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Damasceno RPB, Zandonadi RP, Mendes M, Cunha Junior LC, Raposo A, Teixeira-Lemos E, Chaves C, Farage P. Risk of Gluten Cross-Contamination Due to Food Handling Practices: A Mini-Review. Nutrients 2024; 16:1198. [PMID: 38674888 PMCID: PMC11055037 DOI: 10.3390/nu16081198] [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: 03/13/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Celiac disease (CD) is an autoimmune disease triggered by the ingestion of gluten in genetically predisposed individuals, affecting 1.4% of the world population. CD induces an inflammatory reaction that compromises small intestine villi, leading to nutrient malabsorption, and gastro and extraintestinal manifestations. Although other treatment approaches are being studied, adherence to a gluten-free diet (GFD) is the only effective intervention to date. Despite this, about 50% of patients experience persistent inflammation, often associated with unintentional gluten ingestion through contaminated food. There are regulations for labeling gluten-free foods which specify a limit of 20 mg/kg (20 ppm). The risks of gluten cross-contamination above that level are present throughout the whole food production chain, emphasizing the need for caution. This review explores studies that tested different procedures regarding the shared production of gluten-containing and gluten-free food, including the use of shared equipment and utensils. A literature review covering PubMed, Scielo, Web of Science, VHL and Scopus identified five relevant studies. The results indicate that shared environments and equipment may not significantly increase gluten cross-contamination if appropriate protocols are followed. Simultaneous cooking of gluten-containing and gluten-free pizzas in shared ovens has demonstrated a low risk of contamination. In general, shared kitchen utensils and equipment (spoon, ladle, colander, knife, fryer, toaster) in controlled experiments did not lead to significant contamination of samples. On the other hand, cooking gluten-free and gluten-containing pasta in shared water resulted in gluten levels above the established limit of 20 ppm. However, rinsing the pasta under running water for a few seconds was enough to reduce the gluten content of the samples to less than 20 ppm.
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Affiliation(s)
- Renatta Pereira B. Damasceno
- School of Nutrition, Federal University of Goiás (FANUT/UFG), Goiânia 74690-900, Goiás, Brazil; (R.P.B.D.); (M.M.)
| | - Renata Puppin Zandonadi
- Department of Nutrition, College of Health Sciences, University of Brasília (UNB), Brasília 70910-900, Federal District, Brazil;
| | - Marcela Mendes
- School of Nutrition, Federal University of Goiás (FANUT/UFG), Goiânia 74690-900, Goiás, Brazil; (R.P.B.D.); (M.M.)
| | | | - António Raposo
- CBIOS (Research Center for Biosciences and Health Technologies), Universidade Lusófona de Humanidades e Tecnologias, Campo Grande 376, 1749-024 Lisboa, Portugal
| | - Edite Teixeira-Lemos
- CERNAS Research Centre, Polytechnic University of Viseu, 3504-510 Viseu, Portugal;
| | - Cláudia Chaves
- ESSV, Centre for Studies in Education and Innovation (CI&DEI), Polytechnic University of Viseu, 3504-510 Viseu, Portugal;
| | - Priscila Farage
- School of Nutrition, Federal University of Goiás (FANUT/UFG), Goiânia 74690-900, Goiás, Brazil; (R.P.B.D.); (M.M.)
