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Pinto-Sanchez MI, Blom JJ, Gibson PR, Armstrong D. Nutrition Assessment and Management in Celiac Disease. Gastroenterology 2024; 167:116-131.e1. [PMID: 38593924 DOI: 10.1053/j.gastro.2024.02.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 04/11/2024]
Abstract
Celiac disease (CeD) is the most common immune condition affecting the gastrointestinal tract; it is triggered by gluten and the only available treatment is a strict gluten-free diet (GFD). Therefore, for patients with CeD, adopting a GFD is not a lifestyle choice. The major problem is that a GFD is restrictive and, like all restrictive diets, it has the potential for adverse nutritional outcomes, especially if adopted for a long term. It is well known that GFD can be nutritionally inadequate and is frequently associated with vitamin and mineral deficiencies; it is also associated with excessive sugar and fat intake, particularly when gluten-free substitutes are consumed. Consequently, people with CeD are affected by higher rates of overweight and obesity and metabolic complications, such as fatty liver and cardiovascular disease. Therefore, assessment of nutritional status and diet quality at diagnosis and while on a long-term GFD is key in the management of CeD. This narrative review addresses nutritional considerations in CeD and management of common challenges associated with a GFD.
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Affiliation(s)
- M Ines Pinto-Sanchez
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jedid-Jah Blom
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Peter R Gibson
- Central Clinical School, Department of Gastroenterology, Monash University, Clayton, Victoria, Australia
| | - David Armstrong
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
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Falcomer AL, de Lima BR, Farage P, Fabris S, Ritter R, Raposo A, Teixeira-Lemos E, Chaves C, Zandonadi RP. Enhancing life with celiac disease: unveiling effective tools for assessing health-related quality of life. Front Immunol 2024; 15:1396589. [PMID: 38742113 PMCID: PMC11089154 DOI: 10.3389/fimmu.2024.1396589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/15/2024] [Indexed: 05/16/2024] Open
Abstract
Celiac disease (CD) is an autoimmune chronic enteropathy provoked by gluten ingestion in genetically predisposed individuals. Considering it´s only safe treatment is a lifelong gluten-free diet, the burden of living with the disease becomes evident, as well as the need to assess CD health-related quality of life (HRQOL). This review aims to identify and analyze the instruments used to evaluate the HRQOL of adults with CD. This integrative review using a systematic approach was designed to achieve high scientific standards. Accordingly, the search strategy was developed and executed as recommended by the guideline of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Detailed individual searches were developed to Pubmed, Science Direct, Scopus, Web of Science, and Google Scholar. After careful analysis of the papers, 43 studies were included, in which seven instruments were identified: Celiac Disease Questionnaire (CDQ) (n=21), Celiac Disease Specific Quality of Life Instrument (CD-QOL) (n=17), Celiac Disease Assessment Questionnaire (CDAQ) (n=4), CeliacQ-7 (n=1), CeliacQ-27 (n=1), Black and Orfila´s self-developed instrument (n=1) and the Coeliac Disease Quality of Life Questionnaire (CDQL) (n=1). The CDQ and CD-QOL were the two most applied instruments. Since the first focuses on the physical and mental symptoms related to the disease and the second focuses on the emotional repercussions of adhering to the GFD treatment for life (dysphoria), the CDQ application is an interesting option for countries that struggle with public policies for CD patients and patients with active CD. The CD-QOL could be used for countries with strict regulations for CD and gluten-free products and populations in remission. When comparing results among different populations, it is preferable to utilize culturally validated instruments, which have been applied across multiple countries, providing greater comparability between study findings.
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Affiliation(s)
- Ana Luísa Falcomer
- Department of Nutrition, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
- Department of Nutrition, Centro Universitário IESB, Brasília, Brazil
| | - Bernardo Romão de Lima
- Department of Nutrition, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
- Department of Nutrition, Centro Universitário IESB, Brasília, Brazil
| | - Priscila Farage
- Faculty of Nutrition (FANUT), Federal University of Goiás, Goiânia, Brazil
| | - Samantha Fabris
- Department of Nutrition, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
| | - Ruth Ritter
- Department of Nutrition, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
| | - António Raposo
- CBIOS (Research Center for Biosciences and Health Technologies), Universidade Lusófona de Humanidades e Tecnologias, Lisboa, Portugal
| | | | - Cláudia Chaves
- ESSV, Centre for Studies in Education and Innovation (CI&DEI), Polytechnic University of Viseu, Viseu, Portugal
| | - Renata Puppin Zandonadi
- Department of Nutrition, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
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Silva LC, Nakano EY, Zandonadi RP. Division of Responsibility in Child Feeding and Eating Competence: A Cross-Sectional Study in a Sample of Caregivers of Brazilian Children with Celiac Disease. Nutrients 2024; 16:1052. [PMID: 38613085 PMCID: PMC11013579 DOI: 10.3390/nu16071052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 04/14/2024] Open
Abstract
The objective of this cross-sectional study was to assess eating competence (EC) and the adherence to the division of responsibility in child feeding (sDOR) of Brazilian caregivers of children with celiac disease (CD). It also examined the association between EC and sDOR, children's adherence to a gluten-free diet, and sociodemographic data. This study administered a survey set that included sociodemographic data, health-related data, eating habits, and the instruments ecSI2.0TMBR and sDOR.2-6yTM BR, validated for a Brazilian population. The sample comprised 50 caregivers of children with CD (between 24 and 72 months of age). The participants following a gluten-free diet (GFD) presented higher scores for all EC domains and the total EC. The total EC scores were higher for the participants over 40 y/o, frequently having meals as a family, with their children consuming more than three servings of fruit and at least one serving of vegetables daily and complying with a GFD. Different from the EC, the sDOR.2-6yTM scores did not differ between the participants complying with a GFD. The sDOR.2-6yTM mealtime structure domain scores were significantly associated with the EC eating attitude, food acceptance, contextual skills, and total. These findings support the need for greater attention to exploring the division of responsibility in feeding and EC in pediatric celiac disease, potentially enhancing intervention strategies for patients and their families.
