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Abstract
Oats in a gluten-free diet increase the diet's nutritional value, but their use remains controversial. Contamination with prolamins of other cereals is frequent, and some clinical and experimental studies support the view that a subgroup of celiac patients may be intolerant to pure oats. Thus, this issue is more complex than previously suggested. In order to produce oats that are safe for all celiac patients, the following topics should be addressed: selection of oat cultivars with low avenin content, research on such recombinant varieties of oats, development of assay methods to detect avenins in oat products, guidelines for the agricultural processing of oats and the manufacture of oat products, as well as guidelines for following up with celiac patients who consume oats.
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Affiliation(s)
- Premysl Fric
- Department of Medicine, First Faculty of Medicine and Central Military Hospital, Charles University, CZ-169 02 Prague 6, Czech Republic.
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202
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Effect of organic calcium supplements on the technological characteristic and sensory properties of gluten-free bread. Eur Food Res Technol 2011. [DOI: 10.1007/s00217-010-1421-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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203
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Prevention measures and exploratory pharmacological treatments of celiac disease. Am J Gastroenterol 2010; 105:2551-61; quiz 2562. [PMID: 20877349 DOI: 10.1038/ajg.2010.372] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Increasing prevalence, protean clinical manifestations, and lack of pharmacological therapy make celiac disease (CD) a complex and highly relevant illness in gastroenterology. This chronic inflammatory disorder of the small intestine is caused by the ingestion of gluten containing cereals in genetically susceptible individuals, leading to a variety of gastrointestinal (GI) and non-GI manifestations. Awareness among physicians is growing due to accessible and highly accurate diagnostic and screening methods. Recent evidence suggests a possible rising incidence of CD. Environmental factors such as early life gluten exposure, intestinal infections, short duration of breast-feeding, and changes in intestinal microbiota have been proposed to have a role in CD pathogenesis. Thus, prevention approaches to diminish the rising prevalence of CD are currently being evaluated. Still, the cornerstone treatment of CD remains a strict gluten-free diet. This nutritional regime is demanding, and non-adherence is common because of social isolation, financial issues, or restriction of food diversity. Allowing patients to occasionally consume small amounts of gluten would greatly improve their quality of life. Owing to recent advances in the understanding of the pathogenesis of CD, different targets have been identified and have motivated the development of several experimental therapeutic strategies. The main goal of this review is to discuss the mechanisms that can be exploited therapeutically to prevent or delay CD, disease associations and its complications. Current treatments for complications of CD, including refractory CD and malignancy, are beyond the scope of this review.
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de la Barca AMC, Rojas-Martínez ME, Islas-Rubio AR, Cabrera-Chávez F. Gluten-free breads and cookies of raw and popped amaranth flours with attractive technological and nutritional qualities. PLANT FOODS FOR HUMAN NUTRITION (DORDRECHT, NETHERLANDS) 2010; 65:241-246. [PMID: 20734143 DOI: 10.1007/s11130-010-0187-z] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Gluten-free bakery foodstuffs are a challenge for technologists and nutritionists since alternative ingredients used in their formulations have poor functional and nutritional properties. Therefore, gluten-free bread and cookies using raw and popped amaranth, a grain with high quality nutrients and promising functional properties, were formulated looking for the best combinations. The best formulation for bread included 60-70% popped amaranth flour and 30-40% raw amaranth flour which produced loaves with homogeneous crumb and higher specific volume (3.5 ml/g) than with other gluten-free breads. The best cookies recipe had 20% of popped amaranth flour and 13% of whole-grain popped amaranth. The expansion factor was similar to starch-based controls and the hardness was similar (10.88 N) to other gluten-free cookies. Gluten content of the final products was around 12 ppm. The functionality of amaranth-based doughs was acceptable although hydrocolloids were not added and the final gluten-free products had a high nutritional value.
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Affiliation(s)
- Ana María Calderón de la Barca
- Centro de Investigación en Alimentación y Desarrollo, A. C., Carretera a la Victoria Km 0.6, P. O. Box 1735, Hermosillo 83000, Mexico.
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205
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Wronkowska M, Zielińska D, Szawara-Nowak D, Troszyńska A, Soral-Śmietana M. Antioxidative and reducing capacity, macroelements content and sensorial properties of buckwheat-enhanced gluten-free bread. Int J Food Sci Technol 2010. [DOI: 10.1111/j.1365-2621.2010.02375.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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206
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Wild D, Robins GG, Burley VJ, Howdle PD. Evidence of high sugar intake, and low fibre and mineral intake, in the gluten-free diet. Aliment Pharmacol Ther 2010; 32:573-81. [PMID: 20528829 DOI: 10.1111/j.1365-2036.2010.04386.x] [Citation(s) in RCA: 200] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The only therapy for coeliac disease (CD) is a long-term gluten-free diet (GFD). Little is known about the detailed composition of such a diet. AIM To clarify the nutritional composition of a GFD and to compare it with a non-GFD diet in representative non-CD populations. METHODS A total of 139 consecutive patients with CD were invited to fill in a prospective validated 5-day food diary, of whom data from 93 were analysed. Results were compared with data from the National Diet and Nutrition Survey of Adults and the UK Women's Cohort Study (UKWCS). RESULTS Individuals consuming a strict GFD generally had similar intakes of energy and nutrients to those of comparison populations, but a higher proportion of carbohydrate intake was obtained from nonmilk extrinsic sugars and intakes of nonstarch polysaccharides were low. Compared with the UKWCS sample, female patients adhering to a GFD had lower intakes of magnesium, iron, zinc, manganese, selenium and folate. In male patients, intakes of magnesium and selenium were particularly low. CONCLUSIONS This study reinforces the need for clinicians to recognize that avoidance of gluten cannot be the sole focus of a gluten-free diet. Maintenance of adequate intakes of essential nutrients and in particular complex carbohydrates must also be the goal for patients.
