Updated Food Composition Database for Cereal-Based Gluten Free Products in Spain: Is Reformulation Moving on?

Associations between artificial sweetener intake from cereals, coffee, and tea and the risk of type 2 diabetes mellitus: A genetic correlation, mediation, and mendelian randomization analysis

BACKGROUND

Previous studies have emphasized the association between the intake of artificial sweeteners (AS) and type 2 diabetes mellitus (T2DM), but the causative relationship remains ambiguous.

METHODS

This study employed univariate Mendelian randomization (MR) analysis to assess the causal link between AS intake from various sources and T2DM. Linkage disequilibrium score (LDSC) regression was used to evaluate the correlation between phenotypes. Multivariate and mediation MR were applied to investigate confounding factors and mediating effects. Data on AS intake from different sources (N = 64,949) were sourced from the UK Biobank, while T2DM data were derived from the DIAbetes Genetics Replication And Meta-analysis.The primary method adopted was inverse variance weighted (IVW), complemented by three validation techniques. Additionally, a series of sensitivity analyses were performed to evaluate pleiotropy and heterogeneity.

RESULTS

LDSC analysis unveiled a significant genetic correlation between AS intake from different sources and T2DM (rg range: -0.006 to 0.15, all P < 0.05). After correction by the false discovery rate (FDR), the primary IVW method indicated that AS intake in coffee was a risk factor for T2DM (OR = 1.265, 95% CI: 1.035-1.545, P = 0.021, PFDR = 0.042). Further multivariable and mediation MR analyses pinpointed high density lipoprotein-cholesterol (HDL-C) as mediating a portion of this causal relationship. In reverse MR analysis, significant evidence suggested a positive correlation between T2DM and AS intake in coffee (β = 0.013, 95% CI: 0.004-0.022, P = 0.004, PFDR = 0.012), cereal (β = 0.007, 95% CI: 0.002-0.012, P = 0.004, PFDR = 0.012), and tea (β = 0.009, 95% CI: 0.001-0.017, P = 0.036, PFDR = 0.049). No other causal associations were identified (P > 0.05, PFDR > 0.05).

CONCLUSION

The MR analysis has established a causal relationship between AS intake in coffee and T2DM. The mediation by HDL-C emphasizes potential metabolic pathways underpinning these relationships.

The Silent Threat: Antimicrobial-Resistant Pathogens in Food-Producing Animals and Their Impact on Public Health

The emergence of antimicrobial resistance (AMR) is a global health problem without geographic boundaries. This increases the risk of complications and, thus, makes it harder to treat infections, which can result in higher healthcare costs and a greater number of deaths. Antimicrobials are often used to treat infections from pathogens in food-producing animals, making them a potential source of AMR. Overuse and misuse of these drugs in animal agriculture can lead to the development of AMR bacteria, which can then be transmitted to humans through contaminated food or direct contact. It is therefore essential to take multifaceted, comprehensive, and integrated measures, following the One Health approach. To address this issue, many countries have implemented regulations to limit antimicrobial use. To our knowledge, there are previous studies based on AMR in food-producing animals; however, this paper adds novelty related to the AMR pathogens in livestock, as we include the recent publications of this field worldwide. In this work, we aim to describe the most critical and high-risk AMR pathogens among food-producing animals, as a worldwide health problem. We also focus on the dissemination of AMR genes in livestock, as well as its consequences in animals and humans, and future strategies to tackle this threat.

Nutritional Composition of Breakfast in Children and Adolescents with and without Celiac Disease in Spain-Role of Gluten-Free Commercial Products

Eating a nutritionally balanced breakfast can be a challenge when following a gluten-free diet (GFD). We assessed the ingredients and nutrient composition of 364 gluten-free breakfast products (GFPs) and 348 gluten-containing counterparts (GCCs), and we analysed the nutritional quality of breakfast in a group of Spanish children and adolescents with celiac disease (CD) (n = 70), as compared to controls (n = 67). Food intakes were estimated using three 24 h dietary records. The composition of GFPs and GCCs was retrieved from the package labels of commercially available products. Most participants (98.5%) ate breakfast daily, and only one person in each group skipped breakfast once. The breakfast contribution of the total daily energy was 19% in participants with CD and 20% in controls. CD patients managed a balanced breakfast in terms of energy (54% from carbohydrates; 12% from proteins; 34% from lipids) and key food groups (cereals, dairy, fruits), but their intake of fruits needs improvement. Compared to controls, breakfast in the CD group provided less protein and saturated fat, a similar amount of carbohydrates and fibre, and more salt. Fibre is frequently added to GFPs, but these contain less protein because of the flours used in formulation. Gluten-free bread contains more fat and is more saturated than is GCC. Sugars, sweets, and confectionery contribute more to energy and nutrient intakes in participants with CD, while grain products do so in controls. Overall, breakfast on a GFD can be adequate, but can be improved by GFPs reformulation and a lower consumption of processed foods.

