Nutritional therapy – Facing the gap between coeliac disease and gluten-free food

Amaranth and buckwheat grains: Nutritional profile, development of functional foods, their pre-clinical cum clinical aspects and enrichment in feed

The resurgence of interest in amaranth and buckwheat as nutrient-rich and versatile grains has incited extensive research aimed at exploring their potential benefits for sustainable agriculture and human nutrition. Amaranth is renowned for its gluten-free nature and exceptional nutritional profile, offering high-quality proteins, fiber, minerals, and bioactive compounds. Similarly, buckwheat is recognized for its functional and nutraceutical properties, offering a plethora of health benefits attributed to its diverse array of biologically active constituents; flavonoids, phytosterols, and antioxidants. This comprehensive review comprehends the existing understanding of the composition, anti-nutritional factors, biological activity, and potential application of these grains, emphasizing their pivotal role in addressing global food insecurity. Developed functional foods using these grains are having enhanced physicochemical properties, mineral content, phenolic content and overall sensory acceptability. In addition, the consumption of developed functional food products proved their health benefits against various type of anomalies. Moreover, enrichment of both grains in the animal feeds also showing positive health benefits.

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

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

Application of sourdough in gluten-free bakery products

ABSTRACTSIn recent years, the demand for gluten-free (GF) bakery products has grown rapidly due to the remarkable rising number of celiac patients and the increasing health awareness of GF products. However, GF products generally suffer from defects such as poor sensorial level, low nutritional value, high prices and short shelf life. Sourdough is the important starter culture applied in bakery field, and it has been proven to be ideal for enhancing the overall quality of bakery products. This review aims to systematically reviewed the application of sourdough in GF bakery products and its improvement to GF bakery products in terms of texture, shelf life, nutrition and flavor. Its positive effects derive from the complex metabolic activities of sourdough microorganisms, such as acidification, proteolysis, production of exopolysaccharides (EPS), activation of endogenous enzymes, and production of antibacterial substances. Finally, researchers are encouraged to expand the use of sourdough in GF bakery products to increase the variety of GF products. And the technical and nutritional potential of sourdough should be developed more widely.

Sunflower seed cake as a source of nutrients in gluten-free bread

An increase in the demand for cold-pressed vegetable oils can be observed, e.g. from sunflower. The press cake formed during sunflower oil production can also be an important source of protein, carbohydrates, and phenolic compounds. The aim of the study was to examine the quality of gluten-free breads fortified with sunflower seed cake. The fortified products were characterized by lower moisture content (49.35-48.87%). The bake loss parameter decreased after the use of the highest 15% dose of the sunflower cake. The addition of the sunflower cake caused an increase in the content of nutrients, compared to the control sample: protein (7.44-9.69%_d.b.), fat (3.41-10.72%_d.b.), crude fiber (1.23-2.34%_d.b.), polyphenols (89.3-222.3 mg·100 g_d.b.^-1), and soluble sugars (2.42-2.73%_d.b.). The gluten-free breads with the sunflower seed cake exhibited lower hardness, springiness, and chewiness but higher cohesiveness. The use of the additive contributed to the darkening of the gluten-free bread crumb. The appearance, consistency, aroma, and palatability of the sunflower cake-fortified gluten-free bread were found to be much more attractive than the parameters of the unmodified bread. The conducted research has shown that, thanks to sunflower cake addition, it is possible to obtain a highly nutritious product with desirable sensory quality.

Gleditsia triacanthos Galactomannans in Gluten-Free Formulation: Batter Rheology and Bread Quality

Gluten-free batters, in general, require the incorporation of agents to control their rheology; this role is commonly played by hydrocolloids. New natural sources of hydrocolloids are under permanent research. In this regard, the functional properties of the galactomannan extracted from the seed of Gleditsia triacanthos (Gledi) have been studied. In this work, we evaluated the incorporation of this hydrocolloid, alone and in combination with Xanthan gum, in gluten-free batters and bread and compared it with Guar gum. The incorporation of hydrocolloids increased the viscoelastic profile of the batters. Gledi addition at 0.5% and 1.25% increased the elastic modulus (G') by 200% and 1500%, respectively, and similar trends were observed when Gledi-Xanthan was used. These increases were more pronounced when Guar and Guar-Xanthan were used. The batters became firmer and more elastically resistant because of the addition of hydrocolloids; batters containing Gledi had lower values of these parameters than batters containing Gledi-Xanthan. The addition of Gledi at both doses significantly increased the volume of the bread compared to the control by about 12%, while when Xanthan gum was included, a decrease was observed, especially at higher doses (by about 12%). The increase in specific volume was accompanied by a decrease in initial crumb firmness and chewiness, and during storage, they were significantly reduced. Bread prepared with Guar gum and Guar-Xanthan gum combinations was also evaluated, and the trends observed were comparable to that of bread with Gledi gum and Gledi-Xanthan gum. The results showed that Gledi addition favors the production of bread of high technological quality.