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de Vargas FM, Cardoso LT, Didoné A, Lima JPM, Venzke JG, de Oliveira VR. Celiac Disease: Risks of Cross-Contamination and Strategies for Gluten Removal in Food Environments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:124. [PMID: 38397615 PMCID: PMC10888188 DOI: 10.3390/ijerph21020124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024]
Abstract
Celiac disease (CD) is the chronic immune-mediated enteropathy of the small bowel, manifesting when exposure to gluten occurs in genetically predisposed individuals. Nowadays, the only treatment considered safe for CD is a gluten-free diet (GFD). However, one of the problems faced by celiac patients is the cross-contamination of gluten-free food when preparing meals, in addition to utensils, surfaces and equipment. This study aimed to evaluate cross-contamination in gluten-free products and strategies for removing gluten from cross-contamination in cooking environments. The selection of papers for this integrative review was carried out by searching different databases. Gluten cross-contamination is a global concern for celiac patients in food environments. Although some practices are positive, such as gluten labeling on processed food in several countries, it is crucial to promote good practices in food services around the world. Only a few studies showed effective results in removing gluten from surfaces and utensils; furthermore, sampling was limited, making it difficult to identify appropriate procedures to reduce cross-contamination. The variation in contamination in different kitchen environments also highlighted that celiac patients must continue paying attention to the methods used to prepare gluten-free food. More research is needed, especially into methods of removing gluten from surfaces and utensils, to ensure food safety for celiac patients in many food environments.
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Affiliation(s)
- Fabiana Magnabosco de Vargas
- Postgraduate Program in Food, Nutrition, and Health (PPGANS), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, RS, Brazil;
| | - Louise Thomé Cardoso
- Postgraduate Program in Agricultural and Environmental Microbiology (PPGMAA), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, RS, Brazil;
| | - Amanda Didoné
- Nutrition Deparment, Faculty of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, RS, Brazil; (A.D.); (J.G.V.)
| | - João P. M. Lima
- Scientific-Pedagogical Unit of Dietetics and Nutrition, Coimbra Health School, Polytechnic University of Coimbra, 3046-854 Coimbra, Portugal;
| | - Janaína Guimarães Venzke
- Nutrition Deparment, Faculty of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, RS, Brazil; (A.D.); (J.G.V.)
| | - Viviani Ruffo de Oliveira
- Postgraduate Program in Food, Nutrition, and Health (PPGANS), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, RS, Brazil;
- Nutrition Deparment, Faculty of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, RS, Brazil; (A.D.); (J.G.V.)
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Gluten contamination in labelled gluten-free, naturally gluten-free and meals in food services in low-, middle- and high-income countries: a systematic review and meta-analysis. Br J Nutr 2022; 127:1528-1542. [PMID: 34753529 DOI: 10.1017/s0007114521002488] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The gluten-free diet is based on the consumption of foods without gluten, which aims to manage celiac disease. The concern of celiac patients is that these foods should be safe. However, gluten contamination can affect these foods. The objectives of this review and meta-analysis were first, to identify articles that detected gluten contamination in gluten-free foods using validated methods. Second, to quantify the overall prevalence of gluten contamination of naturally gluten-free foods, labelled gluten-free products, and meals prepared in food services. Third, to highlight the influence of the country's income and the period of study on this prevalence. The studies were identified in Scopus, Science Direct, Web of Science, PubMed, and Google Scholar. Forty articles were included according to PRISMA guidelines. The statistical meta-analysis was performed using MedCalc 19 software. The results show that in the gluten-free foods analysed, the overall prevalence of gluten contamination was estimated at 15.12% (95% CI: 9.56%-21.70%), with more than 20 mg/kg of gluten. Naturally gluten-free foods were significantly more contaminated than labelled gluten-free products and than meals in food services (28.32%; 9.52%; 4.66% respectively; p < 0.001). Moreover, it was noticed that oats were the most contaminated food. In addition, the prevalence of gluten contamination has significantly decreased over time. The majority of the studies were carried out in upper-middle-income and high-income countries, while only one study was conducted in lower-middle income countries. Therefore, it is necessary to implement preventive actions to reduce gluten contamination, ensuring safe gluten-free foods for celiac patients, including low-income countries.
