Non-coeliac gluten sensitivity: A review of the literature

Effects of fructan and gluten on gut microbiota in individuals with self-reported non-celiac gluten/wheat sensitivity-a randomised controlled crossover trial

BACKGROUND

Individuals with non-celiac gluten/wheat sensitivity (NCGWS) experience improvement in gastrointestinal symptoms following a gluten-free diet. Although previous results have indicated that fructo-oligosaccharides (FOS), a type of short-chain fructans, were more likely to induce symptoms than gluten in self-reported NCGWS patients, the underlying mechanisms are unresolved.

METHODS

Our main objective was therefore to investigate whether FOS-fructans and gluten affect the composition and diversity of the faecal microbiota (16S rRNA gene sequencing), faecal metabolites of microbial fermentation (short-chain fatty acids [SCFA]; gas chromatography with flame ionization detector), and a faecal biomarker of gut inflammation (neutrophil gelatinase-associated lipocalin, also known as lipocalin 2, NGAL/LCN2; ELISA). In the randomised double-blind placebo-controlled crossover study, 59 participants with self-reported NCGWS underwent three different 7-day diet challenges with gluten (5.7 g/day), FOS-fructans (2.1 g/day), and placebo separately (three periods, six challenge sequences).

RESULTS

The relative abundances of certain bacterial taxa were affected differently by the diet challenges. After the FOS-fructan challenge, Fusicatenibacter increased, while Eubacterium (E.) coprostanoligenes group, Anaerotruncus, and unknown Ruminococcaceae genera decreased. The gluten challenge was primarily characterized by increased abundance of Eubacterium xylanophilum group. However, no differences were found for bacterial diversity (α-diversity), overall bacterial community structure (β-diversity), faecal metabolites (SCFA), or NGAL/LCN2. Furthermore, gastrointestinal symptoms in response to FOS-fructans were generally not linked to substantial shifts in the gut bacterial community. However, the reduction in E. coprostanoligenes group following the FOS-fructan challenge was associated with increased gastrointestinal pain. Finally, correlation analysis revealed that changes in gastrointestinal symptoms following the FOS-fructan and gluten challenges were linked to varying bacterial abundances at baseline.

CONCLUSIONS

In conclusion, while FOS-fructans induced more gastrointestinal symptoms than gluten in the NCGWS patients, we did not find that substantial shifts in the composition nor function of the faecal microbiota could explain these differences in the current study. However, our results indicate that individual variations in baseline bacterial composition/function may influence the gastrointestinal symptom response to both FOS-fructans and gluten. Additionally, the change in E. coprostanoligenes group, which was associated with increased symptoms, implies that attention should be given to these bacteria in future trials investigating the impact of dietary treatments on gastrointestinal symptoms.

TRIAL REGISTRATION

Clinicaltrials.gov as NCT02464150.

Utilization of Sustainable Ingredients (Cañihua Flour, Whey, and Potato Starch) in Gluten-Free Cookie Development: Analysis of Technological and Sensorial Attributes

In recent years, the consumption of gluten-free products has increased due to the increasing prevalence of celiac disease and the increased preference for gluten-free diets. This study aimed to make cookies using a mixture of cañihua flour, whey, and potato starch. The use of a Box-Behnken design allowed for flexible ingredient proportions and physicochemical properties, centesimal composition, color, texture, and sensory attributes to be evaluated through consumer tests (Sorting and acceptability). The results highlighted significant variations in physicochemical data, composition, color, and texture across formulations. The blend with 38.51% cañihua flour, 10.91% sweet whey, 25.69% potato starch, 8.34% margarine, 11.10% sugar, 0.19% sodium chloride, 0.51% baking powder, 0.51% vanilla essence, and 4.24% egg exhibited superior sensory appeal. This formulation boasted excellent texture, aroma, flavor, color, and appearance, indicating high sensory and physicochemical quality. The use of cañihua flour, sweet whey, and potato starch not only provides a gluten-free option but also delivers a nutritious and sensorily pleasing choice for those with dietary restrictions. Future research could explore the commercial viability of producing these cookies on a larger scale, as well as investigating the potential health benefits of these ingredients.

