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Wall E, Semrad CE. Celiac Disease, Gluten Sensitivity, and Diet Management. Curr Gastroenterol Rep 2024; 26:191-199. [PMID: 38865028 DOI: 10.1007/s11894-024-00931-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE OF REVIEW Celiac disease is a common chronic inflammatory condition of the small bowel triggered by gluten in wheat, rye and barley in the diet. Non-celiac gluten sensitivity presents with symptoms similar to celiac disease with the ingestion of gluten or other components of wheat. In this article, we review challenges presented by a gluten free diet for the treatment of both disorders. RECENT FINDINGS Wheat is ubiquitous in the diet and medications/products. A registered dietitian is mandatory for patient education on the gluten free diet. Naturally gluten free foods provide a healthy diet for those with celiac disease. Whole grains labelled gluten free, including oats, are encouraged in the diet as refined grains may be deficient in fiber, protein, and micronutrients, particularly folate. Gluten contamination is the most common cause of persistent symptoms in celiac disease though shared equipment of food preparation may not be as large a problem as suspected. Most with celiac disease on a gluten free diet will fully recover and gain weight that poses a problem for those overweight to start. The gluten free diet may have a negative impact on quality of life for both celiac patients and their families. Those with hypervigilance of the gluten free diet and avoidance of dining out have the lowest quality of life. The gluten free diet is currently the only effective treatment for celiac disease. A registered dietitian is needed to educate patients on the complexity of the gluten free diet with a goal of healthy eating, maintaining a healthy weight, and avoiding disordered eating or diet hypervigilance; key to a good quality of life.
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Affiliation(s)
- Elizabeth Wall
- Clinical Nutrition, University of Chicago Medicine, Chicago, IL, USA
| | - Carol E Semrad
- Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, Chicago, IL, USA.
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Luque V, Crespo-Escobar P, Hård Af Segerstad EM, Koltai T, Norsa L, Roman E, Vreugdenhil A, Fueyo-Díaz R, Ribes-Koninckx C. Gluten-free diet for pediatric patients with coeliac disease: A position paper from the ESPGHAN gastroenterology committee, special interest group in coeliac disease. J Pediatr Gastroenterol Nutr 2024; 78:973-995. [PMID: 38291739 DOI: 10.1002/jpn3.12079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/10/2023] [Accepted: 08/20/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND AND OBJECTIVE Coeliac disease is a chronic, immune-mediated disorder for which the only treatment consists of lifelong strict adherence to gluten-free diet (GFD). However, there is a lack of evidence-based guidelines on the GFD dietary management of coeliac disease. This position paper, led by the Special Interest Group in coeliac disease of the European Society of Pediatric, Gastroenterology Hepatology, and Nutrition, supported by the Nutrition Committee and the Allied Health Professionals Committee, aims to present evidence-based recommendations on the GFD as well as how to support dietary adherence. METHODS A wide literature search was performed using the MeSH Terms: "diet, gluten free," "gluten-free diet," "diets, gluten-free," "gluten free diet," and "coeliac disease" in Pubmed until November 8th, 2022. RESULTS The manuscript provides an overview of the definition of the GFD, regulations as basis to define the term "gluten-free," which foods are naturally gluten-free and gluten-containing. Moreover, it provides recommendations and educational tips and infographics on suitable food substitutes, the importance of reading food labels, risk of gluten cross-contact at home and in public settings, nutritional considerations as well as factors associated to dietary adherence based on available evidence, or otherwise clinical expertise. CONCLUSIONS This position paper provides guidance and recommendations to support children with coeliac disease to safely adhere to a GFD.
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Affiliation(s)
- Veronica Luque
- Serra Húnter, Universitat Rovira i Virgili, Reus, Spain
- Paediatric Nutrition and Development Research Unit, IISPV, Reus, Spain
| | - Paula Crespo-Escobar
- Health Sciences Department, ADVISE Research Group, Miguel de Cervantes European University, Valladolid, Spain
- Nutrition and Dietetics Unit, Hospital Recoletas Campo Grande, Valladolid, Spain
| | - Elin M Hård Af Segerstad
- Paediatric Department, Skane University Hospital, Malmoe, Sweden
- Department of Clinical Sciences, Celiac Disease and Diabetes Unit, Faculty of Medicine, Lund University, Malmoe, Sweden
| | - Tunde Koltai
- Direction Board, Association of European Coeliac Societies, Brussels, Belgium
| | - Lorenzo Norsa
- Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Enriqueta Roman
- Paediatric Gastroenterology and Nutrition, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Anita Vreugdenhil
- Department of Pediatrics, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ricardo Fueyo-Díaz
- Department of Psychology and Sociology, Aragonese Primary Care Research Group (GAIAP, B21_20R), University of Zaragoza, Zaragoza, Spain
| | - Carmen Ribes-Koninckx
- Paediatric Gastroenterology, Hepatology and Nutrition, La Fe University Hospital & La Fe Research Institute, Valencia, Spain
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Verma AK, Monachesi C, Catassi GN, Franceschini E, Gatti S, Lionetti E, Catassi C. Performance assessment of a new G12/A1 antibody-based rapid ELISA using commercially available and gluten-spiked food samples. Eur J Gastroenterol Hepatol 2024; 36:416-422. [PMID: 38407849 DOI: 10.1097/meg.0000000000002739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
OBJECTIVE Food products with <20 mg/kg gluten can be labeled 'gluten-free' according to international regulations. Several antibodies-based ELISAs have been develop to track gluten traces in food products. Among them, R5 and G12 antibody-based ELISAs are the frequently used methods. However, these antibodies have certain limitations. We evaluated the accuracy of G12/A1 antibody-based 'Glutentox ELISA Rapid G12' and compared the results with the current reference method i.e., R5 antibody-based 'Ridascreen R5 ELISA'. METHODS In the first step, the performance of Glutentox ELISA Rapid G12 kit was inspected by determination of the threshold value i.e., > or <20 mg/kg gluten in different food products. In the second step, quantification accuracy was assessed by quantification of gluten in gluten-free food products spiked with gliadin reference material. RESULTS In total 47 food products (naturally and labeled gluten-free, and food with traces of gluten) were included. Of them, 29 products were quantified with <20 mg/kg, and 18 with a low level of gluten by both the kits. Six out of 29 gluten-free products were used for the recovery test at different spike levels. Gluten concentration and mean recovery rates of individual kits showed consistency. CONCLUSION GlutenTox Rapid G12 ELISA could be an appropriate choice for detecting gluten in food products but needs more in-house validation and collaborative tests.
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Affiliation(s)
- Anil K Verma
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Celiac Disease Research Laboratory, Polytechnic University of Marche, Ancona, Italy
| | - Chiara Monachesi
- Celiac Disease Research Laboratory, Polytechnic University of Marche, Ancona, Italy
| | - Giulia N Catassi
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, Ancona, Italy
| | - Elisa Franceschini
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, Ancona, Italy
| | - Simona Gatti
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, Ancona, Italy
| | - Elena Lionetti
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, Ancona, Italy
| | - Carlo Catassi
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, Ancona, Italy
- Mucosal Immunology and Biology Research Center, Division of Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital, Boston, USA
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Djorgbenoo R, Hu J, Hu C, Sang S. Fermented Oats as a Novel Functional Food. Nutrients 2023; 15:3521. [PMID: 37630712 PMCID: PMC10459665 DOI: 10.3390/nu15163521] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Fermented oats are gaining popularity due to their nutritional value and the increasing consumer demand for health-conscious foods. These oats are believed to offer enhanced phytochemical and nutritional profiles compared to unfermented oats. The increased nutritional content of fermented oats is associated with various health benefits, including anti-inflammatory and antioxidant activities, which could potentially reduce the risk of chronic diseases. Further investigations are warranted to elucidate the nutritional benefits of fermented oats in human nutrition. This mini review provides a comprehensive overview of fermented oat products available on the market and the various production methods employed for fermenting oats. Furthermore, this review investigates how fermentation affects the chemical composition and biological functions of oats. Additionally, this manuscript presents some future perspectives on fermented oat products by discussing potential research directions and opportunities for further development. The findings presented in this review contribute to the expanding body of knowledge on fermented oats as a promising functional food, paving the way for future studies and applications in the field of nutrition and health.
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Affiliation(s)
| | | | | | - Shengmin Sang
- Laboratory for Functional Foods and Human Health, Center for Excellence in Post-Harvest Technologies, North Carolina Research Campus, North Carolina Agricultural and Technical State University, Kannapolis, NC 28081, USA; (R.D.); (J.H.); (C.H.)
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Gell G, Karsai I, Berki Z, Horváth Á, Florides CG, Birinyi Z, Nagy-Réder D, Varga B, Cseh A, Békés F, Veisz O. Effect of additional water supply during grain filling on protein composition and epitope characteristics of winter oats. Curr Res Food Sci 2022; 5:2146-2161. [DOI: 10.1016/j.crfs.2022.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/12/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022] Open
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Rodríguez JM, Estévez V, Bascuñán K, Ayala J, Araya M. Commercial oats in gluten-free diet: A persistent risk for celiac patients. Front Nutr 2022; 9:986282. [PMID: 36276819 PMCID: PMC9582257 DOI: 10.3389/fnut.2022.986282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background Gluten-free diet is the treatment of celiac disease and other gluten-related disorders and excludes wheat, rye, and barley, while oats inclusion/exclusion has long been a matter of debate. A logo or catchphrase indicating the gluten-free condition in a product is all the consumer relies on to accept the product as suitable for his/her treatment. The oat-based gluten-free products represents a small market, which may have changed, and become more limited during COVID-19 pandemic. Objective To assess gluten contamination in all labeled oat-based gluten-free local and imported products available in the market, comparing them to matched regular gluten containing counterparts. As a secondary objective, unconventional flours available in the same sale points were also assessed. Results The search yielded 25 gluten-free labeled oat flours, rolled, and instant cereals, which were compared to 27 regular gluten containing equivalents. Gluten content was above the local (5 ppm) and the Codex Alimentarius cutoff (20 ppm) in 40 and 36% of the gluten-free labeled products, respectively. When all positive products were analyzed together, there were no differences in gluten content between labeled and unlabeled products. Locally produced products were more expensive, while rolled/instant oats were less contaminated than flours (p = 0.01). Precautionary labels advising presence of gluten as allergen was omitted in 37.0% of regular products. Only 33.3% of unconventional flours obtained from open markets and sold in bulk, were gluten contaminated. Conclusion Oat-based gluten-free products are currently highly contaminated. It is urgent to regulate them and implement protocols that allow safe consumption of these products.