Occurrence of Antibiotic Resistant Bacteria in Flours and Different Plant Powders Used in Cuisine

In recent years, several alimentary diseases have been connected with the consumption or tasting of raw flour and dough. Microbiological quality concern is also raising due to increased consumer demand for plant powders, while some of them can be consumed without prior thermal processing. In this study, we have focused on the occurrence of antibiotic-resistant coliform bacteria and enterococci in flour, plant powder and dough from Slovak retail. Our results indicated the presence of both total and antibiotic-resistant coliform bacteria and enterococci in the flour and powder samples. Lower numbers of the total, as well as resistant bacteria, were detected in flours compared to plant powders. Coliform bacteria isolates were predominantly identified as Klebsiella spp. and Enterobacter spp. Ampicillin resistance appeared in 97% of isolates followed by chloramphenicol resistance (22%) and tetracycline resistance (17%). The presence of the bla_SHV gene was confirmed in 13% of isolates. The tetA and tetE genes were present in 25% of isolates of coliform bacteria. The presence of enterococci was detected only in plant powders. Antibiotic-resistant strains were identified as the following: Enterococcus casseliflavus, E. gallinarium and E. faecium. Despite the isolates showing resistance to vancomycin, the presence of the vanA gene was not detected. The majority of antibiotic-resistant isolates belonged to the group of medium biofilm producers. None of these isolates showed efflux pump overproduction. Antibiotic-resistant coliform bacteria and enterococci were not detected in the processed doughs.

Personalised Nutritional Plan and Resistance Exercise Program to Improve Health Parameters in Celiac Women

Celiac disease (CD) is a permanent immune reaction to gluten in those with a genetic predisposition. This study was designed to evaluate menopause-associated symptoms, mood, bone quality, and IgA antibody levels in women with CD, untreated and treated with a gluten-free diet (GFD), and with or without resistance exercise. The randomised controlled trial was conducted on 28 Spanish women (>40 years old). Participants were divided into the following intervention groups: personalised gluten-free nutrition plan + exercise (GFD + E); personalised gluten-free nutrition plan (GFD); celiac controls (NO-GFD); and non-celiac controls (CONTROL). The participants responded to the Menopause Rating Scale and the Profile of Mood States (POMS) questionnaires. Bone quality was measured with ultrasound and IgA with a blood test. After 12 weeks of intervention, the GFD + E group showed significant improvement in urogenital symptoms and scored higher on the ‘vigour’ subscale of the POMS. Negative associations were found between the total score on the Menopause Rating Scale and the ‘vigour’ subscale of the POMS questionnaire. Only those women who underwent a personalised GFD nutritional intervention combined with resistance exercise demonstrated significant changes after the intervention.

Psychological, Physiological, and Physical Effects of Resistance Training and Personalized Diet in Celiac Women

Background

Gluten intolerance is a systemic process of autoimmune nature; it develops in genetically predisposed subjects with gluten ingestion. The only treatment for celiac disease (CD) is a lifelong strict gluten-free diet (GFD). This study was designed to evaluate adherence to a GFD, risk of an eating disorder, and nutritional status in adult CD patients undergoing different interventions.

Methods

A total of 28 Spanish women, aged 40 years or more, took part in a randomized controlled trial. Each group received a different intervention: group 1, gluten-free nutrition plan + exercise (GFD + E); group 2, gluten-free nutrition plan (GFD); group 3, celiac controls (NO-GFD); and group 4, non-celiac controls (CONTROL). The training was prescribed by a sport scientist. It was based on resistance training with elastic bands; beforehand a warm-up was performed and the resistance was increased progressively. The variables studied were adherence to the GFD, risk of eating disorders, blood values, and body composition.

Results

Celiac women with personalized nutritional planning presented greater adherence to a gluten-free diet (p < 0.001). Regarding leukocytes, significant differences were observed between the GFD and control groups (p = 0.004). Perimeters and folds did not decrease significantly.

Conclusion

Women with celiac disease who follow an adapted and personalized diet have a better adherence to a GFD compared to those who follow a non-professional diet, and therefore have a better immune system status (blood leukocytes).

Texture profile analysis and sensory evaluation of commercially available gluten-free bread samples

The need for better quality gluten-free (GF) bread is constantly growing. This can be ascribed to the rising incidence of celiac disease or other gluten-associated allergies and the widespread incorrect public belief, that GF diet is healthier. Although there is a remarkable scientific interest shown to this topic, among the numerous studies only a few deals with commercially available products. The gap between research and commercial reality is already identified and communicated from a nutritional point of view, but up to date texture studies of commercial GF breads are underrepresented. In this study, 9 commercially available GF bread were compared to their wheat-based counterparts from texture and sensory viewpoints. Results showed that among GF loaves products, some performed significantly better at hardness and springiness attributes during the 4-day-long storage test compared to the wheat-based products. Two of GF cob breads performed significantly better or on the same level as the wheat-based cob regarding to hardness and cohesiveness during 3 days. Among sensorial properties mouth-feel, softness and smell were evaluated as significantly better or similarly for some GF versus wheat-based products. Two GF bread had more salty taste which reduced the flavor experience. Both the texture and sensory data of the storage test indicate that the quality of some GF bread products has significantly improved in the recent years; they stayed comparable with their wheat-based counterparts even for a 4-day-long storage period.