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Affiliation(s)
- Larissa Caetano Silva
- Nutrition Department, Faculty of Health Sciences, University of Brasília, Campus Universitário Darcy Ribeiro, Brasília 70910-900, Brazil;
| | - Eduardo Yoshio Nakano
- Department of Statistics, University of Brasília, Campus Universitário Darcy Ribeiro, Brasília 70910-900, Brazil;
| | - Renata Puppin Zandonadi
- Nutrition Department, Faculty of Health Sciences, University of Brasília, Campus Universitário Darcy Ribeiro, Brasília 70910-900, Brazil;
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Silva LC, Nakano EY, Zandonadi RP. Eating competence in caregivers of celiac children: A cross-sectional study performed in Brazil. Nutrition 2024; 119:112326. [PMID: 38199032 DOI: 10.1016/j.nut.2023.112326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/29/2023] [Accepted: 12/06/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES Eating competence is an intraindividual approach to eating, behaviors, and attitudes related to eating, with repercussions on the individual and family. In pediatric celiac disease, the family is involved in the gluten-free diet management, the only treatment available. A gluten-free diet might affect eating competence because gluten-free diet compliance requires knowledge about food, meal planning, and attention to food choices. The objective is to access eating competence in caregivers of children with celiac disease and the association between caregivers' eating competence, children's adherence to a gluten-free diet, and sociodemographic data of participants. METHODS This cross-sectional study used a snowball spread method by applying a questionnaire, including sociodemographic data, data related to health, eating habits, and the Satter Eating Competence Inventory version validated for the Brazilian population. The sample consisted of 220 Brazilian parents or caregivers of celiac disease children. The scores of the Satter Eating Competence Inventory version validated for the Brazilian population were described in terms of means, SDs, medians, and interquartile range. Student's t test and analysis of variance followed by Tukey's post hoc tests were applied, and the association with the variables of interest was analyzed using Pearson χ2 tests. The tests were conducted considering bilateral hypotheses and a 5% significance level. RESULTS Participants' sex, schooling level, and income did not affect their eating competence. Competent eaters were mostly those with normal weight, following a gluten-free diet, with children complying with a gluten-free diet, and who have meals with family and prepare them at home. Different from vegetable consumption, participants' eating competence did not differ considering the frequency of children's fruit consumption. CONCLUSIONS The caregivers of children with celiac disease have greater eating competence scores than general Brazilian adults, and caregivers of children with celiac disease who comply with the gluten-free diet have higher eating competence scores.
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Affiliation(s)
- Larissa Caetano Silva
- Faculty of Health Sciences, Campus Universitário Darcy Ribeiro, University of Brasília, Brasília, Brazil
| | | | - Renata Puppin Zandonadi
- Nutrition Department, Faculty of Health Sciences, Campus Universitário Darcy Ribeiro, University of Brasília, Brasília, Brazil.
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Posterick A, Ayars CL. Celiac Disease Dietary Adherence on the Rural-Urban Continuum. Nutrients 2023; 15:4535. [PMID: 37960188 PMCID: PMC10649991 DOI: 10.3390/nu15214535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Poor adherence to a gluten-free diet for those with celiac disease is a well-established risk factor, leading to gastrointestinal symptoms, malabsorption of nutrients, and psychiatric complications. Previous studies have shown that those outside urban areas encounter unique barriers to dietary adherence and are less likely to engage in health management behaviors than those in urban regions. This study aimed to examine the relationship between gluten-free dietary adherence and individual, relationship, and community factors, including the geographic location of residence on the rural-urban continuum, for 253 adults with celiac disease living in the United States. Those with celiac disease residing in urban regions had significantly better dietary adherence than those residing in nonurban areas (p < 0.05). Those living in nonurban communities had, on average, poor enough adherence scores to suggest ongoing intestinal damage from gluten consumption. Geographic location, age, years since diagnosis, and annual income significantly predicted compliance with a gluten-free diet for those with celiac disease, accounting for nearly 20% of the variance. Those living outside urban areas with a lower income, younger age, and more recent diagnosis of celiac disease had the worst dietary adherence, placing them at the most risk for ongoing disease progression and complications.