Exploitation of Aureobasidium pullulans NRRL Y-2311-1 xylanase in mulberry and rice flours-based gluten-free cookie formulation: Effects on dough properties and cookie characteristics

Xylanases are mainly utilized in bakery industry for the hydrolysis of dietary fiber-based fractions. Their applications in gluten-free products have not been considered before. In the present study, the xylanase produced by Aureobasidium pullulans NRRL Y-2311-1 was utilized in a mulberry and rice flours-based gluten-free cookie formulation for the first time. Effects of various xylanase concentrations on gluten-free dough rheology and cookie characteristics were elucidated. Only rice flour-based cookie and only wheat flour-based cookie formulations were also prepared as comparison. Incorporation of xylanase into all cookie recipes resulted in softer cookie doughs with lower absolute stickiness. The hardness and absolute stickiness of the cookie doughs prepared by the mixture of mulberry and rice flours decreased by the addition of the enzyme into the formulation in a concentration-dependent manner. Enzyme concentrations above 100 U/100 g flour did not provide statistically significant further changes on gluten-free cookie doughs. Incorporation of xylanase into the cookie recipes resulted in increased baking loss and spread ratio in an enzyme concentration-dependent manner for all cookie types. Hardness values of both types of gluten-free cookies decreased by xylanase incorporation. Different effects on fracturability were observed depending on the cookie type and enzyme concentration. Enzyme concentration of 100 U/100 g flour provided mulberry and rice flours-based cookies with a more flexible and softer structure. No significant effects on color parameters of cookies were observed by xylanase incorporation.

Oral and gastrointestinal nutrient bioaccessibility of gluten-free bread is slightly affected by deficient mastication in the elderly

The main goal of this work was to investigate the impact of impaired mastication on nutrient bioaccessibility of gluten-free bread in the elderly. In vitro boluses were produced with the AM² masticator by using two types of programming: normal mastication (NM) and deficient mastication (DM). Static in vitro gastrointestinal digestion was performed with the digestive physiology conditions of the elderly. Subsequently, the granulometric properties of the in vitro boluses produced, their starch and protein digestibility, and lipid peroxidation after in vitro oral and gastrointestinal digestion were evaluated. DM boluses presented higher proportions of large particles, resulting in insufficiently fragmented boluses. A delay in oral starch digestion was observed in DM boluses, probably due to the presence of larger particles that limited the bolus-saliva exchanges. Furthermore, DM boluses exhibited a lower degree of protein hydrolysis at the end of gastric digestion, whereas no differences were observed for protein hydrolysis, sugar release, and lipid peroxidation at the end of digestion (intestinal phase). The results of this study show that impaired mastication somewhat delays the nutrient bioaccessibility of the gluten-free bread tested. Such understanding of the effect of oral decline on the nutrient bioaccessibility of foods is crucial when designing food commodities with enhanced functionalities for the elderly.

Improvement and Re-Evolution of Tetraploid Wheat for Global Environmental Challenge and Diversity Consumption Demand

Allotetraploid durum wheat is the second most widely cultivated wheat, following hexaploid bread wheat, and is one of the major protein and calorie sources of the human diet. However, durum wheat is encountered with a severe grain yield bottleneck due to the erosion of genetic diversity stemming from long-term domestication and especially modern breeding programs. The improvement of yield and grain quality of durum wheat is crucial when confronted with the increasing global population, changing climate environments, and the non-ignorable increasing incidence of wheat-related disorders. This review summarized the domestication and evolution process and discussed the durum wheat re-evolution attempts performed by global researchers using diploid einkorn, tetraploid emmer wheat, hexaploid wheat (particularly the D-subgenome), etc. In addition, the re-evolution of durum wheat would be promoted by the genetic enrichment process, which could diversify allelic combinations through enhancing chromosome recombination (pentaploid hybridization or pairing of homologous chromosomes gene Ph mutant line induced homoeologous recombination) and environmental adaptability via alien introgressive genes (wide cross or distant hybridization followed by embryo rescue), and modifying target genes or traits by molecular approaches, such as CRISPR/Cas9 or RNA interference (RNAi). A brief discussion of the future perspectives for exploring germplasm for the modern improvement and re-evolution of durum wheat is included.

