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Rostami-Nejad M, Asri N, Olfatifar M, Khorsand B, Houri H, Rostami K. Systematic Review and Dose-Response Meta-Analysis on the Relationship between Different Gluten Doses and Risk of Coeliac Disease Relapse. Nutrients 2023; 15:1390. [PMID: 36986121 PMCID: PMC10057462 DOI: 10.3390/nu15061390] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/27/2023] [Accepted: 03/08/2023] [Indexed: 03/15/2023] Open
Abstract
Gluten proteins are known as immunological triggers for inflammation resulting in mucosal lesions in patients with coeliac disease (CD). Adherence to a strict gluten-free diet (GFD) is currently known as the only effective treatment for CD. In this study, we performed a systematic review and dose-response meta-analysis on data from previous studies to investigate the association between different gluten doses administered and the risk of CD relapse. Electronic databases were systematically searched to retrieve studies that investigated the response of CD patients to different amounts of gluten intake and evaluated the clinical, serologic, and/or histologic evidence to recognize disease relapse. Study-specific relative risks (RRs) were combined using a random effects model. A total of 440 identified published papers were screened, of which 7 records were selected following full-text reviewing and eligibility assessment for dose-response meta-analysis. According to our analysis, the risk of CD relapse is estimated to be 0.2% (RR: 1.002; 95% CI: 1.001 to 1.004) following the consumption of 6 mg gluten/day, which was increased to 7% (RR: 1.07; 95% CI: 1.03 to 1.10), 50% (RR: 1.50; 95% CI: 1.23 to 1.82), 80% (RR: 1.80; 95% CI: 1.36 to 2.38), and 100% (RR: 2.00; 95% CI: 1.43 to 2.78) by the daily intake of 150, 881, 1276, and 1505 mg gluten, respectively. Although good adherence to a GFD can adequately control CD-related symptoms, disease relapse might happen even with a very low dose of gluten, and the duration of exposure to gluten is also an important matter. The current literature has substantial limitations, such as relying on the data from just a few countries that were different in terms of the amount of gluten administered, the duration of the challenge, etc. Therefore, more randomized clinical trials using a standardized gluten challenge protocol are needed to confirm the findings of the present study.
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Affiliation(s)
- Mohammad Rostami-Nejad
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran 1985717411, Iran
| | - Nastaran Asri
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran 1985717411, Iran
| | - Meysam Olfatifar
- Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom 3715614566, Iran
| | - Babak Khorsand
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran 1985717411, Iran
| | - Hamidreza Houri
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran 1985717411, Iran
| | - Kamran Rostami
- Department of Gastroenterology, MidCentral DHB, Palmerston North 4442, New Zealand
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Angelino D, Rosi A, Ruggiero E, Nucci D, Paolella G, Pignone V, Pellegrini N, Martini D. Analysis of Food Labels to Evaluate the Nutritional Quality of Bread Products and Substitutes Sold in Italy: Results from the Food Labelling of Italian Products (FLIP) Study. Foods 2020; 9:foods9121905. [PMID: 33419252 PMCID: PMC7766686 DOI: 10.3390/foods9121905] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/12/2020] [Accepted: 12/17/2020] [Indexed: 02/07/2023] Open
Abstract
Bread is one of the most common staple foods, despite the increasing consumption of the so-called “bread substitutes”. The aim of the present work is to survey the nutritional quality intended as a nutrition declaration of 339 pre-packed bread products and 1020 bread substitutes sold in the major retailers present on the Italian market. Comparisons of energy, macronutrient, and salt content within product types, and between regular and gluten-free (GF) products and products with or without nutrition claim (NC) and health claim (HC) declarations, were performed. A high inter-product variability was detected. The median energy contents were 274 (interquartile range 255–289) and 412 (380–437) kcal/100 for bread products and substitutes, respectively. Irrespective of the category, GF products had lower amounts of energy than their gluten-containing counterpart (p < 0.001), whereas products carrying NC had lower energy, sugar and salt amounts than the products without these declarations on the pack (p < 0.001 for all). A strong positive correlation was observed between energy and carbohydrate in bread (rho = 0.73, p < 0.001), but not in substitutes (rho = 0.033, p = 0.29). The present work highlighted a high variability in the apparent nutritional quality of bread products and substitutes sold on the Italian market, and suggested that bread alternatives should not be considered tout court as substitutes from a nutritional point of view.