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Affiliation(s)
- Juan Manuel Rodríguez
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - Virginia Estévez
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - Karla Bascuñán
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile,Department of Nutrition, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Jimena Ayala
- Corporación de Apoyo al Celíaco (COACEL), Santiago, Chile
| | - Magdalena Araya
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile,Corporación de Apoyo al Celíaco (COACEL), Santiago, Chile,*Correspondence: Magdalena Araya
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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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8
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Detection of gluten content in both naturally and labelled gluten-free products available in Morocco. J Verbrauch Lebensm 2022. [DOI: 10.1007/s00003-022-01374-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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9
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Gell G, Bugyi Z, Florides CG, Birinyi Z, Réder D, Szegő Z, Mucsi E, Schall E, Ács K, Langó B, Purgel S, Simon K, Varga B, Vida G, Veisz O, Tömösközi S, Békés F. Investigation of Protein and Epitope Characteristics of Oats and Its Implications for Celiac Disease. Front Nutr 2021; 8:702352. [PMID: 34660657 PMCID: PMC8511309 DOI: 10.3389/fnut.2021.702352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/23/2021] [Indexed: 12/14/2022] Open
Abstract
The use of pure oats (oats cultivated with special care to avoid gluten contamination from wheat, rye, and barley) in the gluten-free diet (GFD) represents important nutritional benefits for the celiac consumer. However, emerging evidence suggests that some oat cultivars may contain wheat gliadin analog polypeptides. Consequently, it is necessary to screen oats in terms of protein and epitope composition to be able to select safe varieties for gluten-free applications. The overall aim of our study is to investigate the variability of oat protein composition directly related to health-related and techno-functional properties. Elements of an oat sample population representing 162 cultivated varieties from 20 countries and the protein composition of resulting samples have been characterized. Size distribution of the total protein extracts has been analyzed by size exclusion-high performance liquid chromatography (SE-HPLC) while the 70% ethanol-extracted proteins were analyzed by RP-HPLC. Protein extracts separated into three main groups of fractions on the SE-HPLC column: polymeric proteins, avenins (both containing three subgroups based on their size), and soluble proteins, representing respectively 68.79–86.60, 8.86–27.72, and 2.89–11.85% of the total protein content. The ratio of polymeric to monomeric proteins varied between 1.37 and 3.73. Seventy-six reversed phase-HPLC-separated peaks have been differentiated from the ethanol extractable proteins of the entire population. Their distribution among the cultivars varied significantly, 6–23 peaks per cultivar. The number of appearances of peaks also showed large variation: one peak has been found in 107 samples, while 15 peaks have been identified, which appeared in less than five cultivars. An estimation method for ranking the avenin-epitope content of the samples has been developed by using MS spectrometric data of collected RP-HPLC peaks and bioinformatics methods. Using ELISA methodology with the R5 antibody, a high number of the investigated samples were found to be contaminated with wheat, barley, or rye.
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Affiliation(s)
- Gyöngyvér Gell
- Department of Biological Resources, Agricultural Institute, Centre for Agricultural Research, EötvösLoránd Research Network, Martonvásár, Hungary.,Department of Applied Biotechnology and Food Science, Research Group of Cereal Science and Food Quality, Budapest University of Technology and Economics, Budapest, Hungary
| | - Zsuzsanna Bugyi
- Department of Applied Biotechnology and Food Science, Research Group of Cereal Science and Food Quality, Budapest University of Technology and Economics, Budapest, Hungary
| | | | - Zsófia Birinyi
- Department of Biological Resources, Agricultural Institute, Centre for Agricultural Research, EötvösLoránd Research Network, Martonvásár, Hungary
| | - Dalma Réder
- Department of Biological Resources, Agricultural Institute, Centre for Agricultural Research, EötvösLoránd Research Network, Martonvásár, Hungary
| | - Zsuzsanna Szegő
- Department of Applied Biotechnology and Food Science, Research Group of Cereal Science and Food Quality, Budapest University of Technology and Economics, Budapest, Hungary
| | - Edina Mucsi
- Department of Applied Biotechnology and Food Science, Research Group of Cereal Science and Food Quality, Budapest University of Technology and Economics, Budapest, Hungary
| | - Eszter Schall
- Department of Applied Biotechnology and Food Science, Research Group of Cereal Science and Food Quality, Budapest University of Technology and Economics, Budapest, Hungary
| | - Katalin Ács
- Cereal Research Non-Profit Ltd., Szeged, Hungary
| | | | | | | | - Balázs Varga
- Cereal Breeding Department, Agricultural Institute, Centre for Agricultural Research, EötvösLoránd Research Network, Martonvásár, Hungary
| | - Gyula Vida
- Cereal Breeding Department, Agricultural Institute, Centre for Agricultural Research, EötvösLoránd Research Network, Martonvásár, Hungary
| | - Ottó Veisz
- Cereal Breeding Department, Agricultural Institute, Centre for Agricultural Research, EötvösLoránd Research Network, Martonvásár, Hungary
| | - Sándor Tömösközi
- Department of Applied Biotechnology and Food Science, Research Group of Cereal Science and Food Quality, Budapest University of Technology and Economics, Budapest, Hungary
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Escobar-Correas S, Broadbent JA, Andraszek A, Stockwell S, Howitt CA, Juhász A, Colgrave ML. Perennial Ryegrass Contains Gluten-Like Proteins That Could Contaminate Cereal Crops. Front Nutr 2021; 8:708122. [PMID: 34395501 PMCID: PMC8355629 DOI: 10.3389/fnut.2021.708122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/23/2021] [Indexed: 11/25/2022] Open
Abstract
Background: To ensure safe consumption of gluten-free products, there is a need to understand all sources of unintentional contamination with gluten in the food chain. In this study, ryegrass (Lolium perenne), a common weed infesting cereal crop, is analysed as a potential source of gluten-like peptide contamination. Materials and Methods: Ten ryegrass cultivars were analysed using shotgun proteomics for the presence of proteins from the prolamin superfamily. A relative quantitative assay was developed to detect ryegrass gluten-like peptides in comparison with those found in 10 common wheat cultivars. Results: A total of 19 protein accessions were found across 10 cultivars of ryegrass for the protein families of PF00234-Tryp_alpha_amyl, PF13016-Gliadin, and PF03157-Glutenin_HMW. Protein and peptide homology searches revealed that gliadin-like peptides were similar to avenin and gamma-gliadin peptides. A total of 20 peptides, characteristic of prolamin superfamily proteins, were selected for liquid chromatography mass spectrometry (LC-MS) with multiple reaction monitoring (MRM). Only two of the monitored peptides were detected with high abundance in wheat, and all others were detected in ryegrass. Glutenin and alpha-amylase/trypsin inhibitor peptides were reported for the first time in ryegrass and were noted to be conserved across the Poaceae family. Conclusion: A suite of gluten-like peptides were identified using proteomics that showed consistent abundance across ryegrass cultivars but were not detected in wheat cultivars. These peptides will be useful for differentiating wheat gluten contamination from ryegrass gluten contamination.
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Affiliation(s)
- Sophia Escobar-Correas
- CSIRO Agriculture and Food, St. Lucia, QLD, Australia.,Australian Research Council Centre of Excellence for Innovations in Peptide and Protein Science, School of Science, Edith Cowan University, Joondalup, WA, Australia
| | | | | | | | | | - Angéla Juhász
- Australian Research Council Centre of Excellence for Innovations in Peptide and Protein Science, School of Science, Edith Cowan University, Joondalup, WA, Australia
| | - Michelle L Colgrave
- CSIRO Agriculture and Food, St. Lucia, QLD, Australia.,Australian Research Council Centre of Excellence for Innovations in Peptide and Protein Science, School of Science, Edith Cowan University, Joondalup, WA, Australia
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Oat proteins: Review of extraction methods and techno-functionality for liquid and semi-solid applications. Lebensm Wiss Technol 2021. [DOI: 10.1016/j.lwt.2021.111478] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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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: 30] [Impact Index Per Article: 10.0] [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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Colombo F, Di Lorenzo C, Biella S, Bani C, Restani P. Ancient and Modern Cereals as Ingredients of the Gluten-Free Diet: Are They Safe Enough for Celiac Consumers? Foods 2021; 10:foods10040906. [PMID: 33924221 PMCID: PMC8074585 DOI: 10.3390/foods10040906] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/14/2021] [Accepted: 04/17/2021] [Indexed: 02/05/2023] Open
Abstract
Celiac disease is an autoimmune disorder that occurs in genetically predisposed individuals after consuming prolamins from some cereals. Although the products available for celiac subjects have increased significantly in quality and quantity over the last few decades, research still focuses on identifying new ingredients to improve the nutritional, sensorial and functional qualities of gluten-free products. In terms of toxicity for people with celiac disease, there is a wide variability between ancient and modern grains. The most contradictory results are related to the role of oats in the gluten-free diet. In order to clarify the role of minor cereals (such as oat) and ancient grains in the diets of celiac patients, this review discusses recent in vitro and in vivo studies performed on those cereals for which the toxicity for celiac subjects is still controversial. According to in vivo studies, selected oat varieties could be tolerated by celiac patients. On the other hands, although some wheat-ancient grains (Triticum monococcum, Triticum aestivum ssp. spelta and Kamut®) showed a reduced in vitro toxicity, to date, these grains are still considered toxic for celiac patients. Contradictory results underline the importance of studying the safety of "unusual" cereals in more detail.