Nutritional Improvement of Gluten-Free Breadsticks by Olive Cake Addition and Sourdough Fermentation: How Texture, Sensory, and Aromatic Profile Were Affected?

There is a growing need for gluten-free bakery products with an improved nutritional profile. Currently, gluten-free baked goods deliver low protein, fiber, and mineral content and elevated predicted glycaemic index (pGI). Olive cake (OC), a by-product from virgin olive oil extraction, is an excellent natural source of unsaturated fatty acids, dietary fiber and bioactive molecules, including polyphenols and tocopherols. In this framework, this study aimed at using two selected lactic acid bacteria and a yeast for increasing the antioxidant features and the phenol profile of the gluten-free breadsticks fortified with OC with the perspective of producing a functional food. Control (CTR) samples were prepared and compared with fermented ones (fCTR). Samples were added with either non-fermented OC (nfOC) or fermented for 12 and 20 h (fOC-12 and fOC-20). Our results showed that the predicted glycemic index (pGI) was influenced by both OC addition and sourdough fermentation. In fact, the lowest value of pGI was found in fOC-12, and hydrolysis index and pGI values of samples with OC (fOC-12 and nfOC) were statistically lower than fCTR. Both OC addition and fermentation improved the total phenol content and antioxidant activity of breadsticks. The most pronounced increase in hardness values was observed in the samples subjected to sourdough fermentation as evidenced both from texture profile analysis and sensory evaluation. Moreover, in most cases, the concentration of the detected volatile compounds was reduced by fermentation. Our work highlights the potential of OC to be upcycled in combination with fermentation to produce gluten-free breadsticks with improved nutritional profile, although additional trials are required to enhance textural and sensory profile.

Techno-Functional and Gelling Properties of Acha (Fonio) (Digitaria exilis stapf) Flour: A Study of Its Potential as a New Gluten-Free Starch Source in Industrial Applications

Fonio (Digitaria exilis Stapf) is an ancient African cereal that represents a rich source of carbohydrate, fat, fiber, vitamins, minerals, and sulfur-containing amino acids. Processing and utilization of fonio require adequate knowledge of its structural, chemical, and nutritional characteristics. The present work evaluates the structural, techno-functional, and gelling properties of fonio and compares them to other major gluten-free cereals (rice, maize, sorghum, and millet). Fonio flour presented significantly higher water absorption index and swelling power, while it scored a lower water solubility index than the reference flours. The pasting viscosity profile of fonio was similar to that of rice, with equivalent peak viscosity but a breakdown viscosity 24% lower than rice, indicative of higher stability and resistance to shearing and heating. Rheological properties demonstrated that fonio generates gels with remarkably strong structures. At 15% concentration, fonio gel withstood stress 579% higher than those observed in the reference flours without breaking its structure. Fonio flour presented the highest gelatinization enthalpy (11.45 J/g) and a narrow gelatinization temperature range (9.96 °C), indicative of a better-packed starch structure than the other analyzed flours. The texture of the gels made with fonio showed higher firmness over the evaluated period. These combined results suggest that fonio is a suitable ingredient for gel-like food formulations.

Identification of dominant lactic acid bacteria and yeast in rice sourdough produced in New Zealand

This study characterised a commercial New Zealand gluten free (GF) rice sourdough and its starter culture composition. Acidity of the mother sourdough, dough before proofing and dough after proofing was determined during the production of rice sourdough bread, and colour was measured for the baked bread. Yeast and lactic acid bacteria (LAB) were enumerated in the rice sourdough samples and representative colonies characterised using API kits and sequenced by the Internal Transcribed Spacer and 16 S rRNA region. Sourdough LAB isolates were identified as Lactobacillus (L.) papraplantarum DSM 10667 and L. fermentarum CIP 102980 and the yeast isolates as Saccharomyces (S.) cerevisiae CBS 1171. Dough acidity increased significantly (p < 0.05) during fermentation due to the metabolic activities of the sourdough cultures. After baking, the colour of the rice sourdough bread crust was similar to that of unleavened wheat bread (golden brown). The improved colour of the rice sourdough bread crust may be a result of combined use of sourdough technique and optimal baking conditions. The results of this study may allow bakers to improve the overall quality of GF rice sourdough baked bread by selecting suitable fermentation and baking parameters.

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Gluten-free rice sourdough bread. Rice sourdough fermentation of gluten-free bread improved bread crust colour

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Rice sourdough LAB identified as Lactobacillus paraplantarum CIP 102980 and Lactobacillus fermentarum DSM 10667

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Yeast isolated from rice sourdough was identified as S. cerevisiae CBS 1171.

Nutritional facts regarding commercially available gluten-free bread worldwide: Recent advances and future challenges

Recently, there has been an increase in demand for gluten-free (GF) products due to the growing number of gluten-intolerant and healthy individuals choosing to follow a gluten-free diet. Gluten-free bread (GFB) is a staple food product; therefore, many recent studies have reported the nutritional properties of GFB. However, an overview of the current ingredients and nutritional labeling of GFB worldwide has not yet been provided. This review aimed to gather the latest information regarding the most used ingredients in GFB formulations and the nutritional quality of these products from different countries, based on studies published in the last decade (2010-2020). Our analysis showed that GFB had a lower protein and a higher fat content than gluten-containing bread, and the dietary fiber content was highly variable between countries. Some studies have revealed a high glycaemic index in most products, which is associated with the extensive use of rice flour and starch as the main ingredients in GFB formulation. Label information presented significant differences from the data obtained through the chemical analysis of fiber and other nutritional components. Micronutrient fortification is not common in the GFB. The nutritional quality of commercial GFB is a crucial issue that needs to be addressed.