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Affiliation(s)
- D Wild
- Academic Unit of Medicine, St James's University Hospital, Leeds LS97TF, UK
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207
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Alvarez-Jubete L, Arendt EK, Gallagher E. Nutritive value and chemical composition of pseudocereals as gluten-free ingredients. Int J Food Sci Nutr 2010; 60 Suppl 4:240-57. [PMID: 19462323 DOI: 10.1080/09637480902950597] [Citation(s) in RCA: 186] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The only treatment available for patients with coeliac disease is a lifelong elimination of food products containing gluten. The gluten-free products currently available in the market are considered of low quality and poor nutritional value. In the present study, the pseudocereals amaranth, quinoa and buckwheat were studied as potential healthy ingredients for improving the nutritional quality of gluten-free breads. The pseudocereal seeds and pseudocereal-containing gluten-free breads were evaluated in terms of their protein, fat, total starch, dietary fibre, ash and mineral content as well as their fatty acid composition. The pseudocereal containing gluten-free breads showed significantly higher levels of protein, fat, fibre and minerals than the control bread. The attributes of these breads conform to the expert's nutritional recommendations for the gluten-free diet and gluten-free foods. These results suggest that the pseudocereals amaranth, quinoa and buckwheat can represent a healthy alternative to frequently used ingredients in gluten-free products.
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208
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Araújo HMC, Araújo WMC, Botelho RBA, Zandonadi RP. Doença celíaca, hábitos e práticas alimentares e qualidade de vida. REV NUTR 2010. [DOI: 10.1590/s1415-52732010000300014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Esta comunicação apresenta o cenário da doença celíaca e suas implicações em hábitos, práticas alimentares e qualidade de vida de indivíduos intolerantes ao glúten. Apresenta dados importantes sobre a questão que, mundialmente, é considerada problema de saúde pública. Por ser uma doença cujo tratamento é fundamentalmente dietético, a terapia durante a transição alimentar deve ser bem conduzida pelo nutricionista para melhor adesão do paciente à dieta, considerando que a inclusão de novas práticas alimentares pode significar uma ruptura com a identidade individual e cultural: a alimentação de cada cidadão não pode ser deslocada da sociedade. Nesse contexto, a melhoria da qualidade de vida passa a ser um dos resultados esperados tanto das práticas assistenciais quanto das políticas públicas para o setor nos campos da promoção da saúde e da prevenção de doenças. A vigilância sanitária contempla as ações capazes de eliminar, diminuir ou prevenir riscos à saúde e de intervir nos problemas sanitários decorrentes do meio ambiente, da produção e circulação de bens e da prestação de serviços de interesse da saúde. O conhecimento do cenário da doença celíaca no País se justifica pela necessidade de fundamentar as ações da política de alimentação e nutrição ancoradas no conceito de alimentação saudável com ênfase na dieta isenta de glúten. Os artigos pesquisados foram selecionados nas bases de dados MedLine e SciELO, considerando o período de 1995 a 2006.
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209
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Schoenlechner R, Mandala I, Kiskini A, Kostaropoulos A, Berghofer E. Effect of water, albumen and fat on the quality of gluten-free bread containing amaranth. Int J Food Sci Technol 2010. [DOI: 10.1111/j.1365-2621.2009.02154.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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210
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Alvarez-Jubete L, Arendt E, Gallagher E. Nutritive value of pseudocereals and their increasing use as functional gluten-free ingredients. Trends Food Sci Technol 2010. [DOI: 10.1016/j.tifs.2009.10.014] [Citation(s) in RCA: 364] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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211
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The gluten-free diet: safety and nutritional quality. Nutrients 2010; 2:16-34. [PMID: 22253989 PMCID: PMC3257612 DOI: 10.3390/nu20100016] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Accepted: 01/08/2010] [Indexed: 12/28/2022] Open
Abstract
The prevalence of Celiac Disease (CD), an autoimmune enteropathy, characterized by chronic inflammation of the intestinal mucosa, atrophy of intestinal villi and several clinical manifestations has increased in recent years. Subjects affected by CD cannot tolerate gluten protein, a mixture of storage proteins contained in several cereals (wheat, rye, barley and derivatives). Gluten free-diet remains the cornerstone treatment for celiac patients. Therefore the absence of gluten in natural and processed foods represents a key aspect of food safety of the gluten-free diet. A promising area is the use of minor or pseudo-cereals such as amaranth, buckwheat, quinoa, sorghum and teff. The paper is focused on the new definition of gluten-free products in food label, the nutritional properties of the gluten-free cereals and their use to prevent nutritional deficiencies of celiac subjects.