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A Systematic Review on Gluten-Free Bread Formulations Using Specific Volume as a Quality Indicator. Foods 2021; 10:foods10030614. [PMID: 33805719 PMCID: PMC7999268 DOI: 10.3390/foods10030614] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 12/13/2022] Open
Abstract
This study aimed to perform a systematic review on gluten-free bread formulations using specific volumes as a quality indicator. In this systematic review, we identified 259 studies that met inclusion criteria. From these studies, 43 met the requirements of having gluten-free bread with a specific volume greater than or equal to 3.5 cm3/g. Other parameters such as the texture profile, color (crumb and crust), and sensory analysis examined in these studies were presented. The formulations that best compensated the lack of the gluten-network were based on the combination of rice flour, rice flour with low amylose content, maize flour, rice starch, corn starch, potato starch, starch with proteins and added with transglutaminase (TGase), and hydrocolloids like hydroxypropylmethylcellulose (HPMC). Of the 43 studies, three did not present risk of bias, and the only parameter evaluated in common in the studies was the specific volume. However, it is necessary to jointly analyze other parameters that contribute to the quality, such as texture profile, external and internal characteristics, acceptability, and useful life of the bread, especially since it is a product obtained through raw materials and unconventional ingredients.
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Multidimensional Disadvantages of a Gluten-Free Diet in Celiac Disease: A Narrative Review. Nutrients 2021; 13:nu13020643. [PMID: 33669442 PMCID: PMC7920475 DOI: 10.3390/nu13020643] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 12/17/2022] Open
Abstract
A gluten-free diet is the mainstay method of treatment and the prevention of celiac disease complications. However, an inadequately balanced gluten-free diet can increase the risk of obesity, negatively affect glucose and lipid metabolism, and increase the risk of the metabolic syndrome. Therefore, an adequate nutritional counselling is necessary for patients diagnosed with celiac disease in order to prevent and treat the components of the metabolic syndrome.
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Gluten content in labeled and unlabeled gluten-free food products used by patients with celiac disease. Eur J Clin Nutr 2021; 75:1245-1253. [PMID: 33462461 DOI: 10.1038/s41430-020-00854-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/12/2020] [Accepted: 12/17/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Gluten-free (GF) diet is the only reliable treatment for patients with celiac disease (CeD), but data on the extent of gluten contamination in GF food available in India is scanty. We evaluated gluten content in labeled, imported, and non-labeled GF food products currently available in the Indian market. METHODS Overall, 794 processed and commercially available packaged GF products (labeled GF (n = 360), imported GF (n = 80), and non-labeled/naturally GF (n = 354)) were collected from supermarkets of National Capital Region of India. Those unavailable in stores were purchased from e-commerce sites or directly from the manufacturers. Gluten level in them was determined by Ridascreen Gliadin sandwich R5 enzyme-linked immunosorbent assay (R-Biopharm AG, Germany). As per Codex Alimentarius and Food Safety and Standard Authority of India, "gluten free" labeled products must not contain > 20 mg/kg of gluten. RESULTS Overall, 10.1% of 794 GF products including 38 (10.8%) of 360 labeled and 42 (11.8%) of 354 non-labeled/naturally GF food products had gluten content > 20 mg/kg (range: 24.43-355 and 23.2-463.8 mg/kg, respectively). None of the imported GF products had gluten more than the recommended limits. Contaminated products most commonly belonged to cereal and their products (flours, coarse grains, pasta/macaroni, snack foods) pulse flours, spices, and bakery items. CONCLUSIONS A substantial proportion (10.1%) of GF food products (both labeled and non-labeled) available in India have gluten content greater than the prescribed limits of <20 mg/kg. Physicians, dietitians, support group, and patients with CeD should be made aware of this fact and regulatory bodies should ensure quality assurance.
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Quantification of Accidental Gluten Contamination in the Diet of Children with Treated Celiac Disease. Nutrients 2021; 13:nu13010190. [PMID: 33435453 PMCID: PMC7827942 DOI: 10.3390/nu13010190] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 12/31/2020] [Accepted: 01/07/2021] [Indexed: 11/16/2022] Open
Abstract
A strict gluten-free diet is extremely difficult to maintain. Protracted ingestion of gluten traces (>10 mg/day) is sufficient to cause significant damage in the architecture of the small intestinal mucosa in patients on treatment for celiac disease. The aim of this study was to directly measure the level of contaminating gluten in the daily diet of celiac children following a gluten-free diet. From April 2019 to December 2019, celiac disease children (2-18 years old) on a gluten-free diet for ≥6 months were offered to participate in this prospective-observational study. Patients and their caregivers were invited to provide a representative portion (about 10 g) of all meals consumed during a 24-h period. Participants were requested to weigh all ingested food and report items in a 24-h food diary. The gluten content was quantified by the R5 sandwich enzyme-linked immunosorbent assay method. Sixty-nine children completed the protocol. Overall, 12/448 (2.7%) food samples contained detectable amounts of gluten; of them, 11 contained 5-20 ppm and 1 >20 ppm. The 12 contaminated food samples belonged to 5/69 enrolled patients. In these 5 children, the daily gluten intake was well below the safety threshold of 10 mg/day. The present findings suggest that in a country characterized by high celiac disease awareness, the daily unintended exposure to gluten of treated celiac children on regular follow-up is very low; reassuringly, the presence of gluten traces did not lead to exceed the tolerable threshold of 10 mg/day of gluten intake in the gluten-free diet.
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Parsons K, Brown L, Clark H, Allen E, McCammon E, Clark G, Oblad R, Kenealey J. Gluten cross-contact from common food practices and preparations. Clin Nutr 2020; 40:3279-3287. [PMID: 33190992 DOI: 10.1016/j.clnu.2020.10.053] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 12/18/2022]
Abstract
Patients with celiac disease continue to be exposed to gluten despite efforts to maintain a gluten-free diet (GFD). Gluten exposure in those with celiac disease leads to pathological changes in the small intestine that may or may not be associated with gastrointestinal distress. While several studies have investigated a GFD, little is known about sources of gluten contamination that prevent proper maintenance of such a diet by celiac patients. In this study, we investigate common food practices that could lead to gluten cross-contact. Three different practices were examined for gluten cross-contact: gluten-free foods fried in a fryer also used for gluten containing foods, gluten-free bread toasted in a toaster also used for gluten-containing bread, and popular sandwich spreads applied with a knife used on gluten-containing bread (mayonnaise, jam, and peanut butter). We used the ALLER-TEK™ Gluten ELISA test kit and the sandwich ELISA RIDASCREEN Gliadin test kit, which is endorsed for determination of gluten content and used for the evaluation of food cross-contact. Using both kits gave the advantage of using the 401.2 antibody as well as the better established R5 antibody, providing increased confidence in our results. We found these practices resulted in small amounts of gluten cross-contact, although the majority of the results (93.6%) showed no significant cross-contact. Mayonnaise and peanut butter samples were contaminated with gluten above the limit designated by the FDA as gluten-free <20 kg/mg (ppm).
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Affiliation(s)
- Katharine Parsons
- Department of Nutrition, Dietetics and Food Science, Brigham Young University, Provo, UT, 84602, USA
| | - Lindsay Brown
- Department of Nutrition, Dietetics and Food Science, Brigham Young University, Provo, UT, 84602, USA
| | - Hannah Clark
- Department of Nutrition, Dietetics and Food Science, Brigham Young University, Provo, UT, 84602, USA
| | - Eliza Allen
- Department of Nutrition, Dietetics and Food Science, Brigham Young University, Provo, UT, 84602, USA
| | - Elyse McCammon
- Department of Nutrition, Dietetics and Food Science, Brigham Young University, Provo, UT, 84602, USA
| | - Greyden Clark
- Department of Nutrition, Dietetics and Food Science, Brigham Young University, Provo, UT, 84602, USA
| | - Richard Oblad
- Department of Nutrition, Dietetics and Food Science, Brigham Young University, Provo, UT, 84602, USA
| | - Jason Kenealey
- Department of Nutrition, Dietetics and Food Science, Brigham Young University, Provo, UT, 84602, USA.
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20
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Silvester JA, Comino I, Rigaux LN, Segura V, Green KH, Cebolla A, Weiten D, Dominguez R, Leffler DA, Leon F, Bernstein CN, Graff LA, Kelly CP, Sousa C, Duerksen DR. Exposure sources, amounts and time course of gluten ingestion and excretion in patients with coeliac disease on a gluten-free diet. Aliment Pharmacol Ther 2020; 52:1469-1479. [PMID: 32981131 PMCID: PMC7780203 DOI: 10.1111/apt.16075] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/16/2020] [Accepted: 08/16/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND A major deficit in understanding and improving treatment in coeliac disease (CD) is the lack of empiric data on real world gluten exposure. AIMS To estimate gluten exposure on a gluten-free diet (GFD) using immunoassays for gluten immunogenic peptides (GIP) and to examine relationships among GIP detection, symptoms and suspected gluten exposures METHODS: Adults with biopsy-confirmed CD on a GFD for 24 months were recruited from a population-based inception cohort. Participants kept a diary and collected urine samples for 10 days and stools on days 4-10. 'Doggie bags' containing ¼ portions of foods consumed were saved during the first 7 days. Gluten in food, stool and urine was quantified using A1/G12 ELISA. RESULTS Eighteen participants with CD (12 female; age 21-70 years) and three participants on a gluten-containing diet enrolled and completed the study. Twelve out of 18 CD participants had a median 2.1 mg gluten per exposure (range 0.2 to >80 mg). Most exposures were asymptomatic and unsuspected. There was high intra-individual variability in the interval between gluten ingestion and excretion. Participants were generally unable to identify the food. CONCLUSIONS Gluten exposure on a GFD is common, intermittent, and usually silent. Excretion kinetics are highly variable among individuals. The amount of gluten varied widely, but was typically in the milligram range, which was 10-100 times less than consumed by those on an unrestricted diet. These findings suggest that a strict GFD is difficult to attain, and specific exposures are difficult to detect due to variable time course of excretion.