Tritordeum breads are well tolerated with preference over gluten-free breads in non-celiac wheat-sensitive patients and its consumption induce changes in gut bacteria

BACKGROUND

The ingestion of wheat and other cereals are related to several gut disorders. The specific components responsible for non-celiac wheat-sensitivity (NCWS) may include gluten and other compounds. Tritordeum is a new cereal derived from crossing durum wheat with a wild barley species, which differs from bread wheat in its gluten composition. In the present work, we examined the response of NCWS patients to tritordeum bread Gastrointestinal symptoms as well as tritordeum acceptability, gluten immunogenic peptides excretion, and the composition and structure of the intestinal microbiota were evaluated.

RESULTS

Gastrointestinal symptoms of the subjects showed no significant change between the gluten-free bread and the tritordeum bread. Participating subjects rated tritordeum bread higher than the gluten-free bread. Analysis of the bacterial gut microbiota indicated that tritordeum consumption does not alter the global structure and composition of the intestinal microbiota, and only a few changes in some butyrate-producing bacteria were observed.

CONCLUSIONS

All the results derived from acceptability, biochemical and microbiological tests suggest that tritordeum may be tolerated by a sub-set of NCWS sufferers who do not require strict exclusion of gluten from their diet. © 2020 Society of Chemical Industry.

Use of Underexploited Flours for the Reduction of Glycaemic Index of Gluten-Free Biscuits: Physicochemical and Sensory Characterization

The type and the amount of starch present in bakery products affect their glycaemic index. The control of glycaemic index in our diet can be relevant to reduce the risk of type 2 diabetes and heart diseases. The use of alternative flours to rice, maize, and their starches may improve the nutritional quality of gluten-free baked goods by reducing the glycaemic index. This work aimed at the formulation of satisfactory gluten-free biscuits by using underexploited flour mixes (from cereals, pseudocereals, and legumes), at the evaluation of their physical properties, starch digestibility and subsequent estimation of the glycaemic index. The presence of chickpea flour increased biscuit hardness and gluten-free flours darkened biscuit surface. The greatest differences in starch composition and its digestion were found between gluten-free samples and wheat-containing control. Experimental biscuits had also a lower predicted glycaemic index compared to commercial products, whereas experimental formulations presented similar values between each other. Consumers’ acceptance and sensory profiling by Check All That Apply questionnaire were carried out. All formulations but one were above the acceptance threshold (50); crumbliness and easiness to swallow were drivers of acceptance, whereas sandiness exerted a negative impact on liking score.

Mycotoxin Occurrence and Risk Assessment in Gluten-Free Pasta through UHPLC-Q-Exactive Orbitrap MS

Celiac disease (CD) is a genetic-based autoimmune disorder which is characterized by inflammation in the small intestinal mucosa due to the intolerance to gluten. Celiac people should consume products without gluten, which are elaborated mainly with maize or other cereals. Contamination of cereals with mycotoxins, such as fumonisins (FBs) and aflatoxins (AFs) is frequently reported worldwide. Therefore, food ingestion is the main source of mycotoxin exposure. A new analytical method was developed and validated for simultaneous analysis of 21 mycotoxins in gluten-free pasta, commonly consumed by celiac population as an alternative to conventional pasta. Ultrahigh-performance liquid chromatography coupled to quadrupole Orbitrap high-resolution mass spectrometry (UHPLC-Q-Exactive Orbitrap MS) was used for analyte separation and detection. The mycotoxins included in this work were those widely reported to occur in cereal samples, namely, ochratoxin-A (OTA), aflatoxins (AFB1, AFB2, AFG1 and AFG2), zearalenone (ZON), deoxynivalenol (DON), 3-acetyl-deoxynivalenol and 15-acetyl-deoxynivalenol (3-AcDON and 15-AcDON, respectively), nivalenol (NIV), neosolaniol (NEO), fusarenone-X, (FUS-X), T-2 toxin (T-2) and HT-2 toxin (HT-2), fumonisin B1 and B2 (FB1 and FB2, respectively), enniatins (ENN A, ENN A1, ENN B and ENN B1) and beauvericin (BEA). The validated method was successfully applied to 84 gluten-free pasta samples collected from several local markets of Campania region (Italy) during September to November 2020 to monitor the occurrence of mycotoxins and to assess the exposure to these food contaminants. A significant number of samples (95%) showed mycotoxin contamination, being Fusarium mycotoxins (FB1, ZON and DON) the most commonly detected ones. Regarding the risk assessment, the higher exposures were obtained for NIV, DON and FB1 for children and teenagers age group which can be explained due to their lower body weight.