Use of different proportions of rice milling fractions as strategy for improving quality parameters and nutritional profile of gluten-free bread

The growing consumer exigency and the lack of gluten-free (GF) bakery products with good technological and nutritional characteristics in the market have increase the need of researching in this area. Few studies have analysed the simultaneous influence of different flour fractions from rice dry milling to formulate GF bread and its effects on rheology and product quality. The aim of this study was to characterize the chemical and physical properties of rice milling fractions (flour, coarse, bran); and to evaluate the effect of these fractions on rheology, and quality of GF bread. High fibre content (31.5%) and good hydration and functional properties demonstrated the suitability of bran for food development. A mixture design with three components was used. Pasting parameters, bread specific volume (BSV), firmness and colour intensity (Chr) responses were fitted to linear and quadratic polynomial models. The presence of bran in the blends reduced almost all pasting parameters. The optimal mixture proportion was flour:coarse:bran (45:35:20), presenting a BSV 1.7 ± 0.1 cm³/g; firmness 0.23 ± 0.01 MPa, and Chr 23.8 ± 0.4. A portion (50 g) of GF bread increased four times the dietary fibre intake. The utilization of different rice fractions to formulate GF bread improved the product quality and enhance the nutritional profile.

Guidelines on Standard and Therapeutic Diets for Adults in Hospitals by the French Association of Nutritionist Dieticians (AFDN) and the French Speaking Society of Clinical Nutrition and Metabolism (SFNCM)

AIM

Hospital food provision is subject to multiple constraints (meal production, organization, health safety, environmental respect) which influence the meal tray offered to the patient. Multiple diets can add complexity and contribute to non-consumption of the meal. To avoid undernutrition, it appeared necessary to propose guidelines for foods and diets in hospitals.

METHODS

These guidelines were developed using the Delphi method, as recommended by the HAS (French Health Authority), based on a formal consensus of experts and led by a group of practitioners and dieticians from the AFDN (French Association of Nutritionist Dieticians) and SFNCM (French Society of Clinical Nutrition and Metabolism).

RESULTS

Twenty-three recommendations were deemed appropriate and validated by a panel of 50 national experts, following three rounds of consultations, modifications and final strong agreement. These recommendations aim to define in adults: 1-harmonized vocabulary related to food and diets in hospitals; 2-quantitative and qualitative food propositions; 3-nutritional prescriptions; 4-diet patterns and patient adaptations; 5-streamlining of restrictions to reduce unnecessary diets and without scientific evidence; 6-emphasizing the place of an enriched and adapted diet for at-risk and malnourished patients.

CONCLUSION

These guidelines will enable catering services and health-care teams to rationalize hospital food and therapeutic food prescriptions in order to focus on individual needs and tasty foods. All efforts should be made to create meals that follow these recommendations while promoting the taste quality of the dishes and their presentation such that the patient rediscovers the pleasure of eating in the hospital.

