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McDermid JM, Almond MA, Roberts KM, Germer EM, Geller MG, Taylor TA, Sinley RC, Handu D. Celiac Disease: An Academy of Nutrition and Dietetics Evidence-Based Nutrition Practice Guideline. J Acad Nutr Diet 2023; 123:1793-1807.e4. [PMID: 37499866 DOI: 10.1016/j.jand.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023]
Abstract
Celiac disease is an autoimmune disorder in which the immune system of genetically susceptible individuals elicits a reaction to gluten causing small intestine damage. If left undiagnosed and untreated, the resulting nutrition malabsorption can lead to anemia, bone disease, growth faltering, or other consequences. The condition is lifelong and lacks a cure; the only treatment is lifelong adherence to a gluten-free diet (GFD). This diet is challenging to follow and adversely influences quality of life; however, it is essential to ensure intestinal recovery and prevent future negative health consequences. The Academy of Nutrition and Dietetics convened an expert panel complemented by a celiac disease patient advocate to evaluate evidence for six topics, including medical nutrition therapy; the GFD; oat consumption; micronutrients; pro-/prebiotics; and the low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet. This publication outlines the Academy of Nutrition and Dietetics Evidence Analysis Library methods used to complete the systematic review and guideline development, and summarizes the recommendations and supporting evidence. The guidelines affirm that all individuals with celiac disease should follow a GFD (1C, Imperative) that may include gluten-free oats in adults (2D, Conditional). Children should follow a nutritionally adequate GFD that supports healthy growth and development (Consensus, Imperative) and does not unnecessarily restrict gluten-free oats (Consensus, Conditional). The guidelines indicate nutritional care should include routine nutritional assessment (Consensus, Imperative) and medical nutrition therapy (Consensus, Imperative). At this time, the guidelines do not support a recommendation for the addition of the low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet (2C, Conditional); prebiotic or probiotic supplementation (2D, Conditional); or micronutrient supplementation (in the absence of nutritional deficiency) (Consensus, Conditional). The 2021 Celiac Disease Evidence-Based Nutrition Guideline will assist registered dietitian nutritionists in providing appropriate evidence-based medical nutrition therapy to support people with celiac disease in achieving and maintaining nutritional health and avoiding adverse celiac disease consequences throughout their lives.
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Affiliation(s)
| | - M Angie Almond
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | | | - Emily M Germer
- Matthew Walker Comprehensive Health Center, Nashville, Tennessee
| | | | | | | | - Deepa Handu
- Academy of Nutrition and Dietetics, Chicago, Illinois.
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Nutrient intakes in adult and pediatric coeliac disease patients on gluten-free diet: a systematic review and meta-analysis. Eur J Clin Nutr 2023:10.1038/s41430-023-01280-0. [PMID: 36859658 DOI: 10.1038/s41430-023-01280-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 02/03/2023] [Accepted: 02/13/2023] [Indexed: 03/03/2023]
Abstract
Celiac Disease (CD) continues to require a strict lifetime gluten-free diet (GFD) to maintain healthy status. Many studies have assessed the GFD nutritional adequacy in their cohorts, but an overall picture in adults and children would offer a lifetime vision to identify actionable areas of change. We aimed at assessing the nutrient intakes of adult and pediatric CD patients following a GFD diet and identifying potential areas of improvement. Systematic review was carried out across PubMed, Scopus and Scholar up to October 2022, including full-text studies that assessed the nutrient intakes of CD patients on GFD, in terms of macro- and/or micronutrients (absolute or percentage daily average). Random-effect meta-analysis and univariable meta-regression were applied to obtain pooled estimates for proportions and influencing variables on the outcome, respectively. Thirty-eight studies with a total of 2114 patients were included. Overall, the daily energy intake was 1995 (CI 1884-2106) Kcal with 47.8% (CI 45.7-49.8%) from carbohydrates, 15.5% (CI 14.8-16.2%) from proteins, and 35.8% (CI 34.5-37.0%) from fats. Of total fats, 13.2% (CI 12.4-14.0%) were saturated fats. Teenagers had the highest consumption of fats (94.9, CI 54.8-134.9 g/day), and adults presented insufficient dietary fiber intake (18.9 g, CI 16.5-21.4 g). Calcium, magnesium, and iron intakes were particularly insufficient in adolescence, whereas vitamin D was insufficient in all age groups. In conclusion, GFD may expose CD patients to high fat and low essential micronutrient intakes. Given GFD is a lifelong therapy, to prevent the occurrence of diseases (e.g. cardiovascular or bone disorders) dietary intakes need to be assessed on long-term follow-ups.