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212
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213
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Leffler DA, Dennis M, Edwards George J, Jamma S, Cook EF, Schuppan D, Kelly CP. A validated disease-specific symptom index for adults with celiac disease. Clin Gastroenterol Hepatol 2009; 7:1328-34, 1334.e1-3. [PMID: 19665584 DOI: 10.1016/j.cgh.2009.07.031] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Revised: 07/21/2009] [Accepted: 07/25/2009] [Indexed: 02/05/2023]
Abstract
BACKGROUND & AIMS Although the incidence of celiac disease (CD) is increasing, studies have been hampered by the lack of validated outcome measures. We sought to create a disease-specific Celiac Symptom Index (CSI) to reliably assess relevant symptoms. METHODS A 36-item questionnaire was created after design by an expert committee and review/revision by patient focus groups. The survey, covering domains of CD-related symptoms and general health, was initially administered to 154 individuals with biopsy-proven CD; immunoglobulin (Ig)A tissue transglutaminase titers were determined, and gluten-free diet adherence was evaluated by a dietitian. The questionnaire was then revised to exclude questions with poor test characteristics and administered to a second, independent group of 52 individuals, to ensure validity. RESULTS The subscales of "specific symptoms" and "general health" had excellent psychometric qualities that consisted of 11 and 5 items, respectively. The additive score based on these items was correlated with current general health, as measured by a visual analog scale and short form 36 general health subscale (P < or = .001 for both), as well as degree of adherence to the gluten-free diet (P = .008), lending external validity to the CSI. The resulting 16 questions make up the first CD-specific symptom index. CONCLUSIONS The CSI allows for disease-specific monitoring of symptoms as an independent outcome measure or as part of a surrogate for disease activity in individuals with CD. The CSI might be an important tool for future clinical CD research.
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Affiliation(s)
- Daniel A Leffler
- Celiac Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
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214
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Baking properties and microstructure of pseudocereal flours in gluten-free bread formulations. Eur Food Res Technol 2009. [DOI: 10.1007/s00217-009-1184-z] [Citation(s) in RCA: 187] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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215
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Capriles VD, Martini LA, Arêas JAG. Metabolic osteopathy in celiac disease: importance of a gluten-free diet. Nutr Rev 2009; 67:599-606. [PMID: 19785691 DOI: 10.1111/j.1753-4887.2009.00232.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Reduced bone mineral density (BMD) is frequently found in individuals with untreated celiac disease (CD), possibly due to calcium and vitamin D malabsorption, release of pro-inflammatory cytokines, and misbalanced bone remodeling. A gluten-free diet (GFD) promotes a rapid increase in BMD that leads to complete recovery of bone mineralization in children. Children may attain normal peak bone mass if the diagnosis is made and treatment is given before puberty, thereby preventing osteoporosis in later life. A GFD improves, but rarely normalizes, BMD in patients diagnosed with CD in adulthood. In some cases, nutritional supplementation may be necessary. More information on therapeutic alternatives is needed.
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Affiliation(s)
- Vanessa D Capriles
- Nutrition Department, School of Public Health, São Paulo University, São Paulo, Brazil
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216
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217
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Abstract
Pediatric nutritional deficiencies are associated not only with poverty and developing countries, but also in children in the developed world who adhere to restricted diets. At times, these diets are medically necessary, such as the gluten-free diet for management of celiac disease or exclusion diets in children with food allergies. At other times, the diets are self-selected by children with behavioral disorders, or parent-selected because of nutrition misinformation, cultural preferences, alternative nutrition therapies, or misconceptions regarding food tolerance. Health care providers must be vigilant in monitoring both growth and feeding patterns to identify inappropriate dietary changes that may result in nutritional deficiencies.
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Affiliation(s)
- Midge Kirby
- Clinical Nutrition, Children's Hospital of Wisconsin, 9000 W. Wisconsin Avenue, Milwaukee, WI 53201, USA.