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Affiliation(s)
- Donato Angelino
- Faculty of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, 64100 Teramo, Italy;
| | - Alice Rosi
- Human Nutrition Unit, Department of Food and Drug, University of Parma, 43121 Parma, Italy;
| | - Emilia Ruggiero
- Department of Epidemiology and Prevention, IRCCS Neuromed, 86077 Pozzilli, Italy;
| | - Daniele Nucci
- Digestive Endoscopy Unit, Veneto Institute of Oncology IOV-IRCCS, 35100 Padua, Italy;
| | - Gaetana Paolella
- Department of Chemistry and Biology A. Zambelli, University of Salerno, 84084 Fisciano, Italy;
| | | | - Nicoletta Pellegrini
- Department of Agricultural, Food, Environmental and Animal Sciences, University of Udine, 33100 Udine, Italy
- Correspondence: ; Tel.: +39-0432-558183
| | - Daniela Martini
- Department of Food, Environmental and Nutritional Sciences (DeFENS), Università degli Studi di Milano, 20133 Milan, Italy;
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Mumolo MG, Rettura F, Melissari S, Costa F, Ricchiuti A, Ceccarelli L, de Bortoli N, Marchi S, Bellini M. Is Gluten the Only Culprit for Non-Celiac Gluten/Wheat Sensitivity? Nutrients 2020; 12:E3785. [PMID: 33321805 PMCID: PMC7762999 DOI: 10.3390/nu12123785] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/05/2020] [Accepted: 12/07/2020] [Indexed: 12/12/2022] Open
Abstract
The gluten-free diet (GFD) has gained increasing popularity in recent years, supported by marketing campaigns, media messages and social networks. Nevertheless, real knowledge of gluten and GF-related implications for health is still poor among the general population. The GFD has also been suggested for non-celiac gluten/wheat sensitivity (NCG/WS), a clinical entity characterized by intestinal and extraintestinal symptoms induced by gluten ingestion in the absence of celiac disease (CD) or wheat allergy (WA). NCG/WS should be regarded as an "umbrella term" including a variety of different conditions where gluten is likely not the only factor responsible for triggering symptoms. Other compounds aside from gluten may be involved in the pathogenesis of NCG/WS. These include fructans, which are part of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs), amylase trypsin inhibitors (ATIs), wheat germ agglutinin (WGA) and glyphosate. The GFD might be an appropriate dietary approach for patients with self-reported gluten/wheat-dependent symptoms. A low-FODMAP diet (LFD) should be the first dietary option for patients referring symptoms more related to FODMAPs than gluten/wheat and the second-line treatment for those with self-reported gluten/wheat-related symptoms not responding to the GFD. A personalized approach, regular follow-up and the help of a skilled dietician are mandatory.
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Affiliation(s)
| | - Francesco Rettura
- Gastrointestinal Unit, Department of Translational Sciences and New Technologies in Medicine and Surgery, University of Pisa, 56124 Pisa, Italy; (M.G.M.); (S.M.); (F.C.); (A.R.); (L.C.); (N.d.B.); (S.M.); (M.B.)
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Gutowski ED, Weiten D, Green KH, Rigaux LN, Bernstein CN, Graff LA, Walker JR, Duerksen DR, Silvester JA. Can individuals with celiac disease identify gluten-free foods correctly? Clin Nutr ESPEN 2020; 36:82-90. [PMID: 32220373 PMCID: PMC7322618 DOI: 10.1016/j.clnesp.2020.01.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND & AIMS Patients with celiac disease (CD) often report inadvertent gluten exposures and challenges reading labels. The most common cause of non-responsive CD is gluten exposure. We aimed to assess whether recently diagnosed CD patients can determine whether a food is gluten-free based on labeling, and to assess skills over time. A secondary aim was to identify factors associated with label reading proficiency. METHODS Inception cohort with follow-up at 6, 12, and 24 months after diagnosis. Participants were asked to determine whether 25 food items were gluten-free based on labeling information. Diet adherence was assessed using the Celiac Diet Assessment Tool (CDAT) and the Gluten-Free Eating Assessment Tool (GF-EAT). 144 adults with newly diagnosed celiac disease were enrolled. The initial quiz at 6 months was completed by 83%. Quizzes were completed by 72% at 12 months and 70% at 24 months. RESULTS Median overall accuracy scores were: 23/25, 24/25 and 21/25 at 6, 12 and 24 months respectively. Gluten-free products with explicit "gluten-free" claims had the fewest errors. Quiz scores were not correlated with tTG IgA levels, or CDAT or GF-EAT scores. Diet adherence was generally good (>85% with CDAT <13 suggesting adequate GFD adherence); however, at 24 months, only 11% reported no gluten exposure. CONCLUSIONS CD patients may be unable to consistently choose gluten-free foods based on product labeling. Explicit identification of gluten-free products may be helpful. Label reading ability appears stable over time. Further studies are needed to evaluate whether erroneous label reading or misleading labels are associated with persistent villous atrophy.