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Food Safety and Cross-Contamination of Gluten-Free Products: A Narrative Review. Nutrients 2021; 13:nu13072244. [PMID: 34210037 PMCID: PMC8308338 DOI: 10.3390/nu13072244] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/23/2021] [Accepted: 06/26/2021] [Indexed: 02/06/2023] Open
Abstract
A gluten-free diet (GFD) is currently the only effective treatment for celiac disease (CD); an individual’s daily intake of gluten should not exceed 10 mg. However, it is difficult to maintain a strict oral diet for life and at least one-third of patients with CD are exposed to gluten, despite their best efforts at dietary modifications. It has been demonstrated that both natural and certified gluten-free foods can be heavily contaminated with gluten well above the commonly accepted threshold of 20 mg/kg. Moreover, meals from food services such as restaurants, workplaces, and schools remain a significant risk for inadvertent gluten exposure. Other possible sources of gluten are non-certified oat products, numerous composite foods, medications, and cosmetics that unexpectedly contain “hidden” vital gluten, a proteinaceous by-product of wheat starch production. A number of immunochemical assays are commercially available worldwide to detect gluten. Each method has specific features, such as format, sample extraction buffers, extraction time and temperature, characteristics of the antibodies, recognition epitope, and the reference material used for calibration. Due to these differences and a lack of official reference material, the results of gluten quantitation may deviate systematically. In conclusion, incorrect gluten quantitation, improper product labeling, and poor consumer awareness, which results in the inadvertent intake of relatively high amounts of gluten, can be factors that compromise the health of patients with CD.
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Demirkesen I, Ozkaya B. Recent strategies for tackling the problems in gluten-free diet and products. Crit Rev Food Sci Nutr 2020; 62:571-597. [DOI: 10.1080/10408398.2020.1823814] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Ilkem Demirkesen
- Department of Animal Health, Food and Feed Research, General Directorate of Agricultural Research and Policies, Ministry of Agriculture and Forestry, Ankara, Turkey
| | - Berrin Ozkaya
- Department of Food Engineering, Ankara University, Ankara, Turkey
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Farage P, Zandonadi RP, Gandolfi L, Pratesi R, Falcomer AL, Araújo LS, Nakano EY, Ginani VC. Accidental Gluten Contamination in Traditional Lunch Meals from Food Services in Brasilia, Brazil. Nutrients 2019; 11:nu11081924. [PMID: 31426287 PMCID: PMC6723046 DOI: 10.3390/nu11081924] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 01/04/2023] Open
Abstract
This study aimed to evaluate the occurrence of gluten contamination in naturally gluten-free meals from food services in the Federal District, Brazil. This is an exploratory cross-sectional quantitative study in which a total of 180 samples of naturally gluten-free dishes were collected from 60 food services in Brazil. The enzyme-linked immunosorbent assay was used for the quantification of gluten. As established by the Codex Alimentarius, the threshold of 20 ppm of gluten was considered as the accepted upper gluten level for gluten-free food. A total of 2.8% (95% CI: 0.3-5.2%) gluten contamination was found in the samples. Among the 60 food services, 6.7% (95% CI: 2.7-10.6%) displayed at least one contaminated food in our sample. The occurrence of gluten contamination in naturally gluten-free preparations was uncommon and low on a quantitative basis.
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Affiliation(s)
- Priscila Farage
- Faculty of Nutrition, Federal University of Goiás (UFG), Campus Colemar Natal e Silva, Rua 227 qd.68 s/n, Setor Leste Universitário, Goiânia 74605-080, Brazil.
| | - Renata Puppin Zandonadi
- Department of Nutrition, Faculty of Health Sciences, University of Brasilia (UnB), Campus Darcy Ribeiro, Asa Norte, Brasilia 70910-900, Brazil.