Gluten-Free Product Contribution to Energy and Macronutrient Intakes in Spanish Children and Adolescents with Celiac Disease

Gluten-free products (GFP) are a good choice for the replacement of cereals when following a gluten-free diet due to celiac disease (CD). However, commercial GFP are made with highly refined flours and may contain more fat, sugar, and salt, and less fiber and micronutrients than gluten-containing analogues, thus challenging the nutritional adequacy of the diet. The aim of this study is to assess the contribution of GFP to the diets of children and adolescents with CD. Food intakes were assessed in a cross-sectional study on 70 children and adolescents with CD (aged four to 18, 50% females), using three 24-h dietary records. GFP consumption reached 165 g a day and comprised mostly bread and fine bakery ware, followed by pasta. GFP contributed with a high percentage (>25%) to total energy, carbohydrates, fiber, and salt daily intakes and, to a lesser extent (<20%), to fat (including saturated fat), sugars and protein. Contribution of homemade products was testimonial. GFP contribution to total energy intake is significant and, consequently, relevant to the nutritional adequacy of the diet. Children and adolescents with CD could benefit from fat, saturated fat, and salt reduction, and fiber enrichment of processed GFP.

The Update of the Italian Food Composition Database of Gluten-Free Products and Its Application in Food-Based Dietary Guidelines Menus

Complete food composition databases (FCDBs) on gluten-free (GF) foods are needed to assess the nutrient intakes of celiac disease patients. The aim of the present work was to update the previously developed version of the Italian GF-FCDB and to apply it to a theoretical GF diet. The updated GF-FCDB includes the composition of 108 GF cereal-based foods, as sold, in terms of energy and macro- and micro-nutrients, imputed using food label information combined with the standard recipe approach. Three scenarios (i.e., refined, mixed, and wholegrain cereals) of the weekly guideline menu for the general Italian population were analyzed for energy and nutrient content in a theoretical dietary assessment using traditional gluten-containing (GC) foods and the corresponding GF substitutes. All GF menus were higher than the corresponding GC menus in polyunsaturated fatty acids, linoleic acid, and vitamin E. Zinc was lower in GF than in GC menus only in the wholegrain-cereal scenario. Thanks to the application of the updated GF-FCDB including a comprehensive list of micronutrients, we observed that it is possible for celiac disease patients to meet nutrient requirements by simply substituting GC with GF cereal-based products following recommendations for the general population.

Safety Assessment of Foods and Drinks Consumed by People on a Gluten-Free Diet

Naturally gluten-free foods and processed foods that do not contain information about the potential presence of gluten in them pose a hypothetical threat to people with food allergies and celiac disease. Patients who should follow a strict gluten-free diet do not always do so. Therefore, the aim of this research was to analyze certified “gluten-free” and naturally gluten-free products without labeled “may contain gluten” information in terms of their content of gluten proteins. The enzyme immunoassay AgraQuant Gluten G12 ELISA test kit was used for the analysis. Of all the products used in the research, only 5.8% were found to contain gluten above 20 ppm. Only one product labeled “gluten-free” was contaminated with gluten at 79.3 ppm (cider cake). In addition, our research also examined the gluten content of commercial beers containing barley malt not labeled as “gluten-free”. Research has shown that 60% of samples are not safe for those on a strict gluten-free diet. Our research clearly shows that many manufacturers, although they do not monitor their products for the presence of gluten in them, offer safe products, although they cannot be recommended in a gluten-free diet. Therefore, there is a strong need to increase the frequency of testing by food manufacturers for the presence of gluten in their products, so that the number of products approved for people on a gluten-free diet continues to increase.