Small and Large Intestine (I): Malabsorption of Nutrients

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

All Things Gluten: A Review

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

Design of a "Clean-Label" Gluten-Free Bread to Meet Consumers Demand

The market of gluten-free (GF) products has been steadily increasing in last few years. Due to the technological importance of gluten, the GF food production is still a challenge for the industry. Indeed, large quantities of fat, sugars, structuring agents, and flavor enhancers are added to GF formulations to make textural and sensorial characteristics comparable to conventional products, leading to nutritional and caloric intake imbalances. The formulation of the novel "clean-label" GF bread included a commonly used mixture of maize and rice flour (ratio 1:1) fortified with selected protein-rich flours. Naturally hydrocolloids-containing flours (psyllium, flaxseed, chia) were included in the bread formulation as structuring agents. A type-II sourdough was obtained by using a selected Weissella cibaria P9 and a GF sucrose-containing flour as substrate for fermentation to promote the exo-polysaccharides synthesis by the starter lactic acid bacterium. A two-step protocol for bread-making was set-up: first, the GF sourdough was fermented (24 h at 30 °C); then, it was mixed with the other ingredients (30% of the final dough) and leavened with baker's yeast before baking. Overall, the novel GF bread was characterized by good textural properties, high protein content (8.9% of dry matter) and in vitro protein digestibility (76.9%), low sugar (1.0% of dry matter) and fat (3.1% of dry matter) content, and an in vitro predicted glycemic index of 85.

Evaluation of nutritional characteristics and consumers’ acceptance of gluten-free sweet biscuits made from rice-based pregelatinized composite flours containing orange pomace and soy protein isolate

Gluten-free bakery products are usually deficient in dietary fiber and inferior sources of protein. Studies that have assessed sensory characterization of products prepared with orange pomace are scarce. This study evaluated the employment of 30% of rice-based pregelatinized composite flours (containing 15, 25 or 35% orange pomace blended with 5% soy protein isolate) on gluten-free biscuits. The target was the investigation of the nutritional profile and consumer’s acceptance of three short dough sweet biscuit samples. Thermoplastic extrusion was an efficient unit operation for the elaboration of a new gluten-free ingredient in which a by-product rich in total dietary fiber and a component with a high level of protein were employed. All pregelatinized composite flours in this study can be labeled as protein sources and can be claimed as high in total dietary fiber content, as well as two biscuit samples that can be labeled as total dietary fiber source. Also, all pregelatinized composite flours and biscuits presented low moisture and water activity, being microbiologically stable to room temperature (25 ± 2 °C). Complementarily, the results of the microbiological evaluations [(coagulase-positive Staphylococcus, thermotolerant coliform (45 °C) and Salmonella sp. (absence in 25 g)] of the biscuits and their comparison with the Brazilian microbiological standards legislation attested their safety. Concerning the sensory analysis, adults’ results showed that the flavor attribute might be responsible for increasing the overall impression score of a sample. In contrast, children’s results showed that they did not distinguish (p ≥ 0.05) two of three samples of biscuits analyzed.

Non-Celiac Gluten Sensitivity in the Context of Functional Gastrointestinal Disorders

Gluten-free diets are increasingly chosen in the Western world, even in the absence of a diagnosis of celiac disease. Around 10% of people worldwide self-report gluten-related complaints, including intestinal and extra-intestinal symptoms. In most cases, these subjects would be labeled as patients suffering from irritable bowel syndrome (IBS) who place themselves on a gluten-free diet even in the absence of celiac disease. In some instances, patients report a clear benefit by avoiding gluten from their diet and/or symptom worsening upon gluten reintroduction. This clinical entity has been termed non-celiac gluten sensitivity (NCGS). The symptoms referred by these patients are both intestinal and extra-intestinal, suggesting that similarly to functional gastrointestinal disorders, NCGS is a disorder of gut-brain interaction. It remains unclear if gluten is the only wheat component involved in NCGS. The mechanisms underlying symptom generation in NCGS remain to be fully clarified, although in the past few years, the research has significantly moved forward with new data linking NCGS to changes in gut motility, permeability and innate immunity. The diagnosis is largely based on the self-reported reaction to gluten by the patient, as there are no available biomarkers, and confirmatory double-blind challenge protocols are unfeasible in daily clinical practice. Some studies suggest that a small proportion of patients with IBS have an intolerance to gluten. However, the benefits of gluten-free or low-gluten diets in non-celiac disease-related conditions are limited, and the long-term consequences of this practice may include nutritional and gut microbiota unbalance. Here, we summarize the role of gluten in the clinical features, pathophysiology, and management of NCGS and disorders of gut-brain interaction.

Determinants of gluten-free diet adoption among individuals without celiac disease or non-celiac gluten sensitivity

OBJECTIVES

Gluten-free (GF) foods are typically less nutritious and more expensive than their gluten-containing variants, yet people without a diagnosed gluten sensitivity continue to adopt this diet. There is a lack of research about what factors drive people without Celiac disease or non-Celiac gluten sensitivity to follow the GF diet.

METHODS

A nationally representative sample of 2982 US residents without a diagnosed gluten sensitivity were surveyed about their attitudes, perceptions, and experiences with the GF diet. Logistic regression was used to compare respondents who were currently avoiding or had avoided gluten previously (GF consumer) to respondents who had never tried a GF diet (non-GF consumer).