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Söderström H, Cervin M, Dereke J, Hillman M, Tiberg I, Norström F, Carlsson A. Does a gluten-free diet lead to better glycemic control in children with type 1 diabetes? Results from a feasibility study and recommendations for future trials. Contemp Clin Trials Commun 2022; 26:100893. [PMID: 35243123 PMCID: PMC8866053 DOI: 10.1016/j.conctc.2022.100893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 11/09/2021] [Accepted: 01/17/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Hanna Söderström
- Department of Clinical Sciences, Pediatrics, Skåne University Hospital Lund, Lund University, Lund, Sweden
- Corresponding author.
| | - Matti Cervin
- Department of Clinical Sciences, Child and Adolescent Psychiatry, Lund University, Lund, Sweden
| | - Jonatan Dereke
- Department of Clinical Sciences, Diabetes Research Laboratory, Lund University, Lund, Sweden
| | - Magnus Hillman
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Iren Tiberg
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Fredrik Norström
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Annelie Carlsson
- Department of Clinical Sciences, Pediatrics, Skåne University Hospital Lund, Lund University, Lund, Sweden
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Akhavan Sabbagh M, Mahdavi R, Shirmohammadi M, Nikniaz Z. Barriers of Adherence to a Gluten-Free Diet in Iranian Adults With Celiac Disease. Gastroenterol Nurs 2021; 44:320-327. [PMID: 34319935 DOI: 10.1097/sga.0000000000000575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 09/29/2020] [Indexed: 11/25/2022] Open
Abstract
This cross-sectional study aimed to evaluate and classify barriers to adherence to the gluten-free diet in 137 Iranian adults with celiac disease. We used a 23-point Likert questionnaire and exploratory factor analysis to identify and classify the barriers. Adherence to gluten-free diet was assessed by measuring the serum level of anti-tTG-IgA. The correlation between the barriers and adherence to gluten-free diet was assessed using logistic regression. A total of 117 subjects completed the study. Seven factors were extracted: "gluten-free diet restrictions," "self-awareness and social awareness," "psychological barriers," "education," "situational barriers and gatherings," "lack of access/labeling," and "cost." There was a significant correlation between the situational barriers and gatherings and nonadherence to the diet in the adjusted model (odds ratio = 1.63; 95% confidence interval [1.03, 2.54], p = .03). Nutritionists and physicians should consider these barriers when consulting patients with celiac disease.
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Affiliation(s)
- Mojgan Akhavan Sabbagh
- Mojgan Akhavan Sabbagh, MS, is in Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Reza Mahdavi, PhD, is at Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Masood Shirmohammadi, MD, is a gastroenterologist at Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Zeinab Nikniaz, PhD, is at Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Mahdavi
- Mojgan Akhavan Sabbagh, MS, is in Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Reza Mahdavi, PhD, is at Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Masood Shirmohammadi, MD, is a gastroenterologist at Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Zeinab Nikniaz, PhD, is at Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masood Shirmohammadi
- Mojgan Akhavan Sabbagh, MS, is in Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Reza Mahdavi, PhD, is at Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Masood Shirmohammadi, MD, is a gastroenterologist at Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Zeinab Nikniaz, PhD, is at Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zeinab Nikniaz
- Mojgan Akhavan Sabbagh, MS, is in Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Reza Mahdavi, PhD, is at Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Masood Shirmohammadi, MD, is a gastroenterologist at Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Zeinab Nikniaz, PhD, is at Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Zysk W, Głąbska D, Guzek D. Role of Front-of-Package Gluten-Free Product Labeling in a Pair-Matched Study in Women with and without Celiac Disease on a Gluten-Free Diet. Nutrients 2019; 11:nu11020398. [PMID: 30769829 PMCID: PMC6412319 DOI: 10.3390/nu11020398] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/11/2019] [Accepted: 02/11/2019] [Indexed: 12/16/2022] Open
