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Matias S, Perez-Junkera G, Martínez O, Miranda J, Larretxi I, Peña L, Bustamante MÁ, Churruca I, Simón E. FODMAP Content Like-by-like Comparison in Spanish Gluten-free and Gluten-containing Cereal-based Products. Plant Foods Hum Nutr 2024:10.1007/s11130-024-01177-8. [PMID: 38642193 DOI: 10.1007/s11130-024-01177-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/07/2024] [Indexed: 04/22/2024]
Abstract
Gluten-free foods (GF) availability on supermarket shelves is growing and it is expected to continue expanding in the years ahead. These foods have been linked to a lower content of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs), molecules that trigger gastrointestinal symptoms in sensitive persons. In this study, the FODMAP content of 25 cereal-based GF foods in Spain (breakfast cereals, pasta, bread, biscuits, bakery products, and dough and puff pastry) and 25 gluten-containing equivalents (GC) available in the same supermarket were analysed and compared. Lactose, fructose, glucose, sorbitol, mannitol, raffinose, stachyose and fructans were quantified. In a like-by-like analysis, GF foods were found to generally contain fewer FODMAPs than their GC counterparts. The ingredients used in the manufacture of GF cereal-based foods may contribute to this fact. When the individually wrapped size was considered, the proportion of samples classified as high-FODMAPs in GC and GF foods showed a trend towards fewer samples in the GF. However, not all the GF samples were low-FODMAP. Altogether, our findings provide essential information for FODMAP content databases of GF products in Spain.
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Affiliation(s)
- Silvia Matias
- GLUTEN3S Research Group, Department of Pharmacy and Food Science, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, 01006, Spain
| | - Gesala Perez-Junkera
- GLUTEN3S Research Group, Department of Pharmacy and Food Science, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, 01006, Spain
| | - Olaia Martínez
- GLUTEN3S Research Group, Department of Pharmacy and Food Science, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, 01006, Spain
- Gluten Analysis Laboratory, Department of Pharmacy and Food Science, Faculty of Pharmacy, University of the Basque Country (UPV/EHU), University of the Basque Country (UPV/EHU), Paseo de la Universidad, 7, Vitoria- Gasteiz, 01006, Spain
- Nutrition and Food Safety Research Group, Bioaraba Health Research Institute, Vitoria- Gasteiz, 01006, Spain
| | - Jonatan Miranda
- GLUTEN3S Research Group, Department of Pharmacy and Food Science, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, 01006, Spain.
- Gluten Analysis Laboratory, Department of Pharmacy and Food Science, Faculty of Pharmacy, University of the Basque Country (UPV/EHU), University of the Basque Country (UPV/EHU), Paseo de la Universidad, 7, Vitoria- Gasteiz, 01006, Spain.
- Nutrition and Food Safety Research Group, Bioaraba Health Research Institute, Vitoria- Gasteiz, 01006, Spain.
| | - Idoia Larretxi
- GLUTEN3S Research Group, Department of Pharmacy and Food Science, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, 01006, Spain
- Gluten Analysis Laboratory, Department of Pharmacy and Food Science, Faculty of Pharmacy, University of the Basque Country (UPV/EHU), University of the Basque Country (UPV/EHU), Paseo de la Universidad, 7, Vitoria- Gasteiz, 01006, Spain
- Nutrition and Food Safety Research Group, Bioaraba Health Research Institute, Vitoria- Gasteiz, 01006, Spain
- Ayuntamiento de Vitoria-Gasteiz, Centro Integral de Atención a Mayores San Prudencio, Vitoria-Gasteiz, 01006, Spain
| | - Lidia Peña
- Gluten Analysis Laboratory, Department of Pharmacy and Food Science, Faculty of Pharmacy, University of the Basque Country (UPV/EHU), University of the Basque Country (UPV/EHU), Paseo de la Universidad, 7, Vitoria- Gasteiz, 01006, Spain
| | - María Ángeles Bustamante
- Gluten Analysis Laboratory, Department of Pharmacy and Food Science, Faculty of Pharmacy, University of the Basque Country (UPV/EHU), University of the Basque Country (UPV/EHU), Paseo de la Universidad, 7, Vitoria- Gasteiz, 01006, Spain
- Nutrition and Food Safety Research Group, Bioaraba Health Research Institute, Vitoria- Gasteiz, 01006, Spain
| | - Itziar Churruca
- GLUTEN3S Research Group, Department of Pharmacy and Food Science, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, 01006, Spain
- Gluten Analysis Laboratory, Department of Pharmacy and Food Science, Faculty of Pharmacy, University of the Basque Country (UPV/EHU), University of the Basque Country (UPV/EHU), Paseo de la Universidad, 7, Vitoria- Gasteiz, 01006, Spain
- Nutrition and Food Safety Research Group, Bioaraba Health Research Institute, Vitoria- Gasteiz, 01006, Spain
| | - Edurne Simón
- GLUTEN3S Research Group, Department of Pharmacy and Food Science, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, 01006, Spain
- Gluten Analysis Laboratory, Department of Pharmacy and Food Science, Faculty of Pharmacy, University of the Basque Country (UPV/EHU), University of the Basque Country (UPV/EHU), Paseo de la Universidad, 7, Vitoria- Gasteiz, 01006, Spain