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218
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Gambuś H, Gambuś F, Pastuszka D, Wrona P, Ziobro R, Sabat R, Mickowska B, Nowotna A, Sikora M. Quality of gluten-free supplemented cakes and biscuits. Int J Food Sci Nutr 2009; 60 Suppl 4:31-50. [DOI: 10.1080/09637480802375523] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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219
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Sabanis D, Lebesi D, Tzia C. Development of fibre-enriched gluten-free bread: a response surface methodology study. Int J Food Sci Nutr 2009; 60 Suppl 4:174-90. [DOI: 10.1080/09637480902721196] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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220
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Nutrient intakes during diets including unkilned and large amounts of oats in celiac disease. Eur J Clin Nutr 2009; 64:62-7. [PMID: 19756027 DOI: 10.1038/ejcn.2009.113] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND/OBJECTIVES We have shown earlier that consumption of moderate amount of oats improve intakes of vitamin B(1), fiber, magnesium and iron in celiac patients using gluten-free diet (GFD). The objective of this study was to clarify the effect of high amount of both kilned and unkilned oats on food and nutrient intakes in celiac patients in remission. Kilning as an industrial heating process is performed to preserve the main properties of oats and to lengthen its useableness. Kilning may, however, change the protein structure of oats and therefore influence on the intake of nutrients. SUBJECTS/METHODS The study group consisted of 13 men and 18 women with celiac disease in remission. The patients who were earlier using moderate amount of oats as part of their GFD were randomized to consume kilned or unkilned oats. After 6 months, the patients changed the treatment groups. The goal of daily intake of oats was 100 g. Food records and frequency questionnaire were used to follow nutrient intakes. RESULTS Type of oats did not affect the amount of oats used. In the group using kilned oats, the intake of vitamin B1 and magnesium and in the group of unkilned oats that of magnesium and zinc increased significantly during the first 6 months (P<or=0.05). CONCLUSIONS :Large amounts of oats, both kilned and unkilned in GFD, can increase intakes of nutrients in celiac patients in remission. Oats improve the nutritional value of GFD.
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221
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Gastrointestinal symptoms and well-being of adults living on a gluten-free diet: a case for nursing in celiac disease. Gastroenterol Nurs 2009; 32:196-201. [PMID: 19506436 DOI: 10.1097/sga.0b013e3181a85e7b] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Women with celiac disease (CD) living on a gluten-free diet (GFD) show a lower health-related quality of life and report a higher rate of gastrointestinal (GI) symptoms than men with CD. Uncertainty exists as to whether GI symptoms may explain the poorer treatment outcome of women with CD. This study was designed to explore relationships of GI symptoms and psychological well-being in men and women with long-standing CD. Patients with CD (n = 108; 59% women), aged 45-64 years, treated with a GFD for at least 8 years were evaluated by the Gastrointestinal Symptom Rating Scale and the Psychological General Well-Being index. The results show that women with a high rate of GI symptoms have no lower level of psychological well-being than corresponding men with CD and that women with CD with reduced psychological well-being have no more GI symptoms than corresponding men. Our results fail to support the notion that the reduced subjective health in CD is explained by GI symptoms. They may be secondary to perceived difficulties in managing everyday life, suggesting that launching a nurse-led follow-up may be helpful, as has been proven to be useful in other lifelong disorders.
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222
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Smart C, Aslander-van Vliet E, Waldron S. Nutritional management in children and adolescents with diabetes. Pediatr Diabetes 2009; 10 Suppl 12:100-17. [PMID: 19754622 DOI: 10.1111/j.1399-5448.2009.00572.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Carmel Smart
- John Hunter Children's Hospital, Newcastle, New South Wales, Australia
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223
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Lee AR, Ng DL, Dave E, Ciaccio EJ, Green PHR. The effect of substituting alternative grains in the diet on the nutritional profile of the gluten-free diet. J Hum Nutr Diet 2009; 22:359-63. [PMID: 19519750 DOI: 10.1111/j.1365-277x.2009.00970.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The only treatment for coeliac disease is lifelong adherence to a gluten-free diet. Several studies have reported nutritional deficiencies in individuals on a gluten-free diet. The present study aimed to determine whether the nutritional profile of gluten-free diet could be improved through the use of alternative grains. METHODS A retrospective review of diet history records by a celiac specialist dietitian were used to establish a 'standard' gluten-free dietary pattern. An 'alternative' gluten-free dietary pattern was developed that substituted naturally gluten-free grains or gluten-free products made from 'alternative' flours (oats, high fibre gluten-free bread and quinoa) in the standard pattern. A paired t-test was performed to identify statistical significance between the 'alternative' and standard gluten-free dietary pattern. RESULTS Analysis of standard pattern indicated that 38% of meals and snacks contained no grain or starch choice. Of those meals that contained a grain or starch component, rice was the grain chosen 44% of the time. The inclusion of alternative grains or grain products provided a higher nutrient profile compared to the standard gluten-free dietary pattern (P = 0.002). Several nutrients; protein (20.6 g versus 11 g), iron (18.4 mg versus 1.4 mg), calcium (182 mg versus 0 mg) and fibre (12.7 g versus 5 g) were significantly increased by changing the grain or starch component in the dietary pattern. The B vitamin content (riboflavin, niacin and folate) was improved, although this was not statistically significant (P = 0.125). DISCUSSION The inclusion of alternative grain-based products increased the nutrient profile of the gluten-free dietary pattern significantly.
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Affiliation(s)
- A R Lee
- Celiac Disease Center, Department of Medicine, Columbia University, New York, NY, USA.