Abstract
Gluten-free (GF) product labeling is one of the most important determinants of food product choices by patients with celiac disease, due to the need for following a GF diet. The aim of this study was to assess the role of front-of-package GF product labeling in pair-matched celiac and non-celiac women on a GF diet in a choice experiment (CE). In subgroups of celiac (n = 77) and non-celiac pair-matched respondents on a GF diet, but with no gluten-related diseases diagnosed (n = 77), the influence of front-of package labeling of GF bread on the choice of products was assessed. The labeling assessed in a CE included for all the products crossed grain logotype and additional logotypes of European Union (EU) organic production, “dairy-free” product, wheat starch-free product, quality and vegan product, as well as additional “gluten-free” written information. It was stated that the frequency of selection of products with “gluten-free” written information did not differ between subgroups of celiac and non-celiac respondents, as well as in subgroups stratified by age, body mass index (BMI), place of residence, and economic status. The frequency of selection of products with “vegan” logotype was higher for non-celiac respondents than for celiac ones (p = 0.0011). The frequency of selection of a product with additional logotypes was influenced by BMI and place of residence, but not by age and economic status of assessed women.
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Affiliation(s)
- Wioleta Zysk
- Department of Organization and Consumption Economics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences (SGGW⁻WULS), 159C Nowoursynowska Street, 02⁻776 Warsaw, Poland.
| | - Dominika Głąbska
- Department of Dietetics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences (SGGW⁻WULS), 159C Nowoursynowska Street, 02⁻776 Warsaw, Poland.
| | - Dominika Guzek
- Department of Organization and Consumption Economics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences (SGGW⁻WULS), 159C Nowoursynowska Street, 02⁻776 Warsaw, Poland.
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Differences in the macronutrient and dietary fibre profile of gluten-free products as compared to their gluten-containing counterparts. Eur J Clin Nutr 2019; 73:930-936. [PMID: 30647439 DOI: 10.1038/s41430-018-0385-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/06/2018] [Accepted: 12/15/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND/OBJECTIVES Gluten-free diet is the lifelong therapy for patients with coeliac disease. A wide range of gluten-free products (GFP) is available, which mimics the characteristics of their gluten-containing counterparts (GCC). The aim of this study was to compare the macronutrient and dietary fibre composition of GFP and GCC currently available in Spain. SUBJECTS/METHODS A cross-sectional study analysing the nutritional differences between 621 GFP and 600 GCC based on labelling information was conducted. Food items were categorized in one of 14 food groups. The first six ingredients were noted for each food item. A linear regression model was used to explain differences in nutritional composition between GFP and GCC and three independent models were created for bread, pasta and biscuits. RESULTS Results showed that GCC had higher protein content than GFP, especially in flour, bread, pasta and pizza. Bread had higher total and saturated fat contents in the GFP in which palm oil was the main fat used. Flours and starchy ingredients used in GFP formulation were mainly rice and corn flours and corn starch, and palm oil was the most commonly used fat. CONCLUSIONS In conclusion, GFP cannot currently be considered as equivalent substitutes for their GCC. The reformulation of the GFP with more healthy ingredients and ingredients is encouraged, using a healthy oil, pseudocereals and whole flour.