Gluten-Free Diet in Prisons in Poland: Nutrient Contents and Implementation of Dietary Reference Intake Standards

The gluten-free diet (GFD) requires special attention from nutritionists due to the potential risk of nutrient deficiencies in its users. This risk may be greater when this type of nutrition is implemented in prisons due to the limited possibilities of external control, a low catering budget for meals, and insufficiently defined recommendations regulating nutrition for prisoners. The aim of the present study was to assess the nutritional value of GFD and regular diet meals served in some Polish prisons and to compare the values to the dietary reference intake (DRI) standards. Using a specialized computer program, 7-day menus of both types of diet provided in 10 prisons were analyzed. The percentage coverage of the DRI was calculated based on the recommendations of the Polish National Food and Nutrition Institute. GFD was characterized by lower average contents of energy and 11 out of 14 essential nutrients, i.e., protein, carbohydrates, dietary fiber, starch, ash, sodium, calcium, iron, zinc, folate, and vitamin B12. The average content of phosphorus, niacin, and riboflavin in the gluten-free diet was higher than that in the regular diet. It was shown that the meals in GFD and the regular diet did not provide the recommended amounts of calcium (38 and 44% DRI, respectively), vitamin D (29 and 30% DRI), vitamin C (86 and 76% DRI), and folate (51 and 56% DRI). In turn, the supply of sodium, phosphorus, copper, and vitamins A and B6 substantially exceeded the recommended levels. The results indicate a need for greater quality control of GFD meals served in catering facilities. It is also necessary to develop legal provisions that will regulate more specifically the nutrition for prisoners in terms of an adequate supply of minerals and vitamins.

Probiotics: Versatile Bioactive Components in Promoting Human Health

The positive impact of probiotic strains on human health has become more evident than ever before. Often delivered through food, dietary products, supplements, and drugs, different legislations for safety and efficacy issues have been prepared. Furthermore, regulatory agencies have addressed various approaches toward these products, whether they authorize claims mentioning a disease's diagnosis, prevention, or treatment. Due to the diversity of bacteria and yeast strains, strict approaches have been designed to assess for side effects and post-market surveillance. One of the most essential delivery systems of probiotics is within food, due to the great beneficial health effects of this system compared to pharmaceutical products and also due to the increasing importance of food and nutrition. Modern lifestyle or various diseases lead to an imbalance of the intestinal flora. Nonetheless, as the amount of probiotic use needs accurate calculations, different factors should also be taken into consideration. One of the novelties of this review is the presentation of the beneficial effects of the administration of probiotics as a potential adjuvant therapy in COVID-19. Thus, this paper provides an integrative overview of different aspects of probiotics, from human health care applications to safety, quality, and control.

Sourdough Fermentation Degrades Wheat Alpha-Amylase/Trypsin Inhibitor (ATI) and Reduces Pro-Inflammatory Activity

The ingestion of gluten-containing foods can cause wheat-related disorders in up to 15% of wheat consuming populations. Besides the role of gluten, α-amylase/trypsin inhibitors (ATI) have recently been identified as inducers of an innate immune response via toll-like receptor 4 in celiac disease and non-celiac wheat sensitivity. ATI are involved in plant self-defense against insects and possibly in grain development. Notably, they are largely resistant to gastrointestinal proteases and heat, and their inflammatory activity affects not only the intestine, but also peripheral organs. The aim of this study was to understand the changes of ATI throughout the sourdough and yeast-fermented bread-making processes. ATI tetramers were isolated, fluorescein-labelled, and added to a mini-dough bread-making system. When the pH decreased below 4.0 in sourdough fermentation, the ATI tetramers were degraded due to the activation of aspartic proteases, whilst in yeast fermentation, ATI tetramers remained intact. The amylase inhibitory activity after sourdough fermentation decreased significantly, while the concentration of free thiol groups increased. The glutathione reductase activity of Fructilactobacillus sanfranciscensis did not contribute to the reduction of ATI tetramers. Compared to the unfermented wheat, sourdough fermentation was able to decrease the release of pro-inflammatory cytokines monocyte chemoattractant protein-1 (MCP-1) and tumor necrosis factor alpha (TNF-α) in quantitative ATI extracts added to the human monocytic cell line THP-1. The current data suggest that sourdough fermentation can degrade ATI structure and bioactivity, and point to strategies to improve product development for wheat sensitivity patients.