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224
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Sverker A, Östlund G, Hallert C, Hensing G. ‘I lose all these hours…’- exploring gender and consequences of dilemmas experienced in everyday life with coeliac disease. Scand J Caring Sci 2009; 23:342-52. [DOI: 10.1111/j.1471-6712.2008.00628.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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225
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Leffler DA, Dennis M, Edwards George JB, Jamma S, Magge S, Cook EF, Schuppan D, Kelly CP. A simple validated gluten-free diet adherence survey for adults with celiac disease. Clin Gastroenterol Hepatol 2009; 7:530-6, 536.e1-2. [PMID: 19268725 DOI: 10.1016/j.cgh.2008.12.032] [Citation(s) in RCA: 200] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 11/13/2008] [Accepted: 12/26/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Celiac disease is an increasingly prevalent disorder. To monitor response to treatment in clinical and research settings, it is essential to accurately measure gluten-free diet (GFD) adherence in a standardized manner. The aim of this study was to develop a valid and reliable Celiac Dietary Adherence Test (CDAT). METHODS Items and domains believed to be essential for successful GFD adherence were used to develop an 85-item survey with input from patient focus groups. The survey was administered to 200 individuals with biopsy-proven celiac disease who underwent standardized dietician evaluation (SDE) and serologic testing. RESULTS Of the initial 85 items, 41 were correlated highly with the SDE (P < .01). Responses for all 200 participants for the 41 items were entered into a single database. Computer-generated randomization produced a derivation cohort of 120 subjects and a validation cohort of 80. By using the derivation cohort, a 7-item questionnaire was developed using logistic regression. The additive score based on these items was correlated highly with the SDE in both the derivation and validation cohorts (P < .001) and performed significantly better than immunoglobulin A tissue transglutaminase titers in receiver operating characteristic curve analysis with areas under the curve of 0.830 and 0.652, respectively. CONCLUSIONS The CDAT is a clinically relevant, easily administered, 7-item instrument that allows for standardized evaluation of GFD adherence and is superior to tissue transglutaminase serology. The CDAT may be useful in both research and clinical settings.
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Affiliation(s)
- Daniel A Leffler
- Celiac Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
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226
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Hallert C, Svensson M, Tholstrup J, Hultberg B. Clinical trial: B vitamins improve health in patients with coeliac disease living on a gluten-free diet. Aliment Pharmacol Ther 2009; 29:811-6. [PMID: 19154566 DOI: 10.1111/j.1365-2036.2009.03945.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with coeliac disease living on a gluten-free diet show vitamin deficiency and reduced subjective health status. AIM To study the biochemical and clinical effects of B vitamin supplementation in adults with longstanding coeliac disease. METHODS In a double blind placebo controlled multicentre trial, 65 coeliac patients (61% women) aged 45-64 years on a strict gluten-free diet for several years were randomized to a daily dose of 0.8 mg folic acid,0.5 mg cyanocobalamin and 3 mg pyridoxine or placebo for 6 months. The outcome measures were psychological general well-being (PGWB) and the plasma total homocysteine (tHcy) level, marker of B vitamin status. RESULTS Fifty-seven patients (88%) completed the trial. The tHcy level was baseline median 11.7 micromol/L (7.4-23.0), significantly higher than in matched population controls [10.2 micromol/L (6.7-22.6) (P < 0.01)]. Following vitamin supplementation, tHcy dropped a median of 34% (P < 0.001), accompanied by significant improvement in well-being (P < 0.01), notably Anxiety (P < 0.05) and Depressed Mood (P < 0.05) for patients with poor well-being. CONCLUSIONS Adults with longstanding coeliac disease taking extra B vitamins for 6 months showed normalized tHcy and significant improvement in general well-being, suggesting that B vitamins should be considered in people advised to follow a gluten-free diet.
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Affiliation(s)
- C Hallert
- Coeliac Centre, Norrköping Hospital, Norrköping, Sweden.
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227
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Thom S, Longo BM, Running A, Ashley J. Celiac Disease. J Nurse Pract 2009. [DOI: 10.1016/j.nurpra.2008.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
(Table is included in full-text article). Studies suggest that oats can be tolerated in the gluten-free diet by a majority of patients with coeliac disease. Concerns remain, however, about the possibility of contamination of commercially available oat products by wheat, barley and rye. The R5 ELISA allows the identification and quantification of wheat, barley and rye prolamins, and has demonstrated significant contamination in a range of products. If patients with coeliac disease are to take oats, it is important that those consumed are free of contamination. This assay should allow the identification of safe oat products.