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Taetzsch A, Das SK, Brown C, Krauss A, Silver RE, Roberts SB. Are Gluten-Free Diets More Nutritious? An Evaluation of Self-Selected and Recommended Gluten-Free and Gluten-Containing Dietary Patterns. Nutrients 2018; 10:nu10121881. [PMID: 30513876 PMCID: PMC6317051 DOI: 10.3390/nu10121881] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/16/2018] [Accepted: 11/23/2018] [Indexed: 12/25/2022] Open
Abstract
Gluten-free (GF) eating patterns are frequently perceived to be healthier than gluten-containing (GC) ones, but there has been very little research to evaluate this viewpoint. The effect of GF eating patterns on dietary composition was assessed using two independent approaches. One approach compared macronutrients and typical shortfall nutrients between MyPlate example menus developed with either GC or equivalent GF foods. In this analysis, the GF menus were significantly lower in protein, magnesium, potassium, vitamin E, folate, and sodium (p = 0.002⁻0.03), with suggestive trends towards lower calcium and higher fat (p = 0.06⁻0.08). The second approach was a meta-analysis of seven studies comparing information on the nutrient intakes of adults with celiac disease following a GF diet with control subjects eating a GC diet, and differences were evaluated using paired t-tests or Wilcoxon Signed rank tests. In this analysis, consuming a GF diet was associated with higher energy and fat intakes, and lower fiber and folate intakes compared to controls (p < 0.001 to p = 0.03). After adjusting for heterogeneity and accounting for the large mean effect size (-0.88 ± 0.09), the lower fiber remained significant (p < 0.001). These combined analyses indicate that GF diets are not nutritionally superior except for sodium, and in several respects are actually worse.
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Affiliation(s)
- Amy Taetzsch
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA 02111, USA.
| | - Sai Krupa Das
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA 02111, USA.
| | - Carrie Brown
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA 02111, USA.
| | - Amy Krauss
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA 02111, USA.
| | - Rachel E Silver
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA 02111, USA.
| | - Susan B Roberts
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA 02111, USA.
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Morreale F, Agnoli C, Roncoroni L, Sieri S, Lombardo V, Mazzeo T, Elli L, Bardella MT, Agostoni C, Doneda L, Scricciolo A, Brighenti F, Pellegrini N. Are the dietary habits of treated individuals with celiac disease adherent to a Mediterranean diet? Nutr Metab Cardiovasc Dis 2018; 28:1148-1154. [PMID: 30143412 DOI: 10.1016/j.numecd.2018.06.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 06/26/2018] [Accepted: 06/26/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS The only treatment for celiac disease (CD) is strict, lifelong adherence to a gluten-free (GF) diet. To date, there are contrasting data concerning the nutritional adequacy of GF products and diet. There have been no studies that have assessed the adherence of individuals with CD to a Mediterranean diet (MD), a protective dietary regimen against major non-communicable diseases (NCDs). Therefore, we examined the adherence to an MD of a group of Italian individuals with CD and compared it with that of a healthy control group. METHODS AND RESULTS In a cross-sectional study, a sample of individuals with CD and a group of healthy subjects were included. The dietary habits of all participants were recorded using a validated food frequency questionnaire, and the adherence to an MD was determined using the Italian Mediterranean Index. Typical Mediterranean food consumption was not significantly different between individuals with CD and the healthy participants, except for fruits (P = 0.017). However, individuals with CD consumed significantly higher amounts of potatoes (P = 0.003) and red and processed meat (P = 0.005) than healthy participants. The resulting mean Italian Mediterranean Index was significantly higher in healthy participants than in individuals with CD (P < 0.001). CONCLUSION The results raise questions concerning the food choices of individuals with CD, suggesting the need of encouraging them to make better food choices more in line with an MD, which would improve their nutritional status and better protect them from NCDs at long term. PROTOCOL REGISTRATION ClinicalTrials.gov (ID NCT01975155) on November 4 2013.
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Affiliation(s)
- F Morreale
- Human Nutrition Unit, Department of Food and Drug, University of Parma, Parma, Italy
| | - C Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - L Roncoroni
- Center for Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - S Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - V Lombardo
- Center for Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - T Mazzeo
- Human Nutrition Unit, Department of Food and Drug, University of Parma, Parma, Italy
| | - L Elli
- Center for Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M T Bardella
- Center for Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - C Agostoni
- Pediatric Intermediate Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ospedale Cà Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - L Doneda
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - A Scricciolo
- Center for Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - F Brighenti
- Human Nutrition Unit, Department of Food and Drug, University of Parma, Parma, Italy
| | - N Pellegrini
- Human Nutrition Unit, Department of Food and Drug, University of Parma, Parma, Italy.