Gluten-free grains: Importance, processing and its effect on quality of gluten-free products

Gluten-enteropathy affects a significant number of people, making gluten a major concern in the food industry. With medical advancements, the diagnosis of allergies is becoming easier, and people who are allergic to gluten are recommended a complete gluten-free diet. Since wheat provides a major part of the energy and nutrition in the diet, its elimination affects nutrition intake of allergic population. Food scientists are working to formulate products using protein-rich gluten-free grains with quality attributes at par with gluten-containing products. Focused research has been done to provide nutrition and a variety of food to people suffering from gluten-related disorders. Efforts are being made to remove the gluten from the wheat and other gluten-containing grains, while applying different processing/treatments to enhance the properties of gluten-free grains. Hence, the present review summarizes the importance, processing, and products of different gluten-free grains. It also highlights the digestibility of gluten-free grains with clinical trials and gluten elimination strategies for gluten-containing grains.

Development of a Canadian Food Composition Database of Gluten-Free Products

Country-specific food composition data are needed for gluten-free (GF) food products to assess nutritional adequacy and diet quality. This research aimed to develop a comprehensive GF food composition database for key GF foods consumed in Canada. Average nutrient data from 167 products were estimated from Nutrition Fact Panel labels and the commercial ingredient list, using an iterative and systematic approach. The database reports mean values for energy and 29 nutrients per 100 g for 33 GF commercial grain-based foods. Nutrient values were evaluated with Health Canada’s nutrient content claims per standard reference serving. On average, GF products were, at minimum, a source of thiamin (73%), riboflavin (70%), niacin (58%), iron (58%), fibre (55%), magnesium (48%), folate (36%), zinc (19%), and calcium (15%). Most GF products were low in saturated fat (85%) and cholesterol (64%) but only 15% were low in total fat and 6% were free of sugar. Micronutrient enrichment and the use of nutrient-dense whole grain flours, legume flours, oil seed husks, and functional fibre ingredients varied within and between categories and brands but appeared to contribute to nutrient content. This database provides a new tool to enhance GF diet assessment in individuals or populations in Canada.

Calcium and Iron Content of Cereal-Based Gluten-Free Products

The impact of a gluten-free (GF) diet on the intake of calcium and iron is broadly unknown, as the micronutrient content of GF cereal-based products has scarcely been measured. The study aimed to measure the calcium and iron content of GF cereal-based products from the UK. Seventy-three GF products were analysed. A laboratory analysis of calcium and iron from GF food samples was performed by spectrophotometric and flame emission photometry, respectively. The values for wheat-based products were from a nutrient database. The calcium in GF white loaf samples varied greatly from 54 to 140 mg/100 g, with a lower average calcium content compared with wheat-based values (99 ± 29 mg/100 g n = 13 versus 177 mg/100 g; p < 0.01). Only 27% of the white loaves and rolls were fortified with calcium; this contrasts with 100% of white wheat-based loaves. The calcium in GF flour mixes ranged from 54 to 414 mg/100 g, with 66% fortified. GF white pasta had more calcium compared with wheat-based pasta (76 ± 27 mg/100 g n = 7 versus 24 mg/100 g; p = 0.002). The iron in GF bread loaves and pasta samples was similar to wheat-based comparators, whereas lower iron levels were observed in GF wraps (0.8 ± 0.2 n = 11 versus 1.6 mg/100 g). GF bread had a significantly higher fibre content, and the majority of GF bread had a lower protein content, compared with wheat-based bread products. These calcium and iron values provide a valuable addition towards enabling more accurate nutrient intake analysis for adults and children with coeliac disease.

Performance of Apple Pomace for Gluten-Free Bread Manufacture: Effect on Physicochemical Characteristics and Nutritional Value

Apple pomace has been proposed as a quality enhancer for gluten-free bread, but its composition and physicochemical features differ significantly depending on the apple cultivar. The objective of this article was to characterize apple pomace powder (APP) from certain varieties from the Basque Country and to study the feasibility of adding it to gluten-free bread, focusing on physicochemical and nutritional aspects. APP was obtained by washing, drying and grinding, and it was added at 0, 5, 6 and 8%, together with other ingredients, such as gluten-free flours, corn starch and whey protein. APP had a reddish-grey coloration (L* 56.49 ± 1.39, a* 11.07 ± 0.47, b* 27.69 ± 1.76), pH 4.19 ± 0.15 and Aw 0.235 ± 0.084. Pomace powder was used successfully in higher amounts than experiences reported before. Key physicochemical parameters such as specific volume (≥2.5 cm3/g) and cohesiveness or resilience values (0.538 and 0.378, respectively) suggested good acceptability for gluten-free breads with 8% APP. Additionally, breads were a source of antioxidant potential (437.66 ± 38.95 µM DPPHeq/g APP), fiber (80.13 ± 6.07 g/100 g) and micronutrients such as Cu, Mg, Mn and Fe. In conclusion, local apple varieties are a good source of raw material for gluten-free bread manufacture, which offers a solution for environmental pollution and may contribute to boosting the circular economy.

