Part of celiac population still at risk despite current gluten thresholds

Development of gluten-free craft beer: Impact of brewing process on quality attributes and consumer expectations for sensory properties

To date, few studies investigated the differences between the two main gluten-free (GF) brewing techniques, such as the use of enzymes and the use of unconventional GF grains in brewing, by consumer perspective. In this study a GF beer brewed with sorghum and quinoa, as brewing adjuncts, was compared to the enzymatic-treated counterpart, in order to evaluate the effect of deglutinization treatment on physicochemical, volatile, and sensory characteristics of final beer. Moreover, the influence of brewing process and raw materials information on consumers' sensory perceptions, willingness to buy (WTB) and willingness to pay (WTP) was also investigated (n = 105 consumers), under blind (B), expected (E), and informed (I) conditions. The enzymatic-treated sample showed comparable physicochemical attributes with the untreated counterpart, except for a significant reduction in color and foam stability (p < 0.05). Non-significant difference between samples was found in the overall liking, WTB, and WTP mean scores in all three sensory test conditions (p > 0.05). The information about the deglutinization treatment had a negative impact on overall liking (p < 0.01), although WTP for both samples was significantly higher in the informed test than in blind condition (p < 0.05). Overall, Check-All-That-Apply test results confirmed that the deglutinization treatment does not affect the beer sensory profile, even if the information about brewing ingredients and technologies may slightly influence the consumers' sensory perception. Therefore, this result proves that it is possible to produce a marketable GF beer, simply by partially replacing 40% of barley malt with unconventional GF grains, without using enzymes for gluten reduction purpose.

Systematic Review and Dose-Response Meta-Analysis on the Relationship between Different Gluten Doses and Risk of Coeliac Disease Relapse

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.

Detection of gluten in duplicate portions to determine gluten intake of coeliac disease patients on a gluten-free diet

This study determined the gluten content of foods and meals consumed by coeliac disease (CD) patients who adhere to a gluten-free diet, and to estimate the total daily intake of gluten of these patients. CD patients fulfilling defined inclusion criteria were preselected and approached for participation in the study. Duplicate portions (DP) of foods and mixed dishes were collected from the CD patients for evaluating complete daily food intake during two individual days. Also, for these days, written food records were completed by the participants. From each DP, a laboratory sample was prepared and analysed for its gluten concentration and total daily gluten intake was calculated. Each individual's total daily intakes of energy and macronutrients were calculated using the Dutch food composition database. In total, twenty-seven CD patients participated, seven males and twenty females, aged between 21 and 64 years. In thirty-two (6 %) of 499 food samples collected in total, more than 3 mg/kg gluten was present. In four of these thirty-two samples, the gluten concentration was above the European legal limit of 20 mg/kg and three of the four samples had a gluten-free label. The maximal gluten intake was 3·3 mg gluten/d. The gluten tolerance for sensitive CD patients (>0·75 mg/d) was exceeded on at least six out of fifty-four study days. To also protect these sensitive CD patients, legal thresholds should be re-evaluated and the detection limit of analytical methods for gluten analysis lowered.

Immunological Methods in Gluten Risk Analysis: A Snapshot

Gluten is among the 14 major food allergens officially recognized by Regulation (EU) No. 1169/2011. The risk to coeliac patients from gluten presence in the food products they consume is likely due to the unintentional contamination of naturally gluten-free (GF) and GF-labelled products, or to hidden sources of gluten in processed GF products. The aim of this paper is to provide a snapshot of gluten risk analysis, with emphasis on immunological methods currently used in gluten detection. The study highlights that immunoassays have some advantages over other analytical methods in gluten determination and are suitable for routine tests. However, some factors (e.g., complexity of the food matrix, type of the applied antibody, gluten extraction procedures and lack of reference material) affect the reliability of obtained results. Hence, efforts are required at an analytical level to overcome the drawbacks of the immunological methods currently available. Harmonization is necessary, so as to assist both consumers in making safe food choices, and the food industry in gluten risk assessment, management and communication.

The Nutritional Quality of Gluten-Free Products for Children

OBJECTIVES

To examine the nutritional quality of gluten-free (GF) products specifically marketed for children.

METHODS

All child-targeted food products were purchased from 2 major supermarket chains in Calgary, Alberta, Canada. Using the Pan American Health Organization Nutrient Profile Model, the nutritional quality of products with a GF claim was compared with those without such a claim. A secondary analysis further compared the nutrient profile of child-targeted GF products to their product "equivalents."

RESULTS

Overall, child-targeted GF products had lower levels of sodium, total fat, and saturated fat but also had less protein and a similar percentage of calories from sugar compared with child-targeted products without a GF claim. According to the Pan American Health Organization criteria, both GF products and "regular" products designed for children can be classified as having poor nutritional quality (88% vs 97%; P < .001). When analyzed in light of their product equivalents without a GF claim, both had similarly high levels of sugar (79% vs 81%; P < .001).

CONCLUSIONS

GF supermarket foods that are targeted at children are not nutritionally superior to regular child-targeted foods and may be of greater potential concern because of their sugar content. The health halo often attributed to the GF label is not warranted, and parents who substitute GF products for their product equivalents (assuming GF products to be healthier) are mistaken. Parents of children with gluten intolerance and/or sensitivity, along with parents who purchase GF products for other health reasons, need to carefully assess product labels when making purchases.

Improved Quantitation of Gluten in Wheat Starch for Celiac Disease Patients by Gel-Permeation High-Performance Liquid Chromatography with Fluorescence Detection (GP-HPLC-FLD)

Purified wheat starch (WSt) is commonly used in gluten-free products for celiac disease (CD) patients. It is mostly well-tolerated, but doubts about its safety for CD patients persist. One reason may be that most ELISA kits primarily recognize the alcohol-soluble gliadin fraction of gluten, but insufficiently target the alcohol-insoluble glutenin fraction. To address this problem, a new sensitive method based on the sequential extraction of gliadins, glutenins, and gluten from WSt followed by gel-permeation high-performance liquid chromatography with fluorescence detection (GP-HPLC-FLD) was developed. It revealed that considerable amounts of glutenins were present in most WSt. The gluten contents quantitated by GP-HPLC-FLD as sum of gliadins and glutenins were higher than those by R5 ELISA (gluten as gliadin content multiplied by a factor of 2) in 19 out of 26 WSt. Despite its limited selectivity, GP-HPLC-FLD may be applied as confirmatory method to ELISA to quantitate gluten in WSt.