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Affiliation(s)
- Jocelyn A Silvester
- Harvard Medical School Celiac Research Program, Boston, USA
- Boston Children’s Hospital, Boston, USA
- Beth Israel Deaconess Medical Center, Boston, USA
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Isabel Comino
- Faculty of Pharmacy, University of Seville, Seville, Spain
| | | | | | | | | | | | | | - Daniel A Leffler
- Harvard Medical School Celiac Research Program, Boston, USA
- Beth Israel Deaconess Medical Center, Boston, USA
| | | | - Charles N Bernstein
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lesley A Graff
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ciaran P Kelly
- Harvard Medical School Celiac Research Program, Boston, USA
- Beth Israel Deaconess Medical Center, Boston, USA
| | - Carolina Sousa
- Faculty of Pharmacy, University of Seville, Seville, Spain
| | - Donald R Duerksen
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- St Boniface Hospital, Winnipeg, Canada
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21
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Rej A, Aziz I, Sanders DS. Coeliac disease and noncoeliac wheat or gluten sensitivity. J Intern Med 2020; 288:537-549. [PMID: 32573000 DOI: 10.1111/joim.13120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/15/2020] [Accepted: 04/21/2020] [Indexed: 12/15/2022]
Abstract
Coeliac disease (CD) and noncoeliac wheat or gluten sensitivity (NCWS/NCGS) are common gluten-related disorders. Both conditions can present with gastrointestinal and extraintestinal manifestations, which can be a challenge for physicians to discern between. Whilst coeliac serology and histological assessment are required for the diagnosis of CD, there are no clear biomarkers for the diagnosis of NCGS. The management of both conditions is with a gluten-free diet (GFD), although the duration, as well as strictness of adherence to a GFD in NCGS, is unclear. Adherence to a GFD in CD can also be challenging, with recent developments of noninvasive assessments, although histological assessment via duodenal biopsies remains the gold standard. The management of refractory coeliac disease remains particularly challenging, often requiring specialist input. Whilst wheat is noted to be a trigger for symptom generation in NCGS, it is unclear which components of wheat are responsible for symptom generation in this group, with further research required to elucidate the pathophysiology.
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Affiliation(s)
- A Rej
- From the, Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - I Aziz
- From the, Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, Academic Unit of Gastroenterology, University of Sheffield, Sheffield, UK
| | - D S Sanders
- From the, Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, Academic Unit of Gastroenterology, University of Sheffield, Sheffield, UK
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22
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Meineri G, Candellone A, Dal Bello F, Gastaldi D, Medana C, Peiretti PG. Gluten contamination of canned and dry grain-free commercial pet foods determined by HPLC-HRMS. ITALIAN JOURNAL OF ANIMAL SCIENCE 2020. [DOI: 10.1080/1828051x.2019.1705190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Giorgia Meineri
- Dipartimento di Scienze Veterinarie, Università di Torino, Grugliasco, Italy
| | - Alessia Candellone
- Dipartimento di Scienze Veterinarie, Università di Torino, Grugliasco, Italy
| | - Federica Dal Bello
- Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, Università di Torino, Torino, Italy
| | - Daniela Gastaldi
- Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, Università di Torino, Torino, Italy
| | - Claudio Medana
- Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, Università di Torino, Torino, Italy
| | - Pier Giorgio Peiretti
- Istituto di Scienze delle Produzioni Animali, Consiglio Nazionale delle Ricerche, Grugliasco, Italy
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Raju N, Joshi AKR, Vahini R, Deepika T, Bhaskarachari K, Devindra S. Gluten contamination in labelled and naturally gluten-free grain products in southern India. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2020; 37:531-538. [PMID: 32011974 DOI: 10.1080/19440049.2020.1711970] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Consumption of a gluten-free diet or avoiding exposure to gluten is the only feasible and effective treatment available for coeliac patients to date. Although many grains and their products are naturally gluten-free, the possibility of gluten cross-contamination must be considered. Since such data are not available for Indian markets, we carried out this pilot study (n = 160) to assess gluten contamination in various grain-based food products from the category of breakfast products, flours, and batters made from grain that are naturally gluten free. The gluten was extracted from samples using 60% ethanol and gluten analysis was carried out using a commercially available competitive ELISA, which utilises a monoclonal antibody. Nearly 9.8% of the products labelled as gluten-free and 36.7% of the products made from naturally gluten-free grain were found to contain gluten above 20 mg/kg. Among products made from naturally gluten-free grain, 35.9% of the flour samples and 85% of the oat samples (11.67-1830 mg/kg) were contaminated with gluten. In the case of flours, unbranded samples collected from local markets (70%) and directly from local mills (30%) showed gluten content above Codex safety levels (20-400 mg/kg). Among products labelled as gluten free (n = 51), only 5 samples showed gluten contamination above 20 mg/kg although levels were well within 100 mg/kg (32.5 ± 5.8). Our study suggests that there is a likelihood of gluten contamination in products that are sourced from local retailers and millers.
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Affiliation(s)
- Nagaraju Raju
- Department of Dietetics, National Institute of Nutrition (ICMR), Hyderabad, India
| | - Apurva Kumar R Joshi
- Department of Dietetics, National Institute of Nutrition (ICMR), Hyderabad, India
| | - Raidu Vahini
- Department of Dietetics, National Institute of Nutrition (ICMR), Hyderabad, India
| | - Thappatla Deepika
- Department of Dietetics, National Institute of Nutrition (ICMR), Hyderabad, India
| | | | - S Devindra
- Department of Dietetics, National Institute of Nutrition (ICMR), Hyderabad, India
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24
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Fritz RD, Chen Y. Commentary: To Be Oats or Not to Be? An Update on the Ongoing Debate on Oats for Patients With Celiac Disease. Front Pediatr 2020; 8:573151. [PMID: 33304866 PMCID: PMC7693705 DOI: 10.3389/fped.2020.573151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/07/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ronald D Fritz
- PepsiCo R&D Data Science & Analytics, Barrington, IL, United States
| | - Yumin Chen
- PepsiCo R&D Data Science & Analytics, Barrington, IL, United States
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25
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Oxentenko AS, Rubio-Tapia A. Celiac Disease. Mayo Clin Proc 2019; 94:2556-2571. [PMID: 31806106 DOI: 10.1016/j.mayocp.2019.02.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/08/2019] [Accepted: 02/14/2019] [Indexed: 12/16/2022]
Abstract
Celiac disease (CD) affects approximately 1% of the general population, although most cases remain unrecognized. Because CD is a multisystem disorder with protean clinical manifestations, a high index of suspicion is needed to make an appropriate diagnosis. A diagnosis of CD is made in a patient who is genetically predisposed based on the presence of compatible clinical features, positive highly specific celiac serologic findings, duodenal biopsies that document enteropathy, and improvement with a gluten-free diet. The differential diagnoses for the clinical features and the histologic findings seen in patients with CD are numerous and need to be considered; because the management of celiac disease consists of a lifelong gluten-free diet, ensuring that the diagnosis is correctly established is of utmost importance. The aim of this review is to provide practicing clinicians with the most current information on the diagnosis and management of CD, including new developments and the approach to controversial issues.
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Affiliation(s)
- Amy S Oxentenko
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
| | - Alberto Rubio-Tapia
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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26
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Is Adherence to a Gluten-Free Diet by Adult Patients With Celiac Disease Influenced by Their Knowledge of the Gluten Content of Foods? Gastroenterol Nurs 2019; 42:55-64. [PMID: 30688709 DOI: 10.1097/sga.0000000000000368] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The aim of this study was to investigate adherence to a gluten-free diet and potentially associated factors, focusing on the relationship between adherence and knowledge of the gluten content of foods and of celiac disease in general. A questionnaire was completed by adult patients diagnosed with celiac disease including demographics, dietary practices, sources of information, and attitude to the disease. Their knowledge of disease and gluten-free diet was assessed using a newly developed scale comprising 31 statements on celiac disease in general and foods appropriate in a gluten-free diet. A validated questionnaire was used to measure adherence to diet. One hundred four patients with celiac disease took part in the study, 65% of them reported strictly adhering to a gluten-free diet. Factors associated with adherence were membership of the Italian Celiac Association and receiving support from this association, Internet, and social media. Patients' knowledge regarding celiac disease and gluten-free diet was generally poor: one patient answered all questions correctly. Knowledge of celiac disease and gluten-free diet was strongly and significantly associated with adherence to a gluten-free diet. The association between knowledge of celiac disease and gluten-free diet in patients with celiac disease and their adherence to the diet suggests the promotion of education and behavioral programs.