| | - Lenora Gandolfi
- Faculty of Medicine, University of Brasilia (UnB), Campus Darcy Ribeiro, Asa Norte, Brasilia 70910-900, Brazil
| | - Riccardo Pratesi
- Faculty of Medicine, University of Brasilia (UnB), Campus Darcy Ribeiro, Asa Norte, Brasilia 70910-900, Brazil
| | - Ana Luísa Falcomer
- Department of Nutrition, Faculty of Health Sciences, University of Brasilia (UnB), Campus Darcy Ribeiro, Asa Norte, Brasilia 70910-900, Brazil
| | - Letícia Santos Araújo
- Department of Nutrition, Faculty of Health Sciences, University of Brasilia (UnB), Campus Darcy Ribeiro, Asa Norte, Brasilia 70910-900, Brazil
| | - Eduardo Yoshio Nakano
- Department of Statistics, Central Institute of Sciences, University of Brasilia (UnB), Campus Darcy Ribeiro, Asa Norte, Brasilia 70910-900, Brazil
| | - Verônica Cortez Ginani
- Department of Nutrition, Faculty of Health Sciences, University of Brasilia (UnB), Campus Darcy Ribeiro, Asa Norte, Brasilia 70910-900, Brazil
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Falcomer AL, Santos Araújo L, Farage P, Santos Monteiro J, Yoshio Nakano E, Puppin Zandonadi R. Gluten contamination in food services and industry: A systematic review. Crit Rev Food Sci Nutr 2018; 60:479-493. [PMID: 30582343 DOI: 10.1080/10408398.2018.1541864] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Gluten-related disorders (GRD) affects approximately 10% of the general population. The only treatment for GRD is still so far is the lifelong complete exclusion of gluten from the daily diet. The correct information about the presence/absence of gluten in food is very important to this group. The present study aimed to evaluate the prevalence of gluten contamination in gluten-free industrial and non-industrial products. In this systematic review, 24 cross-sectional studies were analyzed. The authors developed specific search strategies for Science Direct, Scopus, Web of Science, Google Scholar and ProQuest Dissertations & Theses Global. The authors evaluated the methodological quality of the included studies using criteria from Meta-analysis of Statistics Assessment and Review Instrument (MASTARI). We performed the statistical meta-analysis by metafor package of R program. 95.83% (n = 23) of the studies presented positive results for contamination (over 20 ppm). In industrial food products, studies showed a contamination prevalence of 13.2% (95% CI: 10.8%-15.7%). In non-industrial food products, studies showed a contamination prevalence of 41.5% (95% CI: 16.6%-66.4%). Despite the non-industrial products presented higher contamination prevalence than the industrial products, the difference was not significant (p = 0.072). The findings indicate cross-contamination in industrialized and non-industrialized products. As expected, industrial products labeled as gluten-free showed a lower percentage of gluten-contamination than non-industrialized. Despite that, any contaminated sample found in this group present greater relevance than non-labeled foods. It indicates that foods labeled as "gluten-free" should not be considered safe for patients with GRD since information on the label regarding the presence/absence of gluten is unreliable. Therefore, any gluten-contamination in products labeled as gluten-free is a serious problem to whom present GRD. Further studies are needed to estimate gluten cross-contamination in food service meals and industry better.
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Affiliation(s)
- Ana Luísa Falcomer
- Department of Nutrition, Faculty of Health Sciences, Campus Universitário Darcy, Ribeiro, University of Brasília, Distrito Federal, Brazil
| | - Letícia Santos Araújo
- Department of Nutrition, Faculty of Health Sciences, Campus Universitário Darcy, Ribeiro, University of Brasília, Distrito Federal, Brazil
| | - Priscila Farage
- Department of Nutrition, Faculty of Health Sciences, Campus Universitário Darcy, Ribeiro, University of Brasília, Distrito Federal, Brazil
| | - Jordanna Santos Monteiro
- Department of Nutrition, Faculty of Health Sciences, Campus Universitário Darcy, Ribeiro, University of Brasília, Distrito Federal, Brazil
| | - Eduardo Yoshio Nakano
- Department of Statistics, Campus Universitário Darcy Ribeiro, University of Brasília, Distrito Federal, Brazil
| | - Renata Puppin Zandonadi
- Department of Nutrition, Faculty of Health Sciences, Campus Universitário Darcy, Ribeiro, University of Brasília, Distrito Federal, Brazil
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Analysis of Gluten Content in Gluten-Free Pizza from Certified Take-Away Pizza Restaurants. Foods 2018; 7:foods7110180. [PMID: 30384457 PMCID: PMC6262390 DOI: 10.3390/foods7110180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 10/24/2018] [Accepted: 10/29/2018] [Indexed: 12/04/2022] Open
Abstract
Currently, a strict gluten-free diet is the only treatment for celiac disease. In Italy, food service establishments and restaurants can be certified for providing gluten-free foods, including pizza restaurants that make both gluten-free pizza and traditional wheat-based pizza. With this study we analyzed the gluten content in samples of gluten-free pizza prepared and purchased at certified restaurants in the Turin metropolitan area. All samples, from 28 pizzas and 28 cooked dough bases, produced results below the test limit of detection, except for one sample of cooked dough, that tested positive for gluten but still below the warning level for celiac consumers (<20 ppm). Gluten-free pizza, as advertised in the restaurants surveyed, can be considered a safe option for gluten-free consumption. Attention to and compliance with good manufacturing practices, a requisite for obtaining gluten-free certification for restaurants, were noted to have a positive effect on the final product.