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Niewinski MM. Advances in celiac disease and gluten-free diet. ACTA ACUST UNITED AC 2008; 108:661-72. [PMID: 18375224 DOI: 10.1016/j.jada.2008.01.011] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Accepted: 10/15/2007] [Indexed: 01/02/2023]
Abstract
Celiac disease is becoming an increasingly recognized autoimmune enteropathy caused by a permanent intolerance to gluten. Once thought to be a rare disease of childhood characterized by diarrhea, celiac disease is actually a multisystemic disorder that occurs as a result of an immune response to ingested gluten in genetically predisposed individuals. Screening studies have revealed that celiac disease is most common in asymptomatic adults in the United States. Although considerable scientific progress has been made in understanding celiac disease and in preventing or curing its manifestations, a strict gluten-free diet is the only treatment for celiac disease to date. Early diagnosis and treatment, together with regular follow-up visits with a dietitian, are necessary to ensure nutritional adequacy and to prevent malnutrition while adhering to the gluten-free diet for life. The purpose of this review is to provide clinicians with current updated information about celiac disease, its diverse clinical presentation and increased prevalence, the complex pathophysiology and strong genetic predisposition to celiac disease, and its diagnosis. This review focuses in detail on the gluten-free diet and the importance of intense expert dietary counseling for all patients with celiac disease. Recent advances in the gluten-free diet include food allergen labeling as well as the US Food and Drug Administration's proposed definition of the food-labeling term gluten-free. The gluten-free diet is complex and patients need comprehensive nutrition education from a skilled dietitian.
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Affiliation(s)
- Mary M Niewinski
- Department of Pediatrics/Genetics, University of Illinois at Chicago Medical Center, Chicago, IL, USA.
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231
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Hopman E, Dekking L, Blokland ML, Wuisman M, Zuijderduin W, Koning F, Schweizer J. Tef in the diet of celiac patients in The Netherlands. Scand J Gastroenterol 2008; 43:277-82. [PMID: 18266174 DOI: 10.1080/00365520701714871] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Celiac disease (CD) is a multifactorial disease with a strong genetic association. It is caused by a T-cell-mediated immune response to wheat gluten. The treatment is a strict gluten-free diet (GFD). The purpose of this study was to investigate whether the naturally gluten-free cereal Eragrostis tef (tef) is associated with health problems when used by CD patients. MATERIAL AND METHODS In March 2006, all 7990 members of the Dutch Celiac Disease Society were invited to complete a questionnaire on tef use and the development of symptoms after tef consumption. Respondents and their family members willing to participate were sent an extended questionnaire on the use of commercially available tef products and on the character of their subsequent symptoms. RESULTS Thirty-six percent responded to the first questionnaire of whom 53% consumed tef and 15% reported complaints. For the second questionnaire, out of the 1828 participants willing to complete it, 1545 had biopsy-proven CD (median duration GFD: 6.5 years (range: 0-66.5 years)). Of these, 66% used tef (median duration 1.4 years (range: 0.1-5 years)) and 17% reported symptoms after consumption. The percentage for symptoms was significantly lower than that in patients without tef consumption reporting on their regular GFD (17% versus 61%; p = 0.0001). CONCLUSIONS Tef is frequently used by Dutch CD patients and a wide majority can consume tef without experiencing any clinical symptoms. CD patients using tef reported a significant reduction in symptoms, possibly related to a reduction in gluten intake or to an increase in fiber intake. Hence, tef can be a valuable addition to the GFD of CD patients.
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Affiliation(s)
- Erica Hopman
- Department of Dietetics and Nutrition, Leiden University Medical Center, Leiden, The Netherlands.
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232
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Silvester JA, Rashid M. Long-term follow-up of individuals with celiac disease: an evaluation of current practice guidelines. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2007; 21:557-64. [PMID: 17853949 PMCID: PMC2657984 DOI: 10.1155/2007/342685] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Celiac disease can be treated by following a strict gluten-free diet for life. If properly followed, the diet resolves symptoms and nutritional deficiencies. It is generally recommended that individuals with celiac disease have careful long-term follow-up. However, it is not clear which elements of disease status evaluation, laboratory investigations and self-management support should be included in follow-up. OBJECTIVES To examine the current practice guidelines and recommendations regarding follow-up of individuals with celiac disease. METHODS Guidelines issued by gastroenterological societies and associations, and recommendations by experts were retrieved using Medline and other Internet search engines. RESULTS Practice guidelines were available from the American Gastroenterological Association; the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition; the National Institutes of Health Consensus Development Conference 2004; the World Gastroenterology Organization; the British Society for Gastroenterology and the United Kingdom-based Primary Care Society for Gastroenterology. Most guidelines recommended a scheduled annual review and regular measurements of body mass index. The British Society for Gastroenterology recommended dietary review only at times of stress, while others recommended dietary review with a nutritionist. All associations recommended serial tissue transglutaminase antibody testing. The American Gastroenterological Association and the Primary Care Society for Gastroenterology recommended annual hemoglobin, ferritin and folate checks. One guideline recommended annual hemoglobin, electrolyte, calcium, albumin, ferritin, folate, fat-soluble vitamin, liver function test, parathyroid hormone and bone density measurements (approximately $400 per patient). CONCLUSIONS The current practice guidelines regarding the follow-up of patients with celiac disease varied greatly in their recommendations and many were not evidence-based. Prospective studies are required to develop rational, cost-effective and risk-stratified guidelines for long-term follow-up of these patients.