Edible Brown Seaweed in Gluten-Free Pasta: Technological and Nutritional Evaluation

Seaweed is a novel source of important nutritional compounds with interesting biological activities that could be processed into added-value products, namely gluten-free foods. In this study, two previously developed products obtained from Laminaria ochroleuca processing (liquid extract and a purée-like mixture) were incorporated in gluten-free (GF) pasta in order to develop functional products especially designed for the celiac population. The raw and cooked pastas were characterized in terms of their cooking quality parameters, nutritional composition, texture and rheological properties, and antioxidant activity. It was found that the developed GF pastas had similar mechanical and texture characteristics to the control. Both supplemented GF pastas presented a significantly (p < 0.05) higher fibre and mineral content than the control pasta.

Effectiveness of proteolytic enzymes to remove gluten residues and feasibility of incorporating them into cleaning products for industrial purposes

The development of protocols for efficient gluten elimination is one of the most critical aspects of any allergen management strategy in the industry. The suitability of different proteolytic enzymes to be included in a cleaning formulation that allows the effective elimination of gluten residues was studied. Alcalase (ALC), neutrase (NEUT) and flavourzyme (FLAV) were selected from in silico analysis. The presence of 1% (v/v) of linear alkylbenzene sulphonate (LAS), a common anionic detergent, improved the gluten solubility, which may favour its elimination. Chromatographic analysis showed that the three enzymes studied were able to hydrolyse gluten in the presence of LAS. The highest percentage of short peptides (< 5 kDa) was achieved with ALC, what increases the probability of reducing the gluten antigenicity. Besides, in the presence of ALC and detergent LAS have detected the lowest levels of gluten with ELISA kits. So, effective amounts of ALC and LAS were added to a cleaning formulation, where its proteolytic activity was maintained above 90% after 37 days at 4 °C and 25 °C (under dark). Preliminary validation of the effectiveness enzymatic cleaning formulation to hydrolyse gluten was performed in a ready-to-eat/frozen food company, in which previous episodes of cross-contamination with gluten have been detected. The gluten content decreased to values below 0.125 μg/100 cm² when the cleaning formulation was tested on different surfaces with different cleaning protocols, demonstrating the high suitability of the enzymatic cleaning formulation developed.

HLA-DQ2 and -DQ8 haplotypes frequency and diagnostic utility in celiac disease patients of Gaza strip, Palestine

Purpose

Celiac disease (CD) diagnosis can be established by serological and small bowel biopsy (SBB), while absence of HLA-DQ2 and -DQ8 haplotypes excludes the disease. The present study aims at evaluating the diagnosis of a representative sample of pediatric and adult CD patients of Gaza strip in light of DQ2 and DQ8 haplotypes expression.

Methods

Unrelated CD patients (n = 101) and matched healthy controls (n = 97) were genotyped for DQA1*05, DQB1*02 and DQB1*03:02 alleles by allele-specific real-time PCR. The diagnosis was re-evaluated according to the patient laboratory tests and HLA-DQ genotype.

Results

The diagnosis of 35 patients who have been managed for CD could not be confirmed. Twenty-five of them were diagnosed upon their clinical presentation only. The remaining were either negative for serological and SBB tests or negative for HLA-DQ haplotypes. The HLA-DQ alleles were negative in 4 SBB and one Anti-EMA positive patients. The frequency of DQ2 and DQ8 haplotypes among the remaining 65 confirmed cases was 70.8 and 15.4%, respectively, compared to 17.5 and 27.8% in the controls. The DQB1*02 allele was the most common in the cases (84.6%) followed by DQA1*05 allele (80%) and DQB1*03:02 allele (20%). The DQA1*05 allele was commonest in the control group (54.6%) followed by DQB1*02 allele (42.3%) and DQB1*03:02 allele (28.9%).

Conclusions

Absence of HLA-DQ2 and HLA-DQ8 genotyping in the workup of patients may result in CD misdiagnosis, particularly in a setting with poor histopathological diagnostic capacity.