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Farage P, Puppin Zandonadi R, Cortez Ginani V, Gandolfi L, Yoshio Nakano E, Pratesi R. Gluten-Free Diet: From Development to Assessment of a Check-List Designed for the Prevention of Gluten Cross-Contamination in Food Services. Nutrients 2018; 10:nu10091274. [PMID: 30201860 PMCID: PMC6165388 DOI: 10.3390/nu10091274] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/03/2018] [Accepted: 09/07/2018] [Indexed: 01/28/2023] Open
Abstract
Gluten cross-contamination in gluten-free food may jeopardize treatment of celiac patients. Considering the deficit of appropriate instruments to enable the implementation of safe production practices for gluten-free food, this study aimed to evaluate the application of a check-list elaborated for gluten cross-contamination prevention in food services. The instrument was applied in 60 Brazilian food services. Interobserver reproducibility and internal consistency of the check-list were tested. A score classification was created for establishments according to the food contamination risk assessment. Subsequent to the application and statistical analysis, the original instrument was reduced to a 30-item check-list. In the reproducibility analysis, none of the 30 items showed significant divergence among the evaluators (p > 0.05 in the Cochran Q test). The 30-item version of the check-list presented Kuder–Richardson Formula 20 (KR-20) = 0.771, indicating good internal consistency. The proposed classification score is obtained by adding 1 point for each item with an “adequate” response; therefore, the final score may vary between 0 and 30 points. Establishments with up to 15 points exhibit risk of gluten contamination, while establishments with a score above 16 points exhibit low risk of contamination. The check-list displayed good reproducibility and internal consistency, suggesting that it could be a useful gluten contamination control instrument in food services.
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Affiliation(s)
- Priscila Farage
- Department of Nutrition, School of Health Sciences, University of Brasilia (UnB), Campus Darcy Ribeiro, Asa Norte, Brasilia DF 70910-900, Brazil.
| | - Renata Puppin Zandonadi
- Department of Nutrition, School of Health Sciences, University of Brasilia (UnB), Campus Darcy Ribeiro, Asa Norte, Brasilia DF 70910-900, Brazil.
| | - Verônica Cortez Ginani
- Department of Nutrition, School of Health Sciences, University of Brasilia (UnB), Campus Darcy Ribeiro, Asa Norte, Brasilia DF 70910-900, Brazil.
| | - Lenora Gandolfi
- Faculty of Medicine, University of Brasilia (UnB), Campus Darcy Ribeiro, Asa Norte, Brasilia DF 70910-900, Brazil.
| | - Eduardo Yoshio Nakano
- Department of Statistics, Central Institute of Sciences, University of Brasilia (UnB), Campus Darcy Ribeiro, Asa Norte, Brasilia DF 70910-900, Brazil.
| | - Riccardo Pratesi
- Faculty of Medicine, University of Brasilia (UnB), Campus Darcy Ribeiro, Asa Norte, Brasilia DF 70910-900, Brazil.