Implementing effective salt reduction programs and policies in low- and middle-income countries: learning from retrospective policy analysis in Argentina, Mongolia, South Africa and Vietnam

OBJECTIVE

To understand the factors influencing the implementation of salt reduction interventions in low- and middle-income countries (LMIC).

DESIGN

Retrospective policy analysis based on desk reviews of existing reports and semi-structured stakeholder interviews in four countries, using Walt and Gilson's 'Health Policy Triangle' to assess the role of context, content, process and actors on the implementation of salt policy.

SETTING

Argentina, Mongolia, South Africa and Vietnam.

PARTICIPANTS

Representatives from government, non-government, health, research and food industry organisations with the potential to influence salt reduction programmes.

RESULTS

Global targets and regional consultations were viewed as important drivers of salt reduction interventions in Mongolia and Vietnam in contrast to local research and advocacy, and support from international experts, in Argentina and South Africa. All countries had population-level targets and written strategies with multiple interventions to reduce salt consumption. Engaging industry to reduce salt in foods was a priority in all countries: Mongolia and Vietnam were establishing voluntary programs, while Argentina and South Africa opted for legislation on salt levels in foods. Ministries of Health, the WHO and researchers were identified as critical players in all countries. Lack of funding and technical capacity/support, absence of reliable local data and changes in leadership were identified as barriers to effective implementation. No country had a comprehensive approach to surveillance or regulation for labelling, and mixed views were expressed about the potential benefits of low sodium salts.

CONCLUSIONS

Effective scale-up of salt reduction programs in LMIC requires: (1) reliable local data about the main sources of salt; (2) collaborative multi-sectoral implementation; (3) stronger government leadership and regulatory processes and (4) adequate resources for implementation and monitoring.

Gluten-Free Cereal Products and Beverages: A Review of Their Health Benefits in the Last Five Years

In the past decades, food products and beverages made from gluten-free cereals were initially created for certain groups of people who experience gluten-related disorders such as wheat allergies, gluten ataxia, non-celiac gluten sensitivity, and the most well-known, celiac disease. Nowadays, the consumption of gluten-free products is not only restricted to targeted groups, but it has become a food trend for normal consumers, especially in countries such as the UK, the US, and some European countries, who believe that consuming a gluten-free product is a healthier choice compared to normal gluten-containing products. However, some research studies have disapproved of this claim because the currently available gluten-free products in the market are generally known to be lower in proteins, vitamins, and minerals and to contain higher lipids, sugar, and salt compared to their gluten-containing counterparts. The use of other gluten-free cereals such as sorghum, millet, and teff as well as pseudo cereals such as buckwheat and quinoa has gained significant interest in research in terms of their various potential health benefits. Hence, this review highlights the potential health benefits of some gluten-free cereals and pseudo cereals apart from corn and rice in the last decade. The potential health benefits of gluten-free products such as bread, pasta, crackers, and cookies and the health benefits of some other non-alcoholic beverages made from gluten-free cereals and pseudo cereals are reported.

Nutritional facts regarding commercially available gluten-free bread worldwide: Recent advances and future challenges

Recently, there has been an increase in demand for gluten-free (GF) products due to the growing number of gluten-intolerant and healthy individuals choosing to follow a gluten-free diet. Gluten-free bread (GFB) is a staple food product; therefore, many recent studies have reported the nutritional properties of GFB. However, an overview of the current ingredients and nutritional labeling of GFB worldwide has not yet been provided. This review aimed to gather the latest information regarding the most used ingredients in GFB formulations and the nutritional quality of these products from different countries, based on studies published in the last decade (2010-2020). Our analysis showed that GFB had a lower protein and a higher fat content than gluten-containing bread, and the dietary fiber content was highly variable between countries. Some studies have revealed a high glycaemic index in most products, which is associated with the extensive use of rice flour and starch as the main ingredients in GFB formulation. Label information presented significant differences from the data obtained through the chemical analysis of fiber and other nutritional components. Micronutrient fortification is not common in the GFB. The nutritional quality of commercial GFB is a crucial issue that needs to be addressed.