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Tanner G, Juhász A, Florides CG, Nye-Wood M, Békés F, Colgrave ML, Russell AK, Hardy MY, Tye-Din JA. Preparation and Characterization of Avenin-Enriched Oat Protein by Chill Precipitation for Feeding Trials in Celiac Disease. Front Nutr 2019; 6:162. [PMID: 31681788 PMCID: PMC6803533 DOI: 10.3389/fnut.2019.00162] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/26/2019] [Indexed: 12/15/2022] Open
Abstract
The safety of oats for people with celiac disease remains unresolved. While oats have attractive nutritional properties that can improve the quality and palatability of the restrictive, low fiber gluten-free diet, rigorous feeding studies to address their safety in celiac disease are needed. Assessing the oat prolamin proteins (avenins) in isolation and controlling for gluten contamination and other oat components such as fiber that can cause non-specific effects and symptoms is crucial. Further, the avenin should contain all reported immunogenic T cell epitopes, and be deliverable at a dose that enables biological responses to be correlated with clinical effects. To date, isolation of a purified food-grade avenin in sufficient quantities for feeding studies has not been feasible. Here, we report a new gluten isolation technique that enabled 2 kg of avenin to be extracted from 400 kg of wheat-free oats under rigorous gluten-free and food grade conditions. The extract consisted of 85% protein of which 96% of the protein was avenin. The concentration of starch (1.8% dry weight), β-glucan (0.2% dry weight), and free sugars (1.8% dry weight) were all low in the final avenin preparation. Other sugars including oligosaccharides, small fructans, and other complex sugars were also low at 2.8% dry weight. Liquid chromatography tandem mass spectrometry (LC-MS/MS) analysis of the proteins in these preparations showed they consisted only of oat proteins and were uncontaminated by gluten containing cereals including wheat, barley or rye. Proteomic analysis of the avenin enriched samples detected more avenin subtypes and fewer other proteins compared to samples obtained using other extraction procedures. The identified proteins represented five main groups, four containing known immune-stimulatory avenin peptides. All five groups were identified in the 50% (v/v) ethanol extract however the group harboring the epitope DQ2.5-ave-1b was less represented. The avenin-enriched protein fractions were quantitatively collected by reversed phase HPLC and analyzed by MALDI-TOF mass spectrometry. Three reverse phase HPLC peaks, representing ~40% of the protein content, were enriched in proteins containing DQ2.5-ave-1a epitope. The resultant high quality avenin will facilitate controlled and definitive feeding studies to establish the safety of oat consumption by people with celiac disease.
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Affiliation(s)
- Greg Tanner
- School of Biosciences, University of Melbourne, Melbourne, VIC, Australia
| | - Angéla Juhász
- School of Science, Edith Cowan University, Joondalup, WA, Australia
| | | | | | | | | | - Amy K. Russell
- Immunology Division, The Walter and Eliza Hall Institute, Melbourne, VIC, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia
| | - Melinda Y. Hardy
- Immunology Division, The Walter and Eliza Hall Institute, Melbourne, VIC, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia
| | - Jason A. Tye-Din
- Immunology Division, The Walter and Eliza Hall Institute, Melbourne, VIC, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia
- Department of Gastroenterology, The Royal Melbourne Hospital, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
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28
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Croote D, Braslavsky I, Quake SR. Addressing Complex Matrix Interference Improves Multiplex Food Allergen Detection by Targeted LC-MS/MS. Anal Chem 2019; 91:9760-9769. [PMID: 31339301 DOI: 10.1021/acs.analchem.9b01388] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The frequent use of precautionary food allergen labeling (PAL) such as "may contain" frustrates allergic individuals who rely on such labeling to determine whether a food is safe to consume. One technique to study whether foods contain allergens is targeted liquid chromatography-tandem mass spectrometry (LC-MS/MS) employing scheduled multiple reaction monitoring (MRM). However, the applicability of a single MRM method to many commercial foods is unknown as complex and heterogeneous interferences derived from the unique composition of each food matrix can hinder quantification of trace amounts of allergen contamination. We developed a freely available, open source software package MAtrix-Dependent Interference Correction (MADIC) to identify interference and applied it with a method targeting 14 allergens. Among 84 unique food products, we found patterns of allergen contamination such as wheat in grains, milk in chocolate-containing products, and soy in breads and corn flours. We also found additional instances of contamination in products with and without PAL as well as highly variable soy content in foods containing only soybean oil and/or soy lecithin. These results demonstrate the feasibility of applying LC-MS/MS to a variety of food products with sensitive detection of multiple allergens in spite of variable matrix interference.
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Affiliation(s)
- Derek Croote
- Department of Bioengineering , Stanford University , Stanford , California 94305 , United States
| | - Ido Braslavsky
- Department of Bioengineering , Stanford University , Stanford , California 94305 , United States.,Robert H. Smith Faculty of Agriculture, Food, and Environment , The Hebrew University of Jerusalem , Rehovot 7610001 , Israel
| | - Stephen R Quake
- Department of Bioengineering , Stanford University , Stanford , California 94305 , United States.,Department of Applied Physics , Stanford University , Stanford , California 94305 , United States.,Chan Zuckerberg Biohub , San Francisco , California 94158 , United States
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29
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Sample D, Turner J. Improving gluten free diet adherence by youth with celiac disease. Int J Adolesc Med Health 2019; 33:/j/ijamh.ahead-of-print/ijamh-2019-0026/ijamh-2019-0026.xml. [PMID: 30875325 DOI: 10.1515/ijamh-2019-0026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/17/2019] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Celiac disease (CD) is a gluten-triggered autoimmune disorder of the small intestine, which can occur in genetically susceptible individuals at any age. A strict life-long gluten free diet (GFD) is the only medically approved treatment, and non-adherence is associated with significant morbidity. However, gluten use is widespread, complicating efforts to follow the diet. Youth with CD are especially challenged with dietary adherence, as they strive for peer acceptance and personal autonomy in the context of managing a chronic disease. METHODS A scoping review was conducted to identify mechanisms to assist youth with remaining gluten free. RESULTS There is a paucity of literature regarding best approaches to improve diet adherence by youth, however, lessons can also be learned by borrowing ideas from self-management approaches of other chronic diseases. Several mechanisms for improving GFD adherence among youth are identified, including regular engagement of the youth with CD and their family with an experienced multidisciplinary team, electronic tool utilization and awareness of accurate resources for self-guided education and resources. CONCLUSIONS Improvement in GFD adherence by youth is achievable and may influence long-term health outcomes.
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Affiliation(s)
- Dory Sample
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada, Phone: +780-248-5599
| | - Justine Turner
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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30
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Abstract
Coeliac disease (CD) develops in genetically susceptible individuals who, in response to unclear environmental triggers, develop an immune response triggered by gluten ingestion. It is now recognised as a global disease affecting about 0.7% of the world's population. The clinical presentation ranges from malabsorption to asymptomatic individuals diagnosed by screening high-risk groups. Diagnosis requires the demonstration of small intestinal villous atrophy in the presence of circulating coeliac auto-antibodies and/or an unequivocal response to a gluten-free diet (GFD). Recent guidelines suggest that, in a subset of children, duodenal biopsies can be avoided in the presence of strict symptomatic and serological criteria. While the majority of patients respond to a GFD, up to 20% of patients with CD have persistent or recurrent symptoms. There are several aetiologies for residual or new symptoms in a patient with CD on a GFD, with inadvertent exposure to gluten being the most common. Following a GFD can be challenging for patients with CD and understanding the barriers/challenges faced by patients in maintaining a GFD is crucial for compliance. Abbreviations: AGA: anti-gliadin antibodies; Anti-DGP-ab: anti-deamidated gliadin peptide antibodies; Anti-tTG-ab: anti-tissue transglutaminase antibodies; ATD: auto-immune thyroid disorders; BMD: bone mineral density; CD: coeliac disease; DH: dermatitis herpetiformis; EMA: anti-endomysial antibodies; FDR: first-degree relatives; GFD: gluten-free diet; HbA1c: haemoglobin A1c; HLA: human leucocyte antigen; IBS: irritable bowel syndrome; LMIC: low- and middle-income countries; NPV: negative predictive value; NRCD: non-responsive coeliac disease; POCT: point-of-care tests; SDR: second-degree relatives; SIBO: small intestinal bacterial overgrowth; T1DM: type 1 diabetes mellitus; ULN: upper limit of normal.
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Affiliation(s)
- Jeremy R Glissen Brown
- a Division of Gastroenterology and Hepatology , Beth Israel Deaconess Medical Center , Boston , Massachusetts , USA
| | - Prashant Singh
- a Division of Gastroenterology and Hepatology , Beth Israel Deaconess Medical Center , Boston , Massachusetts , USA
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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: 44] [Impact Index Per Article: 7.3] [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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Fritz RD, Chen Y. Oat safety for celiac disease patients: theoretical analysis correlates adverse symptoms in clinical studies to contaminated study oats. Nutr Res 2018; 60:54-67. [PMID: 30527260 DOI: 10.1016/j.nutres.2018.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 08/29/2018] [Accepted: 09/11/2018] [Indexed: 02/07/2023]
Abstract
Inclusion of oats in a gluten-free (GF) diet can provide whole grain nutritional benefits to celiac disease (CD) patients, but there has been debate regarding oat safety for these individuals. This is because of conflicting research findings, with inconsistencies attributed to varying CD subject's sensitivities to "pure" oats. Clinical trials to date have assumed oats provided to subjects to be lightly contaminated, if at all. This assumption is challenged here since oat's propensity to be "kernel" contaminated with gluten sources like wheat and barley has recently been shown to significantly complicate confirmation of a GF state. We therefore hypothesize that clinical studies may have inadvertently provided pill-like gluten kernels intermittently to study subjects, leading to adverse outcomes that could potentially explain inconsistencies between study conclusions. To test this theory, potential gluten contamination of oats used in a cross-section of 12 important oat feeding studies has been estimated, done according to descriptions of oats used, published contamination rates for various oat types, and study oat dosages. Expected gluten exposures were found to be at levels to elicit clinical effects in a large portion of CD patients, correlating with observed clinical reaction rates in those studies (P value = .0006). Estimated gluten doses were found insufficient, however, to affect morphological outcomes, whereas only 1 study had 1 case. Our analysis provides a new perspective with which to view oat safety study conclusions and justifies new clinical trials using today's higher-purity GF oats to settle the oat safety for CD patient debate.