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Social and Emotional Fears and Worries Influencing the Quality of Life of Female Celiac Disease Patients Following a Gluten-Free Diet. Nutrients 2018; 10:nu10101414. [PMID: 30282900 PMCID: PMC6212919 DOI: 10.3390/nu10101414] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/21/2018] [Accepted: 09/26/2018] [Indexed: 12/13/2022] Open
Abstract
The gluten-free diet is effective in the majority of celiac disease (CD) patients, but it is burdensome and may influence quality of life (QoL). The aim of the study was to analyze the social and emotional fears and worries influencing the QoL of female CD patients following a gluten-free (GF) diet, as well as to indicate the sociodemographic interfering factors. The study was conducted on a group of 251 female CD patients, while emotional, social and worries subscales of the Celiac Disease Questionnaire (CDQ) were applied, as well as purchase-related emotions and behaviors were assessed. Respondents declaring worse economic status obtained significantly lower scores in the emotional, social and worries subscales of the CDQ than respondents declaring better economic status, while for other factors (CD duration, GFD adherence, BMI, place of residence and educational level) no significant association was stated in the multi-factor analysis. Moreover, respondents declaring worse economic status more often declared that a bad mood affected their purchase decisions than did respondents declaring better economic status. It was stated, that the economic status of CD patient could be one of the most important factors influencing their social and emotional fears and worries. It may be supposed that low economic status may lead some CD patients to choose to relieve stress by purchasing GF products instead of other products.
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Sue A, Dehlsen K, Ooi CY. Paediatric Patients with Coeliac Disease on a Gluten-Free Diet: Nutritional Adequacy and Macro- and Micronutrient Imbalances. Curr Gastroenterol Rep 2018; 20:2. [PMID: 29356956 DOI: 10.1007/s11894-018-0606-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE OF REVIEW A strict, lifelong gluten-free diet is the cornerstone for management of coeliac disease. Elimination of gluten from the diet may be associated with nutritional imbalance; however, the completeness of this diet in energy and macro- and micronutrients in children is not well described. Understanding the nutritional adequacy of the gluten-free diet in children during this critical period of growth and development when dietary intake is strongly influential is important. RECENT FINDINGS Children, regardless of whether they have eliminated gluten from their diet, have a tendency to consume excess fat and insufficient fibre, iron, vitamin D and calcium, compared to recommendations. In the context of a gluten-free diet, these imbalances may be worsened or have more significant consequences. Paediatric studies have demonstrated that intakes of folate, magnesium, zinc and selenium may decrease on a gluten-free diet. Nutritional inadequacies may be risks of a gluten-free diet in a paediatric population. The potential implications of these inadequacies, both short and long term, remain unclear and warrant further investigation and clarification.
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Affiliation(s)
- Alison Sue
- Discipline of Paediatrics, School of Women's and Children's Health, Medicine, University of New South Wales, Sydney, New South Wales, 2031, Australia
| | - Kate Dehlsen
- Department of Nutrition and Dietetics, Sydney Children's Hospital, Randwick, New South Wales, 2031, Australia
| | - Chee Y Ooi
- Discipline of Paediatrics, School of Women's and Children's Health, Medicine, University of New South Wales, Sydney, New South Wales, 2031, Australia.
- Department of Paediatric Gastroenterology, Sydney Children's Hospital, Randwick, New South Wales, 2031, Australia.
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Hörnell A, Berg C, Forsum E, Larsson C, Sonestedt E, Åkesson A, Lachat C, Hawwash D, Kolsteren P, Byrnes G, De Keyzer W, Van Camp J, Cade JE, Greenwood DC, Slimani N, Cevallos M, Egger M, Huybrechts I, Wirfält E. Perspective: An Extension of the STROBE Statement for Observational Studies in Nutritional Epidemiology (STROBE-nut): Explanation and Elaboration. Adv Nutr 2017; 8:652-678. [PMID: 28916567 PMCID: PMC5593101 DOI: 10.3945/an.117.015941] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/15/2017] [Accepted: 07/13/2017] [Indexed: 01/28/2023] Open
Abstract
Nutritional epidemiology is an inherently complex and multifaceted research area. Dietary intake is a complex exposure and is challenging to describe and assess, and links between diet, health, and disease are difficult to ascertain. Consequently, adequate reporting is necessary to facilitate comprehension, interpretation, and generalizability of results and conclusions. The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement is an international and collaborative initiative aiming to enhance the quality of reporting of observational studies. We previously presented a checklist of 24 reporting recommendations for the field of nutritional epidemiology, called "the STROBE-nut." The STROBE-nut is an extension of the general STROBE statement, intended to complement the STROBE recommendations to improve and standardize the reporting in nutritional epidemiology. The aim of the present article is to explain the rationale for, and elaborate on, the STROBE-nut recommendations to enhance the clarity and to facilitate the understanding of the guidelines. Examples from the published literature are used as illustrations, and references are provided for further reading.