RESULTS

Over one-fifth of respondents were GF consumers. Beliefs that a gluten-reduced diet is healthier (OR 1.69; 95% CI [1.30,2.18]), that GF products are more nutritious (OR 1.46, 95% CI [1.11,1.90), and that a GF diet can help clear acne (OR 1.46; 95% CI [1.13,1.88]) were all positively associated with trying a GF diet. Personal research was the most influential source of information associated with trying a GF diet (OR 2.92; 95% CI [1.91,4.52]). This was followed by "healthcare center or health professional" (OR 2.57; 95% CI [1.71,3.90]. Respondents who were never encouraged to try the GF diet were less likely to try the diet (OR 0.33, 95% CI [0.23,0.46]).

CONCLUSIONS

Positive, but scientifically unsubstantiated, beliefs about the benefits of the GF diet were strongly associated with trying a GF diet, and the source of recommendation to try a GF diet was important.

Effect of Substitution of Rice Flour with Quinoa Flour on the Chemical-Physical, Nutritional, Volatile and Sensory Parameters of Gluten-Free Ladyfinger Biscuits

The present study investigates the effect of partial or total substitution of rice flour (RF) with quinoa flour (QF) (at 25%, 50%, 75% and 100%) on the chemical-physical, nutritional, and sensory characteristics, as well as the volatile compounds, of ladyfinger biscuits. All quinoa-based formulations positively affected the crust colour, endowing it with lower ‘lightness’ and higher ‘redness’ values, giving the biscuits a more appealing crust colour. Biscuits with higher percentages of QF also had better structure, as they were softer. The substitution of RF with QF significantly improved the nutritional profile of the biscuits, as a result of the increase in protein, lipid, ash, total soluble (SP) and insoluble polyphenol (IP), flavonoid, and antioxidant activity levels, which increased linearly with the substitution rate. Quinoa supplementation led to an increase in volatile compounds that were nearly always characterised by positive olfactory attributes. Sensory analysis revealed that the maximal substitution rate of QF able to maintain an adequate consumer acceptability rating is probably 50%, as higher percentages impaired acceptability due to the presence of herbaceous and bitter tastes, even if the consumers also rated these samples as healthier and softer to touch.

Pseudocereal grains: Nutritional value, health benefits and current applications for the development of gluten-free foods

Nowadays, consumers are more conscious of the environmental and nutritional benefits of foods. Pseudocereals grains, edible seeds belonging to dicotyledonous plant species, are becoming a current trend in human diets as gluten-free (GF) grains with excellent nutritional and nutraceutical value. Pseudocereals are a good source of starch, fiber, proteins, minerals, vitamins, and phytochemicals such as saponins, polyphenols, phytosterols, phytosteroids, and betalains with potential health benefits. The present review aims to summarize the nutritional quality and phytochemical profile of the three main pseudocereal grains: quinoa, amaranth and buckwheat. In addition, current evidence about their health benefits in animal models and human studies is also provided in detail. Based on the accumulating research supporting the inclusion of pseudocereals grains in the diet of celiac persons, this review discusses the recent advances in their application for the development of new GF products. Future directions for a wider cultivation and commercial exploitation of these crops are also highlighted.

Tools Used to Measure the Physical State of Women with Celiac Disease: A Review with a Systematic Approach

Celiac disease (CD) is an immunological disorder that mainly affects the small intestine, generating an inflammatory process in response to the presence of gluten (a protein). Autoimmune diseases are part of a group of diseases that are difficult to diagnose without a specific protocol or consensus to detect them due to the number of symptoms and diseases with which it has a relationship. Therefore, the aim of this review was to analyze the diagnostic tools of CD used in middle-aged women, to compare the use and effectiveness of the different tools, and to propose a strategy for the use of the tools based on the results found in the literature. The present research followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The search was conducted in the following databases: Scielo, PubMed, Web of Science, and Worldwide Science org. In the initial literature search, 2004 titles and relevant abstracts were found. Among them, 687 were duplicates, leaving 1130 articles. Based on the inclusion criteria, only 41 articles passed the selection process; 4 main types of analyses appear in the studies: blood tests, questionnaires, clinical history, and biopsy. It can be said that none of the analyses have a 100% reliability since most of them can present false negatives; therefore, the best way to diagnose celiac disease up to now is through a combination of different tests (Immunoglobulin A and small intestinal biopsy).

STUDY OF MICROBIAL POLYSACCHARIDES’ IMPACT ON ORGANOLEPTIC AND PHYSICAL-CHEMICAL PARAMETERS OF PROTEIN-FREE AND GLUTEN-FREE FLOURY PRODUCTS