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Affiliation(s)
| | - Mohsin Rashid
- Division of Gastroenterology and Nutrition, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia
- Correspondence: Dr Mohsin Rashid, Division of Gastroenterology, IWK Health Centre, Dalhousie University, 5850 University Avenue, Halifax, Nova Scotia B3K 6R8. Telephone 902-470-8746, fax 902-470-7249, e-mail
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233
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Sverker A, Ostlund G, Hallert C, Hensing G. Sharing life with a gluten-intolerant person--the perspective of close relatives. J Hum Nutr Diet 2007; 20:412-22. [PMID: 17845375 DOI: 10.1111/j.1365-277x.2007.00815.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Several studies indicate the importance of social support in the case of chronic disease. AIM The aim was to explore dilemmas experienced by close relatives living with a person suffering from coeliac disease, and to describe the strategies they used to deal with these dilemmas. METHODS Twenty-three informants were interviewed. A systematic inductive qualitative method, the critical incident technique was used. RESULTS Disease-related worries included having bad conscience about not being affected by the disease, experiencing anxiety and witnessing the vulnerability of the affected relative in social situations. Dilemmas related to manage daily life were connected with increased domestic work, restricted freedom of action and the diseased person's preferential right of interpretation of health risks associated with the coeliac disease and deviations from the diet restrictions. Dilemmas related to disturbances in social life, concerned lack of information, knowledge and understanding. Different strategies were described to manage daily life. CONCLUSIONS Close relatives experienced a variety of dilemmas that affected the situation of the whole family. The role of relatives in handling the coeliac disease with the diseased person in the everyday life might be underestimated, and to provide relatives with better knowledge regarding the disease might improve the situation also for patients.
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Affiliation(s)
- A Sverker
- Department of Public Health and Community Medicine, Social Medicine, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
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234
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Affiliation(s)
- Ellen Aslander-van Vliet
- Voeding & zo/, Diabeter, Center for paediatric and adolescent diabetes care and research, Rotterdam, The Netherlands
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235
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Affiliation(s)
- Andrew D Hopper
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield S10 2JF.
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236
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Rizzello CG, De Angelis M, Di Cagno R, Camarca A, Silano M, Losito I, De Vincenzi M, De Bari MD, Palmisano F, Maurano F, Gianfrani C, Gobbetti M. Highly efficient gluten degradation by lactobacilli and fungal proteases during food processing: new perspectives for celiac disease. Appl Environ Microbiol 2007; 73:4499-507. [PMID: 17513580 PMCID: PMC1932817 DOI: 10.1128/aem.00260-07] [Citation(s) in RCA: 188] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Presently, the only effective treatment for celiac disease is a life-long gluten-free diet. In this work, we used a new mixture of selected sourdough lactobacilli and fungal proteases to eliminate the toxicity of wheat flour during long-time fermentation. Immunological (R5 antibody-based sandwich and competitive enzyme-linked immunosorbent assay [ELISA] and R5 antibody-based Western blot), two-dimensional electrophoresis, and mass spectrometry (matrix-assisted laser desorption ionization-time of flight, strong-cation-exchange-liquid chromatography/capillary liquid chromatography-electrospray ionization-quadrupole-time of flight [SCX-LC/CapLC-ESI-Q-TOF], and high-pressure liquid chromatography-electrospray ionization-ion trap mass spectrometry) analyses were used to determine the gluten concentration. Assays based on the proliferation of peripheral blood mononuclear cells (PBMCs) and gamma interferon production by PBMCs and intestinal T-cell lines (iTCLs) from 12 celiac disease patients were used to determine the protein toxicity of the pepsin-trypsin digests from fermented wheat dough (sourdough). As determined by R5-based sandwich and competitive ELISAs, the residual concentration of gluten in sourdough was 12 ppm. Albumins, globulins, and gliadins were completely hydrolyzed, while ca. 20% of glutenins persisted. Low-molecular-weight epitopes were not detectable by SCX-LC/CapLC-ESI-Q-TOF mass spectrometry and R5-based Western blot analyses. The kinetics of the hydrolysis of the 33-mer by lactobacilli were highly efficient. All proteins extracted from sourdough activated PBMCs and induced gamma interferon production at levels comparable to the negative control. None of the iTCLs demonstrated immunoreactivity towards pepsin-trypsin digests. Bread making was standardized to show the suitability of the detoxified wheat flour. Food processing by selected sourdough lactobacilli and fungal proteases may be considered an efficient approach to eliminate gluten toxicity.