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Affiliation(s)
- Agneta Hörnell
- Department of Food and Nutrition, Umeå University, Umeå, Sweden
| | - Christina Berg
- Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - Elisabet Forsum
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Christel Larsson
- Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - Emily Sonestedt
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Agneta Åkesson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Carl Lachat
- Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium
| | - Dana Hawwash
- Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium
| | - Patrick Kolsteren
- Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium
| | - Graham Byrnes
- International Agency for Research on Cancer, Lyon, France
| | - Willem De Keyzer
- Department of Biosciences and Food Sciences, University College Ghent, Ghent, Belgium
| | - John Van Camp
- Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium
| | - Janet E Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, and
| | - Darren C Greenwood
- Biostatistics Unit, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Nadia Slimani
- International Agency for Research on Cancer, Lyon, France
| | - Myriam Cevallos
- Department of Clinical Research, University of Bern, Bern, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Elisabet Wirfält
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
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Wagner G, Zeiler M, Grylli V, Berger G, Huber WD, Woeber C, Rhind C, Karwautz A. Coeliac disease in adolescence: Coping strategies and personality factors affecting compliance with gluten-free diet. Appetite 2016; 101:55-61. [PMID: 26924559 DOI: 10.1016/j.appet.2016.02.155] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/09/2016] [Accepted: 02/22/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Patients suffering from a chronic condition such as coeliac disease (CD) need to develop coping strategies in order to preserve emotional balance and psychosocial functioning while adhering to their obligatory life-long gluten free diet (GFD). However, this can be particularly challenging for adolescents and may lead to dietary transgressions. Little is currently known about the influence of coping strategies and personality factors on dietary compliance. This study aims to explore these factors for the first time in adolescents with biopsy-proven CD. STUDY DESIGN We included 281 adolescents with CD and 95 healthy controls. We classified patients according to their GFD adherence status (adherent vs. non-adherent) and assessed coping strategies using the KIDCOPE and personality traits using the Junior-Temperament and Character Inventory (J-TCI). RESULTS Adolescents with CD adherent to GFD used less emotional regulation and distraction as coping strategies than non-adherent patients. In terms of personality traits, adherent patients differed from non-adherent patients with respect to temperament, but not with respect to character, showing lower scores in novelty seeking, impulsivity and rule transgressions and higher scores in eagerness with work and perfectionism compared to non-adherent patients. No differences were found between healthy controls and adherent CD patients across these personality traits. CONCLUSIONS Coping strategies and personality traits differ in adolescent patients with CD adherent to GFD from those not adherent, and may therefore relate to risk or protective factors in adherence. Targeting coping and temperament using psychological interventions may therefore be beneficial to support adolescents with CD and optimise their adherence to GFD.
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Affiliation(s)
- Gudrun Wagner
- Department of Child and Adolescent Psychiatry, General Hospital of Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
| | - Michael Zeiler
- Department of Child and Adolescent Psychiatry, General Hospital of Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Vasileia Grylli
- Department of Child and Adolescent Psychiatry, General Hospital of Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Gabriele Berger
- Gastroenterology Unit at the Department of Paediatrics and Adolescent Medicine, General Hospital of Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Wolf-Dietrich Huber
- Gastroenterology Unit at the Department of Paediatrics and Adolescent Medicine, General Hospital of Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Christian Woeber
- Department of Neurology, General Hospital of Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Charlotte Rhind
- Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Andreas Karwautz
- Department of Child and Adolescent Psychiatry, General Hospital of Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
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