- Nutrition and Food Safety Research Group, Bioaraba Health Research Institute, Vitoria- Gasteiz, 01006, Spain
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Abstract
The aim of this review is to provide a comprehensive overview about the link between viruses and celiac disease. A systematic search on PubMed, Embase, and Scopus was conducted on March 07, 2023. The reviewers independently selected the articles and chose which articles to include. The review is a textual systemic review, and all relevant articles were included based on title and abstract. If there was a disagreement between the reviewers, they came to a consensus during deliberation sessions. A total of 178 articles were selected for the review and read in full; only part of them was retained. We found studies between celiac disease and 12 different viruses. Some of the studies were done only on small groups. Most studies were on pediatric population. Evidence for an association was found with several viruses (trigger or protective). It seems that only a part of the viruses could induce the disease. Several points are important to keep in mind: firstly, simple mimicry or that the virus induces a high level of TGA is not sufficient to promote the disease. Secondly, inflammatory background is necessary to induce CD with virus. Thirdly, IFN type 1 seems to have an important role. Some of the viruses are potential or known triggers like enteroviruses, rotaviruses, reoviruses, and influenza. Further studies are needed to better understand the role of viruses in celiac disease to better treat and prevent the disease.
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Affiliation(s)
- Ramon Cohen
- Internal Department B, Kaplan Medical Center, Rehovot, Israel.
- Department of Clinical Immunology Allergy and AIDS, Kaplan Medical Center, Rehovot, Israel.
| | - Keren Mahlab-Guri
- Department of Clinical Immunology Allergy and AIDS, Kaplan Medical Center, Rehovot, Israel
| | - Malka Atali
- Internal Department B, Kaplan Medical Center, Rehovot, Israel
| | - Daniel Elbirt
- Department of Clinical Immunology Allergy and AIDS, Kaplan Medical Center, Rehovot, Israel
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Schreiber B, Denholm J, Gilbey J, Schönlieb CB, Soilleux E. Stain normalization gives greater generalizability than stain jittering in neural network training for the classification of coeliac disease in duodenal biopsy whole slide images. J Pathol Inform 2023; 14:100324. [PMID: 37577172 PMCID: PMC10416012 DOI: 10.1016/j.jpi.2023.100324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/09/2023] [Accepted: 06/14/2023] [Indexed: 08/15/2023] Open
Abstract
Around 1% of the population of the UK and North America have a diagnosis of coeliac disease (CD), due to a damaging immune response to the small intestine. Assessing whether a patient has CD relies primarily on the examination of a duodenal biopsy, an unavoidably subjective process with poor inter-observer concordance. Wei et al. [11] developed a neural network-based method for diagnosing CD using a dataset of duodenal biopsy whole slide images (WSIs). As all training and validation data came from one source, there was no guarantee that their results would generalize to WSIs obtained from different scanners and laboratories. In this study, the effects of applying stain normalization and jittering to the training data were compared. We trained a deep neural network on 331 WSIs obtained with a Ventana scanner (WSIs; CD: n = 190 ; normal: n = 141 ) to classify presence of CD. In order to test the effects of stain processing when validating on WSIs scanned on varying scanners and from varying laboratories, the neural network was validated on 4 datasets: WSIs of slides scanned on a Ventana scanner (WSIs; CD: n = 48 ; normal: n = 35 ), WSIs of the same slides rescanned on a Hamamatsu scanner (WSIs; CD: n = 48 ; normal: n = 35 ), WSIs of the same slides rescanned on an Aperio scanner (WSIs; CD: n = 48 ; normal: n = 35 ), and WSIs of different slides scanned on an Aperio scanner (WSIs; CD: n = 38 ; normal: n = 37 ). Without stain processing, the F1 scores of the neural network were 0.947 , 0.619 , 0.746 , and 0.727 when validating on the Ventana validation WSIs, Hamamatsu and Aperio rescans of the Ventana validation WSIs, and Aperio WSIs from a different source respectively. With stain normalization, the performance of the neural network improved significantly with respective F1 scores 0.982 , 0.943 , 0.903 , and 0.847 . Stain jittering resulted in a better performance than stain normalization when validating on data from the same source F1 score 1.000 , but resulted in poorer performance than stain normalization when validating on WSIs from different scanners (F1 scores 0.939 , 0.814 , and 0.747 ). This study shows the importance of stain processing, in particular stain normalization, when training machine learning models on duodenal biopsy WSIs to ensure generalizability between different scanners and laboratories.