The aim of the study is to investigate the influence of microbial polysaccharides (MPS): xampan, enposan and gellan on quality parameters of protein-free and gluten-free floury products that will widen the assortment of stiffeners of the microbial origin in technologies of gluten-free products. The formation of the required quality indicators of gluten-free dietary bakery and floury confectionery, which should be made without wheat flour, is difficult due to the lack of gluten. The search for effective structure-forming agents in place of gluten proteins is ongoing. Properties of microbial polysaccharides are considered and the possibility of their use for gluten-free products is investigated. The influence of microbial polysaccharides (MPS) of xanthan, enposan and gellan on the organoleptic parameters of protein-free bread, based on corn starch and gluten-free muffins, based on wheat germ meal was investigated. Their specific volume is determined. The structural-mechanical properties of bread crumbs and muffins on an automated penetrometer in terms of compressibility are determined. It is shown, that the use of MPS in certain quantities leads to the formation of susceptible organoleptic characteristics, increases the specific volume of products and ensure the elastic structure of the baked goods. All the investigated MPS have the same character of influence on certain indicators, but the greatest effect is revealed by xanthan, the least – by gellan

Amelioration in gliadin antigenicity and maintenance of viscoelastic properties of wheat (Triticum aestivum L.) cultivars with mixed probiotic fermentation

Sourdough fermentation of twenty wheat cultivars was carried out using mixed probiotic culture (Lactobacillus acidophilus UNI, Lactobacillus brevis LR/5 and Lactobacillus plantarum ATCC 8014). The gliadin antigenicity was expressed in terms of its content in twenty different wheat cultivars. The gliadin proteins were characterized by SDS-PAGE and structural changes analyzed on FTIR spectrophotometer. Moreover, changes in the viscoelastic character of fermented and non-fermented dough were studied by rheometry. The results showed a remarkable reduction in antigenicity by 60% (average) in all wheat cultivars on sourdough fermentation. This reduction may be due to the synergistic effect of protease secretion by mixed lactobacilli, responsible for gliadin degradation. These changes in gliadins by mixed culture proteolysis were confirmed on SDS-PAGE on observing new gliadin-derived low molecular weight peptides. The results were further validated by FTIR spectroscopy where structural changes of gliadins were analyzed in the fermented dough. The rheological data indicated a higher storage modulus (G') compared to loss modulus (G″) in both control and fermented flour of all wheat cultivars, however, with a lower efficacy in sourdoughs. The present study thus establishes that mixed culture sourdough fermentation decreases the antigenic potential of gliadins without any change in the rheology and thereby maintaining the baking or viscoelastic properties of the wheat flour.

IRRITABLE BOWEL SYNDROME, FOOD INTOLERANCE AND NON- CELIAC GLUTEN SENSITIVITY. A NEW CLINICAL CHALLENGE

Approximately 80% of irritable bowel syndrome (IBS) patients report that their symptoms are triggered after ingesting one or specific food groups. Gluten, wheat and related proteins (e.g., amylase-trypsin inhibitors, and fermentable oligo-di-mono-saccharides and polyols (FODMAPs) are the most relevant IBS symptom triggers, although the true 'culprit(s)' is/are still not well established. The concept of causal relationship between gluten intake and the occurrence of symptoms in the absence of celiac disease and wheat allergy was termed non-celiac gluten sensitivity (NCGS). The borderline between celiac disease, wheat allergy, IBS and NCGS is not always clearly distinguishable, and the frequency and clinical identity of NGCS are still unclear. An overlap between IBS and NCGS has been detected. The incomplete knowledge of the etiopathogenesis of these clinical conditions, lack of data on their real epidemiology, as well as the absence of a gold standard for their diagnosis, make the overall picture difficult to understand "It is crucial to well define the interaction between IBS, food intolerance and NGCS, since the role of diet in IBS and its dietary management is an essential tool in the treatment of a large number of these patients". The objective of the present review is to provide an overview highlighting the interaction between IBS, food intolerance and NCGS in order to unravel whether gluten/wheat/FODMAP sensitivity represents 'facts' and not 'fiction' in IBS symptoms.

Economic effect of innovative flour-based functional foods production

The article presents the analysis of economic effect for the innovative flour-based functional foods production incorporation. Based on the analysis of the current state and prospects for the bakery industry development, the authors propose to expand the range of flour-based foods meant for dietary preventive and dietary therapeutic nutrition using diversification methods. For this, they used alternative recipe ingredients of plant origin, such as amaranth seeds, lentil and lupine seeds, chufa, and carob beans. The innovative technologies improve the chemical composition and consumer characteristics of the foods, provide meeting the market requirements, and increase the efficiency of financial and material resources, which, as a result, facilitates the food competitiveness and leads to the bakery industry effective development. We propose to evaluate the economic effect of innovative foods by determining the retail price and profit with a minimum 10% cost effect. The calculations of economic indicators for traditional and new flour-based foods are presented. Estimated economic efficiency of 1 tonne bakery foods for the standard and high-protein diets (according to therapeutic nutrition diet classification) is 5,030–10,740 rbls, flour confectionary foods – 11,022 rbls, gluten-free breads – 7,625–16,990 rbls, depending on the constituents and bakery technology. The results provide strong evidence of economic effect and the advantages of functional flour-based foods introduction.