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All that a physician should know about gluten-free diet. Indian J Gastroenterol 2018; 37:392-401. [PMID: 30367395 DOI: 10.1007/s12664-018-0895-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/19/2018] [Indexed: 02/06/2023]
Abstract
Gluten-free diet (GFD) is the only definitive treatment for patients with celiac disease (CeD). Strict adherence to GFD improves the symptoms, nutritional deficiencies, and the overall well-being of the patients. The management of CeD is truly different and unique from the treatment of other medical or surgical diseases. While prescribing a GFD is easy, the key to the success lies in the dietary counseling by a nutrition specialist/physician and maintenance of adherence to the prescribed diet by the patient. When restricting gluten from all possible sources, it is pertinent to recommend a diet that is healthy and balanced for patients with celiac disease. Those following GFD must be counseled properly on the ways of balancing their diets and of avoiding cross contamination. They should be taught how to read food labels properly and given tips for dining out or during traveling. Regular follow up with patients is required for assessing the compliance and monitoring growth and the status of recovery. In this review article, we have compiled, for the physicians and gastroenterologists, the relevant information about GFD including counseling, adherence, nutritional adequacy, and many other related issues.
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Content Validation and Semantic Evaluation of a Check-List Elaborated for the Prevention of Gluten Cross-Contamination in Food Services. Nutrients 2017; 9:nu9010036. [PMID: 28067805 PMCID: PMC5295080 DOI: 10.3390/nu9010036] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 12/21/2016] [Accepted: 12/26/2016] [Indexed: 12/30/2022] Open
Abstract
Conditions associated to the consumption of gluten have emerged as a major health care concern and the treatment consists on a lifelong gluten-free diet. Providing safe food for these individuals includes adapting to safety procedures within the food chain and preventing gluten cross-contamination in gluten-free food. However, a gluten cross-contamination prevention protocol or check-list has not yet been validated. Therefore, the aim of this study was to perform the content validation and semantic evaluation of a check-list elaborated for the prevention of gluten cross-contamination in food services. The preliminary version of the check-list was elaborated based on the Brazilian resolution for food safety Collegiate Board Resolution 216 (RDC 216) and Collegiate Board Resolution 275 (RDC 275), the standard 22000 from the International Organization for Standardization (ISO 22000) and the Canadian Celiac Association Gluten-Free Certification Program documents. Seven experts with experience in the area participated in the check-list validation and semantic evaluation. The criteria used for the approval of the items, as to their importance for the prevention of gluten cross-contamination and clarity of the wording, was the achievement of a minimal of 80% of agreement between the experts (W-values ≥ 0.8). Moreover, items should have a mean ≥4 in the evaluation of importance (Likert scale from 1 to 5) and clarity (Likert scale from 0 to 5) in order to be maintained in the instrument. The final version of the check-list was composed of 84 items, divided into 12 sections. After being redesigned and re-evaluated, the items were considered important and comprehensive by the experts (both with W-values ≥ 0.89). The check-list developed was validated with respect to content and approved in the semantic evaluation.
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Gluten contamination in gluten-free bakery products: a risk for coeliac disease patients. Public Health Nutr 2016; 20:413-416. [DOI: 10.1017/s1368980016002433] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AbstractObjectiveThe present study aimed to assess the safety of gluten-free bakery products for consumption by coeliac patients.Design/settingIn the current exploratory cross-sectional quantitative study, a total of 130 samples were collected from twenty-five bakeries in Brasilia (Brazil). For the quantification of gluten, an ELISA was used. The threshold of 20 ppm gluten was considered as the safe upper limit for gluten-free food, as proposed in the Codex Alimentarius.ResultsThe results revealed a total of 21·5 % of contamination among the bakery products sampled. Sixty-four per cent of the bakeries sold at least one contaminated product in our sample.ConclusionsThese findings represent a risk for coeliac patients since the ingestion of gluten traces may be sufficient to adversely impact on their health.
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