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Affiliation(s)
- Emily D Gutowski
- Celiac Research Program, Harvard Medical School, Boston, MA, United States.
| | - Dayna Weiten
- Winnipeg Regional Health Authority, Winnipeg, Canada.
| | - Kathy H Green
- Winnipeg Regional Health Authority, Winnipeg, Canada; St. Boniface Hospital Research Center, Winnipeg, Canada.
| | - Lisa N Rigaux
- St. Boniface Hospital Research Center, Winnipeg, Canada.
| | - Charles N Bernstein
- Winnipeg Regional Health Authority, Winnipeg, Canada; Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Lesley A Graff
- Celiac Research Program, Harvard Medical School, Boston, MA, United States; Winnipeg Regional Health Authority, Winnipeg, Canada; Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - John R Walker
- Winnipeg Regional Health Authority, Winnipeg, Canada; St. Boniface Hospital Research Center, Winnipeg, Canada; Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Donald R Duerksen
- Winnipeg Regional Health Authority, Winnipeg, Canada; St. Boniface Hospital Research Center, Winnipeg, Canada; Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Jocelyn A Silvester
- Celiac Research Program, Harvard Medical School, Boston, MA, United States; Winnipeg Regional Health Authority, Winnipeg, Canada; St. Boniface Hospital Research Center, Winnipeg, Canada; Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Boston Children's Hospital, Boston, MA, United States.
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Food Neophobia in Celiac Disease and Other Gluten-Free Diet Individuals. Nutrients 2019; 11:nu11081762. [PMID: 31370243 PMCID: PMC6722680 DOI: 10.3390/nu11081762] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/24/2019] [Accepted: 07/29/2019] [Indexed: 12/21/2022] Open
Abstract
The only treatment currently available to combat celiac disease (CD) is strict adherence to a gluten-free diet (GFD), but there may be various determinants of its adherence, including food neophobia (FN), that is associated with sensory aversions, or fears of negative consequences of eating specific food products, that may be crucial for CD patients following a GFD. The aim of the present study was to analyze food neophobia levels and its determinants in CD patients in comparison with other individuals who follow a GFD based on their own decision. The study was conducted in two independent groups of individuals following a GFD: those diagnosed with CD (n = 101) and those following a GFD based on their own decision (n = 124). Each group was recruited with cooperation from the local CD and GFD societies located in Poland. The FN was assessed using the Food Neophobia Scale (FNS) and compared between groups, as well as the influence of gender, age, body mass index, educational level, place of residence and employment status was assessed. It was stated, that for the individuals following a GFD, CD was the major determinant of FN. The FNS score values were higher (indicating higher food neophobia) for CD individuals (39.4 ± 9.2), than for those following a GFD based on their own decision (33.6 ± 8.7; p < 0.0001) and it was observed both for general group and for sub-groups stratified by assessed variables. Moreover, the indicated variables did not influence the FNS in any of the analyzed groups. The influence of CD with no influence of other variables was confirmed in the regression analysis. It may be concluded that CD is a major contributor to FN, which can be attributed to fear of developing adverse reactions to gluten-contaminated food products, which is more pronounced in CD patients compared to non-CD patients following a GFD based on their own decision.
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Mothers' Vegetable Consumption Behaviors and Preferences as Factors Limiting the Possibility of Increasing Vegetable Consumption in Children in a National Sample of Polish and Romanian Respondents. Nutrients 2019; 11:nu11051078. [PMID: 31096620 PMCID: PMC6566701 DOI: 10.3390/nu11051078] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/04/2019] [Accepted: 05/10/2019] [Indexed: 12/18/2022] Open
Abstract
Increasing the insufficient intake of vegetables in children may be difficult, due to the influence of parents and at-home accessibility. The aim of this study was to analyze the association between self-reported vegetable consumption behaviors and preferences of mothers and the behaviors and preferences of their children, as declared by them. The nationally representative Polish (n = 1200) and Romanian (n = 1157) samples of mothers of children aged 3-10 were obtained using the random quota sampling method, and interviewed for their and their children's general frequency of consumption and preferences of vegetables in years 2012-2014. A 24 h dietary recall of vegetable consumption was conducted for mothers and their children. Associations were observed for general number of servings consumed per day by mother-child pairs (p < 0.0001; R = 0.6522, R = 0.6573 for Polish and Romanian samples, respectively) and number of types indicated as preferred (p < 0.0001; R = 0.5418, R = 0.5433). The share of children consuming specific vegetables was 33.1-75.3% and 42.6-75.7% while their mothers also consumed, but 0.1-43.2% and 1.2-22.9% while their mothers did not. The share of children preferring specific vegetables was 16.7-74.1% and 15.2-100% when their mother shared the preference, but 1.3-46.9% and 0-38.3% when their mother did not. The mothers' vegetable consumption behaviors and preferences may be a factor limiting the possibility of increasing vegetable consumption in their children.
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