, Puppin Zandonadi R, Cortez Ginani V, Gandolfi L, Yoshio Nakano E, Pratesi R. Gluten-Free Diet: From Development to Assessment of a Check-List Designed for the Prevention of Gluten Cross-Contamination in Food Services. Nutrients 2018; 10:nu10091274. [PMID: 30201860 PMCID: PMC6165388 DOI: 10.3390/nu10091274] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/03/2018] [Accepted: 09/07/2018] [Indexed: 01/28/2023] Open
Abstract
Gluten cross-contamination in gluten-free food may jeopardize treatment of celiac patients. Considering the deficit of appropriate instruments to enable the implementation of safe production practices for gluten-free food, this study aimed to evaluate the application of a check-list elaborated for gluten cross-contamination prevention in food services. The instrument was applied in 60 Brazilian food services. Interobserver reproducibility and internal consistency of the check-list were tested. A score classification was created for establishments according to the food contamination risk assessment. Subsequent to the application and statistical analysis, the original instrument was reduced to a 30-item check-list. In the reproducibility analysis, none of the 30 items showed significant divergence among the evaluators (p > 0.05 in the Cochran Q test). The 30-item version of the check-list presented Kuder–Richardson Formula 20 (KR-20) = 0.771, indicating good internal consistency. The proposed classification score is obtained by adding 1 point for each item with an “adequate” response; therefore, the final score may vary between 0 and 30 points. Establishments with up to 15 points exhibit risk of gluten contamination, while establishments with a score above 16 points exhibit low risk of contamination. The check-list displayed good reproducibility and internal consistency, suggesting that it could be a useful gluten contamination control instrument in food services.
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Affiliation(s)
- Priscila Farage
- Department of Nutrition, School of Health Sciences, University of Brasilia (UnB), Campus Darcy Ribeiro, Asa Norte, Brasilia DF 70910-900, Brazil.
| | - Renata Puppin Zandonadi
- Department of Nutrition, School of Health Sciences, University of Brasilia (UnB), Campus Darcy Ribeiro, Asa Norte, Brasilia DF 70910-900, Brazil.
| | - Verônica Cortez Ginani
- Department of Nutrition, School of Health Sciences, University of Brasilia (UnB), Campus Darcy Ribeiro, Asa Norte, Brasilia DF 70910-900, Brazil.
| | - Lenora Gandolfi
- Faculty of Medicine, University of Brasilia (UnB), Campus Darcy Ribeiro, Asa Norte, Brasilia DF 70910-900, Brazil.
| | - Eduardo Yoshio Nakano
- Department of Statistics, Central Institute of Sciences, University of Brasilia (UnB), Campus Darcy Ribeiro, Asa Norte, Brasilia DF 70910-900, Brazil.
| | - Riccardo Pratesi
- Faculty of Medicine, University of Brasilia (UnB), Campus Darcy Ribeiro, Asa Norte, Brasilia DF 70910-900, Brazil.
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Allen KJ, Taylor SL. The Consequences of Precautionary Allergen Labeling: Safe Haven or Unjustifiable Burden? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018. [DOI: 10.1016/j.jaip.2017.12.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Mitoma H, Manto M, Hampe CS. Immune-mediated cerebellar ataxias: from bench to bedside. CEREBELLUM & ATAXIAS 2017; 4:16. [PMID: 28944066 PMCID: PMC5609024 DOI: 10.1186/s40673-017-0073-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 09/07/2017] [Indexed: 02/08/2023]
Abstract
The cerebellum is a vulnerable target of autoimmunity in the CNS. The category of immune-mediated cerebellar ataxias (IMCAs) was recently established, and includes in particular paraneoplastic cerebellar degenerations (PCDs), gluten ataxia (GA) and anti-GAD65 antibody (Ab) associated-CA, all characterized by the presence of autoantibodies. The significance of onconeuronal autoantibodies remains uncertain in some cases. The pathogenic role of anti-GAD65Ab has been established both in vitro and in vivo, but a consensus has not been reached yet. Recent studies of anti-GAD65 Ab-associated CA have clarified that (1) autoantibodies are generally polyclonal and elicit pathogenic effects related to epitope specificity, and (2) the clinical course can be divided into two phases: a phase of functional disorder followed by cell death. These features provide the rationale for prompt diagnosis and therapeutic strategies. The concept “Time is brain” has been completely underestimated in the field of immune ataxias. We now put forward the concept “Time is cerebellum” to underline the importance of very early therapeutic strategies in order to prevent or stop the loss of neurons and synapses. The diagnosis of IMCAs should depend not only on Ab testing, but rather on a rapid and comprehensive assessment of the clinical/immune profile. Treatment should be applied during the period of preserved cerebellar reserve, and should encompass early removal of the conditions (such as remote primary tumors) or diseases that trigger the autoimmunity, followed by the combinations of various immunotherapies.
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Affiliation(s)
- Hiroshi Mitoma
- Tokyo Medical University, Medical Education Promotion Center, 6-7-1 Nishi-Shinjyuku, Shinjyuku-ku, Tokyo, 160-0023 Japan
| | - Mario Manto
- Unité d'Etude du Mouvement (UEM), FNRS, ULB-Erasme, 1070 Bruxelles, Belgium.,Service des Neurosciences, University of Mons, 7000 Mons, Belgium
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Rostami K, Bold J, Parr A, Johnson MW. Gluten-Free Diet Indications, Safety, Quality, Labels, and Challenges. Nutrients 2017; 9:nu9080846. [PMID: 28786929 PMCID: PMC5579639 DOI: 10.3390/nu9080846] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 07/27/2017] [Accepted: 07/31/2017] [Indexed: 12/22/2022] Open
Abstract
A gluten-free diet (GFD) is the safest treatment modality in patient with coeliac disease (CD) and other gluten-related disorders. Contamination and diet compliance are important factors behind persistent symptoms in patients with gluten related-disorders, in particular CD. How much gluten can be tolerated, how safe are the current gluten-free (GF) products, what are the benefits and side effects of GFD? Recent studies published in Nutrients on gluten-free products’ quality, availability, safety, as well as challenges related to a GFD are discussed.
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Affiliation(s)
- Kamran Rostami
- Department of Gastroenterology, Milton Keynes University Hospital, Milton Keynes MK6 5LD, UK.
| | - Justine Bold
- Allied Health and Social Sciences, Institute of Health and Society University of Worcester, Worcester WR2 6AJ, UK.
| | - Alison Parr
- Freelance Nutrition Therapist, Manchester M33 5PD, UK.
| | - Matt W Johnson
- Department of Gastroenterology, Luton and Dunstable University Hospital, Luton LU4 0DZ, UK.
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