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Affiliation(s)
- Ronald D Fritz
- PepsiCo R&D Measurement Sciences, 617 W Main St, Barrington, IL 60010, USA.
| | - Yumin Chen
- PepsiCo R&D Measurement Sciences, 617 W Main St, Barrington, IL 60010, USA
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Allen KJ, Taylor SL. The Consequences of Precautionary Allergen Labeling: Safe Haven or Unjustifiable Burden? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018. [DOI: 10.1016/j.jaip.2017.12.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Dawson C, Mendoza-Porras O, Byrne K, Hooper T, Howitt C, Colgrave M. Oat of this world: Defining peptide markers for detection of oats in processed food. Pept Sci (Hoboken) 2018. [DOI: 10.1002/pep2.24045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Charlotte Dawson
- CSIRO Agriculture and Food; 306 Carmody Road; St Lucia QLD 4067 Australia
| | | | - Keren Byrne
- CSIRO Agriculture and Food; 306 Carmody Road; St Lucia QLD 4067 Australia
| | - Thomas Hooper
- CSIRO Agriculture and Food; 306 Carmody Road; St Lucia QLD 4067 Australia
| | - Crispin Howitt
- CSIRO Agriculture and Food; GPO Box 1700; Canberra ACT 2601 Australia
| | - Michelle Colgrave
- CSIRO Agriculture and Food; 306 Carmody Road; St Lucia QLD 4067 Australia
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Oats in healthy gluten-free and regular diets: A perspective. Food Res Int 2017; 110:3-10. [PMID: 30029703 DOI: 10.1016/j.foodres.2017.11.031] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/11/2017] [Accepted: 11/19/2017] [Indexed: 12/11/2022]
Abstract
During the 20th century, the economic position of oats (Avena sativa L.) decreased strongly in favour of higher yielding crops including winter wheat and maize. Presently, oat represents only ~1.3% of the total world grain production, and its production system is fragmented. Nonetheless, current interest is growing because of recent knowledge on its potential benefits in food, feed and agriculture. This perspective will serve as a further impetus, with special focus on the recently valued advantages of oats in human food and health. Five approved European Food Safety Authority (EFSA) health claims apply to oats. Four relate to the oat-specific soluble fibres, the beta-glucans, and concern the maintenance and reduction of blood cholesterol, better blood glucose balance and increased faecal bulk. The fifth claim concerns the high content of unsaturated fatty acids, especially present in the endosperm, which reduces the risks of heart and vascular diseases. Furthermore, oat starch has a low glycemic index, which is favourable for weight control. Oat-specific polyphenols and avenanthramides have antioxidant and anti-inflammatory properties. Thus, oats can contribute significantly to the presently recommended whole-grain diet. Next to globulins, oats contain a small fraction of prolamin storage proteins, called 'avenins', but at a much lower quantity than gluten proteins in wheat, barley and rye. Oat avenins do not contain any of the known coeliac disease epitopes from gluten of wheat, barley and rye. Long-term food studies confirm the safety of oats for coeliac disease patients and the positive health effects of oat products in a gluten-free diet. These effects are general and independent of oat varieties. In the EU (since 2009), the USA (since 2013) and Canada (since 2015) oat products may be sold as gluten-free provided that any gluten contamination level is below 20ppm. Oats are, however, generally not gluten-free when produced in a conventional production chain, because of regular contamination with wheat, barley or rye. Therefore, establishing a separate gluten-free oat production chain requires controlling all steps in the chain; the strict conditions will be discussed. Genomic tools, including a single nucleotide polymorphism (SNP) marker array and a dense genetic map, have recently been developed and will support marker-assisted breeding. In 2015, the Oat Global initiative emerged enabling a world-wide cooperation starting with a data sharing facility on genotypic, metabolic and phenotypic characteristics. Further, the EU project TRAFOON (Traditional Food Networks) facilitated the transfer of knowledge to small- and medium-sized enterprises (SMEs) to stimulate innovations in oat production, processing, products and marketing, among others with regard to gluten-free. Finally, with focus on counteracting market fragmentation of the global oat market and production chains, interactive innovation strategies between customers (consumers) and companies through co-creation are discussed.
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Pinto-Sánchez MI, Causada-Calo N, Bercik P, Ford AC, Murray JA, Armstrong D, Semrad C, Kupfer SS, Alaedini A, Moayyedi P, Leffler DA, Verdú EF, Green P. Safety of Adding Oats to a Gluten-Free Diet for Patients With Celiac Disease: Systematic Review and Meta-analysis of Clinical and Observational Studies. Gastroenterology 2017; 153:395-409.e3. [PMID: 28431885 DOI: 10.1053/j.gastro.2017.04.009] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/28/2017] [Accepted: 04/06/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND & AIMS Patients with celiac disease should maintain a gluten-free diet (GFD), excluding wheat, rye, and barley. Oats might increase the nutritional value of a GFD, but their inclusion is controversial. We performed a systematic review and meta-analysis to evaluate the safety of oats as part of a GFD in patients with celiac disease. METHODS We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE databases for clinical trials and observational studies of the effects of including oats in GFD of patients with celiac disease. The studies reported patients' symptoms, results from serology tests, and findings from histologic analyses. We used the GRADE approach to assess the quality of evidence. RESULTS We identified 433 studies; 28 were eligible for analysis. Of these, 6 were randomized and 2 were not randomized controlled trials comprising a total of 661 patients-the remaining studies were observational. All randomized controlled trials used pure/uncontaminated oats. Oat consumption for 12 months did not affect symptoms (standardized mean difference: reduction in symptom scores in patients who did and did not consume oats, -0.22; 95% CI, -0.56 to 0.13; P = .22), histologic scores (relative risk for histologic findings in patients who consumed oats, 0.24; 95% CI, 0.01-4.8; P = .35), intraepithelial lymphocyte counts (standardized mean difference, 0.21; 95% CI, reduction of 1.44 to increase in 1.86), or results from serologic tests. Subgroup analyses of adults vs children did not reveal differences. The overall quality of evidence was low. CONCLUSIONS In a systematic review and meta-analysis, we found no evidence that addition of oats to a GFD affects symptoms, histology, immunity, or serologic features of patients with celiac disease. However, there were few studies for many endpoints, as well as limited geographic distribution and low quality of evidence. Rigorous double-blind, placebo-controlled, randomized controlled trials, using commonly available oats sourced from different regions, are needed.
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Affiliation(s)
- María Inés Pinto-Sánchez
- Department of Medicine, Farncombe Family Digestive Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Natalia Causada-Calo
- Department of Medicine, Farncombe Family Digestive Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Premysl Bercik
- Department of Medicine, Farncombe Family Digestive Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Alexander C Ford
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, United Kingdom; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom
| | - Joseph A Murray
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - David Armstrong
- Department of Medicine, Farncombe Family Digestive Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Carol Semrad
- Celiac Disease Center at University of Chicago Medicine, Chicago, Illinois
| | - Sonia S Kupfer
- Celiac Disease Center at University of Chicago Medicine, Chicago, Illinois
| | - Armin Alaedini
- Celiac Disease Center at Columbia University, New York, New York
| | - Paul Moayyedi
- Department of Medicine, Farncombe Family Digestive Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Daniel A Leffler
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Elena F Verdú
- Department of Medicine, Farncombe Family Digestive Research Institute, McMaster University, Hamilton, Ontario, Canada.
| | - Peter Green
- Celiac Disease Center at Columbia University, New York, New York
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Chen Y, Fritz RD, Kock L, Garg D, Davis RM, Kasturi P. A stepwise, 'test-all-positives' methodology to assess gluten-kernel contamination at the serving-size level in gluten-free (GF) oat production. Food Chem 2017; 240:391-395. [PMID: 28946288 DOI: 10.1016/j.foodchem.2017.07.153] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/22/2017] [Accepted: 07/28/2017] [Indexed: 01/29/2023]
Abstract
A step-wise, 'test-all-positive-gluten' analytical methodology has been developed and verified to assess kernel-based gluten contamination (i.e., wheat, barley and rye kernels) during gluten-free (GF) oat production. It targets GF claim compliance at the serving-size level (of a pouch or approximately 40-50g). Oat groats are collected from GF oat production following a robust attribute-based sampling plan then split into 75-g subsamples, and ground. R-Biopharm R5 sandwich ELISA R7001 is used for analysis of all the first15-g portions of the ground sample. A >20-ppm result disqualifies the production lot, while a >5 to <20-ppm result triggers complete analysis of the remaining 60-g of ground sample, analyzed in 15-g portions. If all five 15-g test results are <20ppm, and their average is <10.67ppm (since a 20-ppm contaminant in 40g of oats would dilute to 10.67ppm in 75-g), the lot is passed.