Assessment of price and nutritional quality of gluten-free products versus their analogues with gluten through the algorithm of the nutri-score front-of-package labeling system

Evidence has shown that the nutritional quality of gluten-free products (GFPs) is lower than that of non-GFPs. Our main objective was to compare the nutritional quality through nutritional profiles of foods underlying the Nutri-Score front-of-pack and the price of GFPs with respect to non-GFPs, and to evaluate whether there is a correlation between both parameters. Nutritional information of all products was obtained from the CELIACBASE database and the price through Spanish supermarkets websites. Global quality using the Nutri-Score algorithm and the price were compared between both types of products. GFPs do not always have poorer quality than their counterparts. A better quality of gluten-free pasta was correlated with the higher price but also a worse quality of gluten-free muesli was correlated with the higher price. The price of GFPs compared to non-GFPs was higher up to 391.5%. However, for ham and cheese pizza, ham pizza, Marie biscuits, and baby biscuits, the difference was not statistically significant. Generally, the price of GFPs did not correlate with better nutritional quality. Nutri-Score would ease the nutritional quality identification, empowering consumers and could also influence manufacturers to improve the nutritional quality of GFPs. Nowadays, given that many GFPs have poor nutritional quality, they should be included only occasionally in a balanced gluten-free diet.

Nutritional Status in Spanish Adults with Celiac Disease Following a Long-Term Gluten-Free Diet Is Similar to Non-Celiac

The only available treatment for celiac disease is life-long gluten exclusion. We conducted a cross-sectional age- and gender-matched study in 64 celiac adults on a long-term (>1 year) gluten-free diet and 74 non-celiac volunteers from Spain, using dietary, anthropometric, and biochemical parameters, as well as assessing bone mineral density and physical activity. Celiac adults had deficient intake (below 2/3 of the recommended intake) for folates, vitamin E, and iodine and low intake of calcium (below 80% of the recommended intake). Iron intake was also below 2/3 of the recommended intake in celiac women. Vitamin D intake was extremely low, and 34% of celiac patients had moderately deficient plasma levels. According to bone mineral density, celiac women may be more prone to osteopenia and osteoporosis. However, we found a perfectly analogous nutritional status scenario in celiac as compared to healthy volunteers, with the dietary deviations found being similar to those of the Spanish population, i.e., both groups followed a high-lipid, high-protein, and low-carbohydrate diet. Values for biochemical parameters were found within the reference ranges. Celiac disease had no influence on body weight, but body fat in celiac patients tended to be higher. According to our results, vitamin D, calcium, folates, vitamin E, iodine, and iron nutritional status should be specifically assessed and monitored in the celiac population.

A New Food Composition Database of Lactose-Free Products Commercialized in Spain: Differences in Nutritional Composition as Compared to Traditional Products

We developed a new database to evaluate the nutritional composition of lactose-free products from Spain. The database includes dairy products and other products, all of which show the "lactose-free" declaration on their label, accounting for 327 products in total. Of these, 123 are dairy products, 16 are non-dairy products which include a dairy ingredient (5%) and 188 items (57% of the sample) are non-dairy products that do not contain any dairy ingredient. The main subgroups are yogurt (25%), milk (24%), and cheese (17%). Nineteen percent of the compiled products included nutritional claims on their labels. Most lactose-free products did not contain either added sugars or low- or no-calorie sweeteners (58%), while 34% included added sugars and only 6%, sweeteners or a combination of both (2%). We found that 19.5%, mainly within the milk subgroup, were fortified with vitamins A, D, E, K, B₉, and B₁₂, P, and Ca. There were no significant differences in the nutritional composition between lactose-free products and traditional products. According to the NOVA classification, 55% of compiled lactose-free products were ultra-processed, and 20% processed. The array of lactose-free products marketed in Spain proves that there are enough, both in quantity and quality, to satisfy the dairy needs of lactose intolerants.

Development of “New” Bread and Cheese

Bread and cheese have been a popular combination since early times. Indeed, the history of bread dates back to 8000 BC and that of cheese to 7200 BC. However, new types of breads and cheeses are increasingly popular for several reasons, such as allergies, lifestyles, economy and religion. The major challenge is that food manufacturers are offering new products most of which are not welcomed by consumers. Therefore, recently, researchers have placed importance on their relationships with consumers to boost the success of new products. This short review summarizes the backgrounds of recent trends, processes, and principles to manufacture new bread and cheese products, and discusses future perspectives. The development of additive-free, gluten-free rice bread we have recently done from basic research to commercialization of the products is highly focused in this review. Additionally, ongoing studies on plant-based cheeses are introduced from material selection to suggest future outlooks.