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Affiliation(s)
- Carlo G Rizzello
- Department of Plant Protection and Applied Microbiology, University of Bari, Bari, Italy
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237
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Leffler DA, Dennis M, Hyett B, Kelly E, Schuppan D, Kelly CP. Etiologies and predictors of diagnosis in nonresponsive celiac disease. Clin Gastroenterol Hepatol 2007; 5:445-50. [PMID: 17382600 DOI: 10.1016/j.cgh.2006.12.006] [Citation(s) in RCA: 225] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Nonresponsive celiac disease (NRCD) is a common problem affecting from 7% to 30% of celiac patients. Because NRCD comprises varied and potentially morbid entities, efficient and cost-effective patient care requires knowledge of the specific causes of this disorder. The aim of this study was to determine the common etiologies of NRCD in a tertiary referral center. METHODS All cases of biopsy examination-proven celiac disease (CD) seen at our institution over the preceding 5 years were included in this study. NRCD was defined as a failure to respond to at least 6 months of treatment with a gluten-free diet or the re-emergence of symptoms or laboratory abnormalities typical of CD while still on treatment with a gluten-free diet. RESULTS A total of 113 patients with NRCD meeting the earlier-described criteria were seen from a total of 603 patients with CD (19%), however, among patients for whom we provided primary specialist care the incidence of NRCD was 10% (P < .001). Gluten exposure was the most common cause of NRCD (36%), followed by irritable bowel syndrome (22%), refractory CD (10%), lactose intolerance (8%), and microscopic colitis (6%). The mean immunoglobulin A tissue transglutaminase level in the gluten-exposed group was 67 vs 17 U/mL (normal, <20) for other diagnoses (P < .05). Weight loss and male sex were highly predictive of refractory CD (P < .05 and < .001, respectively). CONCLUSIONS NRCD is a common phenomenon affecting 10%-19% of celiac patients. A limited number of etiologies account for the majority of cases. Clinical factors may be used to guide evaluation.
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Affiliation(s)
- Daniel A Leffler
- Department of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
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238
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Kiskini A, Argiri K, Kalogeropoulos M, Komaitis M, Kostaropoulos A, Mandala I, Kapsokefalou M. Sensory characteristics and iron dialyzability of gluten-free bread fortified with iron. Food Chem 2007. [DOI: 10.1016/j.foodchem.2006.05.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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239
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Gibert A, Espadaler M, Angel Canela M, Sánchez A, Vaqué C, Rafecas M. Consumption of gluten-free products: should the threshold value for trace amounts of gluten be at 20, 100 or 200 p.p.m.? Eur J Gastroenterol Hepatol 2006; 18:1187-95. [PMID: 17033440 DOI: 10.1097/01.meg.0000236884.21343.e4] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The threshold of gluten contamination in gluten-free products of both dietary and normal consumption is under debate. The objective of this study was to gather information on consumption of gluten-free products intended for dietary use of people under a gluten-free diet. This information is essential to ascertain the exposure of coeliac patients to gluten through their diet and deduce the maximum gluten content that these products should contain to guarantee a safe diet. METHODS A diet diary of consumption of gluten-free products intended for dietary use was distributed to the coeliac societies of two typical Mediterranean countries (Italy and Spain) and two Northern countries (Norway and Germany). The diet diary included a self-weigh table of the selected food items and a 10-day consumption table. Results were reported in percentiles as distributions were clearly right skewed. RESULTS The respondents included in the study accounted for 1359 in Italy, 273 in Spain, 226 in Norway and 56 in Germany. Gluten-free products intended for dietary use contributed significantly to the diet of coeliac patients in Italy, Germany and Norway and to a lesser degree in Spain. The most consumed gluten-free product in all countries was bread, and it was double consumed in the Northern countries (P<0.001). Mediterranean countries showed consumption of a wider variety of gluten-free foods and pasta was eaten to a large degree in Italy. CONCLUSIONS The differences between Northern and Mediterranean countries were not in the total amount of gluten-free products but in the type of products consumed. The observed daily consumption of gluten-free products results in the exposure to rather large amounts of gluten, thus the limit of 200 p.p.m. should be revised. A limit of 20 p.p.m. for products naturally gluten-free and of 100 p.p.m. for products rendered gluten-free is proposed to guarantee a safe diet and to enable coeliac patients to make an informed choice. These limits should be revised as new data become available.
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Affiliation(s)
- Anna Gibert
- SMAP Celíacs de Catalunya, Coeliac Society, Barcelona, Spain.
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240
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Abstract
PURPOSE OF REVIEW This article primarily aims to review critically research in all aspects of celiac disease over the last year. As always, there has been a wealth of relevant papers. RECENT FINDINGS The role of genetics in disease susceptibility is slowly becoming more clearly defined and a more detailed understanding of the disease processes at the molecular level is paving the way towards the development of specific targeted therapies. SUMMARY Despite recent advances in our understanding of celiac disease, the gluten-free diet remains the only current viable therapy and even with advances in serological tests and markers, the duodenal biopsy remains the gold standard for diagnosis and monitoring of the response to therapy.
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Affiliation(s)
- Richard B Jones
- Department of Academic Medicine, St James's University Hospital, Leeds, UK.
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241
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Sanders DS, Karajeh MA, Hurlstone DP. Letter to the editor: Empathy, empowerment, political will and a coeliac specialist dietitian in every hospital? J Hum Nutr Diet 2005; 18:467-8. [PMID: 16351706 DOI: 10.1111/j.1365-277x.2005.00653.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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242
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Rashid M. Diagnosing celiac disease with a positive serological test and without an intestinal biopsy. Pediatrics 2005; 116:1054-5; author reply 1055. [PMID: 16199727 DOI: 10.1542/peds.2005-1480] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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243
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Anderson AS. Diet and daily life. J Hum Nutr Diet 2005. [DOI: 10.1111/j.1365-277x.2005.00614.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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