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Affiliation(s)
- Yumin Chen
- PepsiCo, Inc. Global R&D Measurement Sciences, 617 W. Main Street, Barrington, IL 60010, USA
| | - Ronald D Fritz
- PepsiCo, Inc. Global R&D Measurement Sciences, 617 W. Main Street, Barrington, IL 60010, USA.
| | - Lindsay Kock
- PepsiCo, Inc. Global R&D Measurement Sciences, 617 W. Main Street, Barrington, IL 60010, USA
| | - Dinesh Garg
- PepsiCo, Inc. Milling R&D, 418 2ndStreet NE, Cedar Rapids, IA 52401, USA
| | - R Mark Davis
- PepsiCo, Inc. Global R&D Food Safety, 617 W. Main Street, Barrington, IL 60010, USA
| | - Prabhakar Kasturi
- PepsiCo, Inc. Global R&D Measurement Sciences, 617 W. Main Street, Barrington, IL 60010, USA
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AGY, a Novel Egg Yolk-Derived Anti-gliadin Antibody, Is Safe for Patients with Celiac Disease. Dig Dis Sci 2017; 62:1277-1285. [PMID: 28035551 DOI: 10.1007/s10620-016-4426-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 12/16/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Celiac disease (CD) is a gluten-triggered autoimmune disorder of the small intestine. A lifelong gluten-free diet (GFD) is the only approved treatment; however, strict adherence is difficult and many suffer from inadvertent gluten exposure. Oral egg yolk anti-gliadin antibody (AGY) is a novel treatment to neutralize gluten and may improve the efficacy of the GFD. AIMS To determine the safety, tolerability, and potential efficacy of AGY in patients with CD. METHODS This 6-week, open-label, single-arm study was conducted in adults with biopsy-proven CD on a GFD. Safety measures included adverse events, physical examination, and clinical laboratory tests. Additional measures included a daily Celiac Symptom Index, Health-Related Quality of life, anti-tissue transglutaminase and anti-gliadin IgA/IgG, and lactulose/mannitol excretion ratio (LMER). A 2-week run-in period to assess questionnaire compliance and acceptability of baseline safety laboratory results was followed by a 4-week treatment period with two AGY capsules taken before meals. RESULTS Ten patients completed the study (mean age 43.4 years, nine female). All followed a GFD for at least 6 months (mean 5 years). No safety concerns were identified. Most patients had fewer celiac symptoms (especially tiredness, headache, and bloating), improved quality of life, lowered antibodies, and lowered LMER when taking AGY compared to the run-in period. CONCLUSION In our cohort, AGY was safe and potentially associated with improved CD-related outcome measures in patients on a GFD. A larger study powered for further safety and efficacy evaluation is planned.
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Armstrong PR, Dell’Endice F, Maghirang EB, Rupenyan A. Discriminating Oat and Groat Kernels from Other Grains Using Near-Infrared Spectroscopy. Cereal Chem 2017. [DOI: 10.1094/cchem-06-16-0162-r] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Paul R. Armstrong
- U.S. Department of Agriculture–Agricultural Research Service, Center for Grain and Animal Health Research, Stored Product Insect and Engineering Research Unit, 1515 College Avenue, Manhattan, KS 66502, U.S.A
| | | | - Elizabeth B. Maghirang
- U.S. Department of Agriculture–Agricultural Research Service, Center for Grain and Animal Health Research, Stored Product Insect and Engineering Research Unit, 1515 College Avenue, Manhattan, KS 66502, U.S.A
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Hassan H, Elaridi J, Bassil M. Evaluation of gluten in gluten-free-labeled foods and assessment of exposure level to gluten among celiac patients in Lebanon. Int J Food Sci Nutr 2017; 68:881-886. [PMID: 28325088 DOI: 10.1080/09637486.2017.1303461] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The aim of the study was to evaluate gluten contamination in all the gluten-free (GF)-labeled food products sold in Lebanon. Over a 2-year period, a total of 173 food samples collected from 135 brand names were analyzed. Gluten contamination was detected in 33 of 173 (19%) samples, and its content ranged between 2.5 and >80 mg kg-1. In 10 of the 173 samples (6%), the quantity of gluten exceeded the upper limit of 20 mg kg-1. Out of the 10 contaminated products, eight (80%) were locally manufactured. Among these 10 products, eight (80%) were wheat-starch-based foods. Of the 40 brand names tested twice in 2014 and 2015, 15 (38%) showed significantly (p < .05) different gluten content between the 2 years. Using a food frequency questionnaire, exposure level to gluten through the contaminated products was evaluated among 15 celiac patients. Two patients reported consuming these products more than twice per week.
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Affiliation(s)
- Hussein Hassan
- a Department of Natural Sciences, School of Arts and Sciences , Lebanese American University , Koraytem , Beirut , Lebanon
| | - Jomana Elaridi
- a Department of Natural Sciences, School of Arts and Sciences , Lebanese American University , Koraytem , Beirut , Lebanon
| | - Maya Bassil
- a Department of Natural Sciences, School of Arts and Sciences , Lebanese American University , Koraytem , Beirut , Lebanon
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Huang X, Kanerva P, Salovaara H, Stoddard FL, Sontag-Strohm T. Proposal for C-Hordein as Reference Material in Gluten Quantification. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2017; 65:2155-2161. [PMID: 28233493 DOI: 10.1021/acs.jafc.6b05061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The concentration of residual barley prolamin (hordein) in gluten-free products is overestimated by the R5 ELISA method when calibrated against the wheat gliadin standard. The reason for this may be that the composition of the gliadin standard is different from the composition of hordeins. This study showed that the recognition of whole hordein by R5 antibody mainly came from C-hordein, which is more reactive than the other hordeins. The proportion of C-hordein in total hordein ranged from 16 to 33% of common Finnish barley cultivars used in this study and was always higher than that of ω-gliadin, the homologous protein class in the gliadin standard, which may account for the overestimation. Thus, a hordein standard is needed for barley prolamin quantification instead of the gliadin standard. When gluten-free oat flour was spiked with barley flour, the prolamin concentration was overestimated 1.8-2.5 times with the gliadin standard, whereas estimates in the correct range were obtained when the standard was 40% C-hordein mixed with an inert protein. A preparative-scale method was developed to isolate and purify C-hordein, and C-hordein is proposed as a reference material to calibrate barley prolamin quantification in R5-based assays.
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Affiliation(s)
- Xin Huang
- Department of Food and Environmental Sciences, University of Helsinki , Agnes Sjöberginkatu 2, PL 66, Helsinki FI-00014, Finland
| | - Päivi Kanerva
- Fazer Mills, Oy Karl Fazer Ab , Kasakkamäentie 3, P.O Box 40, Lahti FI-15101, Finland
| | - Hannu Salovaara
- Department of Food and Environmental Sciences, University of Helsinki , Agnes Sjöberginkatu 2, PL 66, Helsinki FI-00014, Finland
| | - Frederick L Stoddard
- Department of Food and Environmental Sciences, University of Helsinki , Agnes Sjöberginkatu 2, PL 66, Helsinki FI-00014, Finland
| | - Tuula Sontag-Strohm
- Department of Food and Environmental Sciences, University of Helsinki , Agnes Sjöberginkatu 2, PL 66, Helsinki FI-00014, Finland
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Benoit L, Masiri J, Del Blanco IA, Meshgi M, Gendel SM, Samadpour M. Assessment of Avenins from Different Oat Varieties Using R5-Based Sandwich ELISA. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2017; 65:1467-1472. [PMID: 28141922 DOI: 10.1021/acs.jafc.6b05105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Gluten derived from wheat and related triticeae cereals possesses distinct amino acid sequences that provoke the immunopathogenic features of celiac disease (CD) in genetically susceptible individuals. However, the role of oat-derived gluten, or avenins, in CD pathogenesis remains a disputed matter, as evidenced by a lack in harmonized legislation regarding gluten classification in relation to gluten-free labeling. In this study, we have analyzed a panel of pure oat cultivars using a sandwich ELISA based on the R5 monoclonal antibody (mAb), which binds to canonical epitopes occurring within celiagenic peptides present in triticeae-derived gluten but reportedly not present in avenins. We have identified three varieties of oats that reproducibly bind R5 antibodies and levels indicating the presence of gluten at more than the 20 ppm gluten regulatory threshold. Nested assessment using Western blot analysis and alternative gluten detection systems corroborated these results. Collectively, these data suggest that select oat varieties may prove problematic to patients with CD and to food companies and regulatory agencies and will extend our basic understanding of current gluten detection systems.
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Affiliation(s)
- Lora Benoit
- IEH Laboratories and Consulting Group, Inc. (IEH) , 15300 Bothell Way N.E., Lake Forest Park, Washington 98155, United States
- Department of Biology, California State University-Fresno , Fresno, California 93740, United States
| | - Jongkit Masiri
- Molecular Epidemiology, Inc. (MEI) , 15300 Bothell Way N.E., Lake Forest Park, Washington 98155, United States
| | - Isabel A Del Blanco
- Department of Plant Sciences, University of California , One Shields Avenue, Davis, California 95616, United States
| | - Mahzad Meshgi
- Molecular Epidemiology, Inc. (MEI) , 15300 Bothell Way N.E., Lake Forest Park, Washington 98155, United States
| | - Steven M Gendel
- IEH Laboratories and Consulting Group, Inc. (IEH) , 15300 Bothell Way N.E., Lake Forest Park, Washington 98155, United States
| | - Mansour Samadpour
- IEH Laboratories and Consulting Group, Inc. (IEH) , 15300 Bothell Way N.E., Lake Forest Park, Washington 98155, United States
- Molecular Epidemiology, Inc. (MEI) , 15300 Bothell Way N.E., Lake Forest Park, Washington 98155, United States
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Gluten Contamination in Naturally or Labeled Gluten-Free Products Marketed in Italy. Nutrients 2017; 9:nu9020115. [PMID: 28178205 PMCID: PMC5331546 DOI: 10.3390/nu9020115] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 01/28/2017] [Accepted: 02/03/2017] [Indexed: 01/09/2023] Open
Abstract
Background: A strict and lifelong gluten-free diet is the only treatment of celiac disease. Gluten contamination has been frequently reported in nominally gluten-free products. The aim of this study was to test the level of gluten contamination in gluten-free products currently available in the Italian market. Method: A total of 200 commercially available gluten-free products (including both naturally and certified gluten-free products) were randomly collected from different Italian supermarkets. The gluten content was determined by the R5 ELISA Kit approved by EU regulations. Results: Gluten level was lower than 10 part per million (ppm) in 173 products (86.5%), between 10 and 20 ppm in 9 (4.5%), and higher than 20 ppm in 18 (9%), respectively. In contaminated foodstuff (gluten > 20 ppm) the amount of gluten was almost exclusively in the range of a very low gluten content. Contaminated products most commonly belonged to oats-, buckwheat-, and lentils-based items. Certified and higher cost gluten-free products were less commonly contaminated by gluten. Conclusion: Gluten contamination in either naturally or labeled gluten-free products marketed in Italy is nowadays uncommon and usually mild on a quantitative basis. A program of systematic sampling of gluten-free food is needed to promptly disclose at-risk products.