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Affiliation(s)
- Amy Posterick
- College of Graduate Health Studies, A.T. Still University, 800 W. Jefferson St., Kirksville, MO 63501, USA;
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Systematic Review and Dose-Response Meta-Analysis on the Relationship between Different Gluten Doses and Risk of Coeliac Disease Relapse. Nutrients 2023; 15:nu15061390. [PMID: 36986121 PMCID: PMC10057462 DOI: 10.3390/nu15061390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/27/2023] [Accepted: 03/08/2023] [Indexed: 03/15/2023] Open
Abstract
Gluten proteins are known as immunological triggers for inflammation resulting in mucosal lesions in patients with coeliac disease (CD). Adherence to a strict gluten-free diet (GFD) is currently known as the only effective treatment for CD. In this study, we performed a systematic review and dose-response meta-analysis on data from previous studies to investigate the association between different gluten doses administered and the risk of CD relapse. Electronic databases were systematically searched to retrieve studies that investigated the response of CD patients to different amounts of gluten intake and evaluated the clinical, serologic, and/or histologic evidence to recognize disease relapse. Study-specific relative risks (RRs) were combined using a random effects model. A total of 440 identified published papers were screened, of which 7 records were selected following full-text reviewing and eligibility assessment for dose-response meta-analysis. According to our analysis, the risk of CD relapse is estimated to be 0.2% (RR: 1.002; 95% CI: 1.001 to 1.004) following the consumption of 6 mg gluten/day, which was increased to 7% (RR: 1.07; 95% CI: 1.03 to 1.10), 50% (RR: 1.50; 95% CI: 1.23 to 1.82), 80% (RR: 1.80; 95% CI: 1.36 to 2.38), and 100% (RR: 2.00; 95% CI: 1.43 to 2.78) by the daily intake of 150, 881, 1276, and 1505 mg gluten, respectively. Although good adherence to a GFD can adequately control CD-related symptoms, disease relapse might happen even with a very low dose of gluten, and the duration of exposure to gluten is also an important matter. The current literature has substantial limitations, such as relying on the data from just a few countries that were different in terms of the amount of gluten administered, the duration of the challenge, etc. Therefore, more randomized clinical trials using a standardized gluten challenge protocol are needed to confirm the findings of the present study.
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Asri N, Fallah S, Rostami-Nejad M, Fallah Z, Khanlari-Kochaksaraei M, Jafari-Marandi S, Forouzesh F, Shahrokh S, Jahani-Sherafat S, Zali MR. The role of mir-197-3p in regulating the tight junction permeability of celiac disease patients under gluten free diet. Mol Biol Rep 2023; 50:2007-2014. [PMID: 36536183 DOI: 10.1007/s11033-022-08147-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Celiac disease (CD) is a hereditary immune-mediated disorder, which is along with the enormous production of pro-inflammatory cytokines and the reduced level of tight junction proteins. The aim of this study was to determine the expression of TNF-α, IFN-γ, IL-18, Occludin, miR-122-5p and miR-197-3p genes in duodenal biopsies of treated CD patients in comparison to the controls. METHODS AND RESULTS Biopsy specimens were taken from the duodenum of 50 treated CD patients (36 (72%) females and 14 (28%) males with mean age of 37.06 ± 7.02 years) and 50 healthy controls (17 (34%) females and 33 (66%) males with mean age of 34.12 ± 4.9). Total RNA was isolated, cDNA was synthesized and mRNA expression of TNF-α, IFN-γ, IL-18, Occludin, miR-122-5p and miR-197-3p were quantified by relative qPCR using B2M and U6 as internal control genes. All data were evaluated using SPSS (V.21) and GraphPad Prism (V.5). Our results showed that there was no significant difference between patients and controls for intestinal mRNA expression of TNF-α, IFN-γ, IL-18, Occludin, and miR-122-5p (p > 0.05) and the expression of miR-197-3p was significantly increased in CD patients relative to control subjects (p = 0.049). CONCLUSION This study suggests that adherence to GFD may have a positive effect on the tight junction (TJ) permeability and in this process, miR-197-3p plays an important role. Increased expression of miR-197-3p with a final protective effect on Occludin expression can be further studied as a complement therapeutic target for Celiac disease.
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Affiliation(s)
- Nastaran Asri
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, 1985717411, Tehran, Iran
| | - Shayan Fallah
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, 1985717411, Tehran, Iran
| | - Mohammad Rostami-Nejad
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, 1985717411, Tehran, Iran.
| | - Zahra Fallah
- Department of Genetics, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Majid Khanlari-Kochaksaraei
- Department of Biology, Faculty of Biological Sciences, North Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Sayeh Jafari-Marandi
- Department of Biology, Faculty of Biological Sciences, North Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Flora Forouzesh
- Department of Genetics, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Shabnam Shahrokh
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somayeh Jahani-Sherafat
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Zali
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, 1985717411, Tehran, Iran
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