New Protocol for Production of Reduced-Gluten Wheat Bread and Pasta and Clinical Effect in Patients with Irritable Bowel Syndrome: A randomised, Double-Blind, Cross-Over Study

It has been suggested that sourdough fermented products have beneficial health effects. Fungal proteases and selected sourdough lactic acid bacteria were used to produce wheat bread and pasta with a reduced-gluten content (<50% of traditional products). Fermentable oligo-, di- and mono- saccharides and polyols and amylase/trypsin inhibitors were also evaluated. The sensorial features of new products were similar to traditional ones. The efficacy of these new products in reducing the severity of symptoms in Irritable Bowel Syndrome (IBS) patients were compared to traditional bread and pasta using a randomized, crossover-controlled trial. While on a strict gluten-free diet, patients were randomized to consume a reduced- or normal-gluten diet for 2weeks; then, patients from both arms started the wash-out period of one week, and subsequently started the final 2-week period on a normal or reduced-gluten diet. Compared to normal-gluten content, the administration of a reduced-gluten content diet resulted in a decrease of the Visual Analogue Scale score (p = 0.042), while no differences were found in the IBS-Severity Score, Hospital Anxiety and Depression Scale, and IBS-Quality of Life. Data herein reported are novel encouraging findings that should spur a new avenue of research aiming to develop products specifically designed for IBS patients.

Gliadin protein antigenicity and health benefitting potential of Indian bread wheat (Triticum aestivum L.) varieties

Health benefitting potential of twenty leading wheat varieties was assessed for grain nutritional quality status in relation to antigenic reactivity level of gluten protein fractions. Among the nutritional parameters, macronutrients viz. starch, total sugar, total protein and gluten content were observed maximum in the varieties RAJ4120, RAJ4083, RAJ3077, and WH1021 respectively. Micronutrients- zinc and iron and phytochemicals- total phenolics and flavonoids were observed to be maximum in RAJ4083. Among the four protein fraction, albumin and globulin contents were the highest in RAJ3077, whereas gliadin and gluten content was maximum in GW322 and minimum in RAJ4120. The varieties were also characterized by SDS-PAGE and the results revealed significant polymorphism in all of the four protein fractions. The antigenic properties of flour gliadin proteins as evaluated by ELISA revealed that all the varieties possessed antigenicity with highest level in GW322 (0.217 OD). However, all the varieties possessed good baking qualities as studied by rheological measurements.

The Handbook of Minerals on a Gluten-Free Diet

The importance of a gluten-free diet (GFD) in the treatment of celiac disease and other gluten-related disorders is undisputable. However, strict GFD often lead to nutritional imbalances and, therefore, to deficiencies. One of the most common deficiencies from a GFD are an insufficient amount of Ca, Fe, Mg, and Zn. This is mainly because the most of popular gluten-free (GF) raw materials are poor in minerals. Although the popularity of GFD is constantly growing, the data on minerals in GF products are still limited. More importantly, an access to the data is even more restricted. Therefore, the paper reviews the Ca, Fe, Mg, and Zn contents in hundreds of grain GF products available worldwide. The data for 444 products from categories of flours, mixes for cooking, bakery products, cereals, groats, rice, and pasta are obtained from research papers and nutritional databases. The calculation of the realization of mineral requirements from a portion of each product with its graphical classification as rich/average/poor source of each mineral is given. The review is a handbook of minerals for people on a GFD, dietitians, and food producers.

Non-coeliac gluten sensitivity and the spectrum of gluten-related disorders: an updated overview

The spectrum of gluten-related disorders includes coeliac disease (CD), wheat allergy (WA) and the suggested entity of non-coeliac gluten sensitivity (NCGS). An increasing number of the world's population are avoiding gluten due to the assumption of health benefits and self-diagnosed gastrointestinal and/or extra-intestinal symptoms. Unlike CD and WA, NCGS is a relatively new entity with an unknown prevalence and mechanisms, complicated by recent literature suggesting that gluten is not the only food component that may trigger symptoms experienced by this group of patients. The term 'non-coeliac wheat sensitivity' has been proposed as a more accurate term, allowing inclusion of other non-gluten wheat components such as fructans and amylase-trypsin inhibitors. There is inconsistent evidence when evaluating the effects of a gluten challenge in patients with suspected NCGS and there is a need for a standardised procedure to confirm the diagnosis, ultimately enabling the optimisation of clinical care. The present review will give an overview of the different gluten-related disorders and discuss the most recent scientific evidence investigating NCGS.

Designing a Score-Based Method for the Evaluation of the Nutritional Quality of the Gluten-Free Bakery Products and their Gluten-Containing Counterparts

Gluten-free (GF) products are consumed both by individuals with celiac disease and by an increasing number of people with no specific medical needs. Although the technological quality of GF products has been recently improved, their nutritional quality is still scarcely addressed. Moreover, the few published studies report conflicting results, mostly because the information from product nutrition facts is the only considered factor. The aim of the present study was to develop a score-based method for the nutritional evaluation of 134 packaged Italian GF bakery products and to compare it with that of 162 matched gluten-containing (GC) food items. The score included the information from the nutrition facts and the presence/absence of some nutritionally relevant components in the ingredients list. Results indicated an overall low nutritional quality of the considered GF bakery products. Additionally, with the sole exception of GF bread substitutes, there was no difference in nutritional quality between GF and equivalent GC bakery products. Future research and development of GF bakery products may take advantage of this scoring method, as it may represent an easy approach to evaluate their nutritional quality. The present findings do not justify the consumption of packaged GF bakery products by people without any specific medical needs.