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Fritz RD, Chen Y, Contreras V. Gluten-containing grains skew gluten assessment in oats due to sample grind non-homogeneity. Food Chem 2017; 216:170-5. [DOI: 10.1016/j.foodchem.2016.08.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/08/2016] [Accepted: 08/10/2016] [Indexed: 02/07/2023]
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45
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Gilissen LJWJ, van der Meer IM, Smulders MJM. Why Oats Are Safe and Healthy for Celiac Disease Patients. Med Sci (Basel) 2016; 4:medsci4040021. [PMID: 29083384 PMCID: PMC5635790 DOI: 10.3390/medsci4040021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 11/09/2016] [Accepted: 11/21/2016] [Indexed: 12/12/2022] Open
Abstract
The water-insoluble storage proteins of cereals (prolamins) are called “gluten” in wheat, barley, and rye, and “avenins” in oat. Gluten can provoke celiac disease (CD) in genetically susceptible individuals (those with human leukocyte antigen (HLA)-DQ2 or HLA-DQ8 serotypes). Avenins are present at a lower concentration (10%–15% of total protein content) in oat as compared to gluten in wheat (80%–85%). The avenins in the genus Avena (cultivated oat as well as various wild species of which gene bank accessions were analyzed) are free of the known CD immunogenic epitopes from wheat, barley, and rye. T cells that recognize avenin-specific epitopes have been found very rarely in CD patients. CD patients that consume oats daily do not show significantly increased levels of intraepithelial lymphocyte (EIL) cells. The safety and the positive health effects of the long-term inclusion of oats in the gluten-free diet have been confirmed in long-term studies. Since 2009 (EC 41/2009) and 2013 (FDA) oat products may be sold as gluten-free in several countries provided a gluten contamination level below 20 ppm. Introduction of oats in the gluten-free diet of celiac patients is advised after the recovery of the intestine. Health effects of oat consumption are reflected in European Food Safety Authority (EFSA)- and Food and Drug Administration (FDA)-approved health claims. Oats can form a healthy, nutritious, fiber-rich, and safe complement to the gluten-free diet.
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Affiliation(s)
- Luud J W J Gilissen
- Wageningen University & Research, Bioscience, 6700 AA Wageningen, The Netherlands.
| | | | - Marinus J M Smulders
- Wageningen University & Research, Plant Breeding, 6700 AA Wageningen, The Netherlands.
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46
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Fritz RD, Chen Y. Kernel-based gluten contamination of gluten-free oatmeal complicates gluten assessment as it causes binary-like test outcomes. Int J Food Sci Technol 2016. [DOI: 10.1111/ijfs.13288] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Ronald D. Fritz
- PepsiCo Global R&D Measurement Sciences; 617 W. Main Street Barrington IL 60010 USA
| | - Yumin Chen
- PepsiCo Global R&D Measurement Sciences; 617 W. Main Street Barrington IL 60010 USA
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47
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Mattioni B, Scheuer PM, Antunes AL, Paulino N, de Francisco A. Compliance with Gluten-Free Labelling Regulation in the Brazilian Food Industry. Cereal Chem 2016. [DOI: 10.1094/cchem-08-15-0158-r] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Bruna Mattioni
- Laboratory of Cereals, Food Science and Technology Department, Federal University of Santa Catarina. Av. Admar Gonzaga, 1346, Itacorubi 88034-001, Florianópolis, SC, Brazil
| | - Patricia M. Scheuer
- Laboratory of Cereals, Food Science and Technology Department, Federal University of Santa Catarina. Av. Admar Gonzaga, 1346, Itacorubi 88034-001, Florianópolis, SC, Brazil
| | - Andre L. Antunes
- Laboratory of Cereals, Food Science and Technology Department, Federal University of Santa Catarina. Av. Admar Gonzaga, 1346, Itacorubi 88034-001, Florianópolis, SC, Brazil
| | - Niraldo Paulino
- Group of Research and Development of Biopharmaceuticals, Pharmacy Professional Master’s Program, University of Anhanguera of São Paulo, Rua Maria Cândida, 1813, Vila Guilherme 02071-013, São Paulo, SP, Brazil
| | - Alicia de Francisco
- Laboratory of Cereals, Food Science and Technology Department, Federal University of Santa Catarina. Av. Admar Gonzaga, 1346, Itacorubi 88034-001, Florianópolis, SC, Brazil
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de Souza MCP, Deschênes ME, Laurencelle S, Godet P, Roy CC, Djilali-Saiah I. Pure Oats as Part of the Canadian Gluten-Free Diet in Celiac Disease: The Need to Revisit the Issue. Can J Gastroenterol Hepatol 2016; 2016:1576360. [PMID: 27446824 PMCID: PMC4904650 DOI: 10.1155/2016/1576360] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 10/15/2015] [Indexed: 11/17/2022] Open
Abstract
The question about recommending pure, noncontaminated oats as part of the gluten-free diet of patients with celiac disease remains controversial. This might be due to gluten cross contamination and to the possible immunogenicity of some oat cultivars. In view of this controversy, a review of the scientific literature was conducted to highlight the latest findings published between 2008 and 2014 to examine the current knowledge on oats safety and celiac disease in Europe and North America. Results showed that regular oats consumed in Canada are largely contaminated. Overall, the consumption of pure oats has been generally considered to be safe for adults and children. However, it appears that some oat cultivars may trigger an immune response in sensitive individuals. Therefore, further long-term studies on the impact of consumption of oats identifying the cultivar(s) constitute an important step forward for drawing final recommendations. Furthermore, a closer and more accurate monitoring of the dietary intake of noncontaminated oats would be paramount to better determine what its actual contribution in the gluten-free diet of adults and children with celiac disease are in order to draw sound recommendations on the safety of pure oats as part of the gluten-free diet.
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Affiliation(s)
| | - Marie-Eve Deschênes
- Fondation Québécoise de la Maladie Cœliaque (FQMC), Montréal, QC, Canada H2J 3E6
| | - Suzanne Laurencelle
- Fondation Québécoise de la Maladie Cœliaque (FQMC), Montréal, QC, Canada H2J 3E6
| | - Patrick Godet
- Fondation Québécoise de la Maladie Cœliaque (FQMC), Montréal, QC, Canada H2J 3E6
- Clinique de Gastroentérologie, Centre Hospitalier Lasalle, Lasalle, QC, Canada H8N 1X7
| | - Claude C. Roy
- Fondation Québécoise de la Maladie Cœliaque (FQMC), Montréal, QC, Canada H2J 3E6
- Service de Gastroentérologie, Hépatologie et Nutrition, CHU Sainte-Justine, Montréal, QC, Canada H3T 1C5
| | - Idriss Djilali-Saiah
- Fondation Québécoise de la Maladie Cœliaque (FQMC), Montréal, QC, Canada H2J 3E6
- Service de Gastroentérologie, Hépatologie et Nutrition, CHU Sainte-Justine, Montréal, QC, Canada H3T 1C5
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Celiac Disease and Gluten-Free Oats: A Canadian Position Based on a Literature Review. Can J Gastroenterol Hepatol 2016; 2016:1870305. [PMID: 27446825 PMCID: PMC4904695 DOI: 10.1155/2016/1870305] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 08/22/2015] [Indexed: 12/14/2022] Open
Abstract
This paper provides an overview of the latest scientific data related to the safety of uncontaminated oats (<20 ppm of gluten) in the diet of individuals with celiac disease (CD). It updates the previous Health Canada position posted on the Health Canada website in 2007 and a related paper published in 2009. It considers a number of recent studies published between January 2008 and January 2015. While recognizing that a few people with celiac disease seem to be clinically intolerant to oats, this review concludes that oats uncontaminated by gluten-containing cereals (wheat, rye, and barley) can be safely ingested by most patients with celiac disease and that there is no conclusive evidence that the consumption of uncontaminated or specially produced oats containing no greater than 20 ppm gluten by patients with celiac disease should be limited to a specific daily amount. However, individuals with CD should observe a stabilization phase before introducing uncontaminated oats to the gluten-free diet (GFD). Oats uncontaminated with gluten should only be introduced after all symptoms of celiac disease have resolved and the individual has been on a GFD for a minimum of 6 months. Long-term regular medical follow-up of these patients is recommended but this is no different recommendation to celiac individuals on a GFD without oats.
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50
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Comino I, Moreno MDL, Sousa C. Role of oats in celiac disease. World J Gastroenterol 2015; 21:11825-11831. [PMID: 26557006 PMCID: PMC4631980 DOI: 10.3748/wjg.v21.i41.11825] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 09/02/2015] [Accepted: 09/15/2015] [Indexed: 02/06/2023] Open
Abstract
A gluten-free diet is currently the only effective means of treating individuals with celiac disease. Such a diet enables celiac patients to control their symptoms and avoid various complications associated with this condition. However, while the quality of gluten-free foods has significantly improved during recent decades, maintenance of a gluten-free diet does not necessarily ensure adequate nutritional intake. Because oats are an important source of proteins, lipids, vitamins, minerals, and fibre, their inclusion in a gluten-free diet might improve the nutritional status of a celiac patient. Although oats are included in the list of gluten-free ingredients specified in European regulations, their safety when consumed by celiac patients remains debatable. Some studies claim that pure oats are safe for most celiac people, and contamination with other cereal sources is the main problem facing people with this disease. However, it is necessary to consider that oats include many varieties, containing various amino acid sequences and showing different immunoreactivities associated with toxic prolamins. As a result, several studies have shown that the immunogenicity of oats varies depending on the cultivar consumed. Thus, it is essential to thoroughly study the variety of oats used in a food ingredient before including it in a gluten-free diet.
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