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Affiliation(s)
- B.A. Schreiber
- Department of Pathology, University of Cambridge, Cambridge, UK
- Department of Applied Mathematics and Theoretical Physics, University of Cambridge, Cambridge, UK
| | - J. Denholm
- Department of Applied Mathematics and Theoretical Physics, University of Cambridge, Cambridge, UK
- Lyzeum Ltd., Cambridge, UK
| | - J.D. Gilbey
- Department of Applied Mathematics and Theoretical Physics, University of Cambridge, Cambridge, UK
| | - C.-B. Schönlieb
- Department of Applied Mathematics and Theoretical Physics, University of Cambridge, Cambridge, UK
- Lyzeum Ltd., Cambridge, UK
| | - E.J. Soilleux
- Department of Pathology, University of Cambridge, Cambridge, UK
- Lyzeum Ltd., Cambridge, UK
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Gan J, Nazarian S, Teare J, Darzi A, Ashrafian H, Thompson AJ. A case for improved assessment of gut permeability: a meta-analysis quantifying the lactulose:mannitol ratio in coeliac and Crohn's disease. BMC Gastroenterol 2022; 22:16. [PMID: 35012471 PMCID: PMC8751358 DOI: 10.1186/s12876-021-02082-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 12/23/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND A widely used method in assessing small bowel permeability is the lactulose:mannitol test, where the lactulose:mannitol ratio (LMR) is measured. However, there is discrepancy in how the test is conducted and in the values of LMR obtained across studies. This meta-analysis aims to determine LMR in healthy subjects, coeliac and Crohn's disease. METHODS A literature search was performed using PRISMA guidance to identify studies assessing LMR in coeliac or Crohn's disease. 19 studies included in the meta-analysis measured gut permeability in coeliac disease, 17 studies in Crohn's disease. Outcomes of interest were LMR values and comparisons of standard mean difference (SMD) and weighted mean difference (WMD) in healthy controls, inactive Crohn's, active Crohn's, treated coeliac and untreated coeliac. Pooled estimates of differences in LMR were calculated using the random effects model. RESULTS Pooled LMR in healthy controls was 0.014 (95% CI: 0.006-0.022) while pooled LMRs in untreated and treated coeliac were 0.133 (95% CI: 0.089-0.178) and 0.037 (95% CI: 0.019-0.055). In active and inactive Crohn's disease, pooled LMRs were 0.093 (95% CI: 0.031-0.156) and 0.028 (95% CI: 0.015-0.041). Significant differences were observed in LMR between: (1) healthy controls and treated coeliacs (SMD = 0.409 95% CI 0.034 to 0.783, p = 0.032), (2) healthy controls and untreated coeliacs (SMD = 1.362 95% CI: 0.740 to 1.984, p < 0.001), (3) treated coeliacs and untreated coeliacs (SMD = 0.722 95% CI: 0.286 to 1.157, p = 0.001), (4) healthy controls and inactive Crohn's (SMD = 1.265 95% CI: 0.845 to 1.686, p < 0.001), (5) healthy controls and active Crohn's (SMD = 2.868 95% CI: 2.112 to 3.623, p < 0.001), and (6) active Crohn's and inactive Crohn's (SMD = 1.429 (95% CI: 0.580 to 2.278, p = 0.001). High heterogeneity was observed, which was attributed to variability in protocols used across different studies. CONCLUSION The use of gut permeability measurements in screening and monitoring of coeliac and Crohn's disease is promising. LMR is useful in performing this function with significant limitations. More robust alternative tests with higher degrees of clinical evidence are needed if measurements of gut permeability are to find widespread clinical use.
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Affiliation(s)
- Jonathan Gan
- Department of Surgery and Cancer, Institute of Global Health Innovation, St Mary's Hospital, Imperial College London, 10th Floor, Queen Elizabeth the Queen Mother WingSouth Wharf Road, London, W2 1NY, UK.
| | - Scarlet Nazarian
- Department of Surgery and Cancer, Institute of Global Health Innovation, St Mary's Hospital, Imperial College London, 10th Floor, Queen Elizabeth the Queen Mother WingSouth Wharf Road, London, W2 1NY, UK
| | - Julian Teare
- Department of Surgery and Cancer, Institute of Global Health Innovation, St Mary's Hospital, Imperial College London, 10th Floor, Queen Elizabeth the Queen Mother WingSouth Wharf Road, London, W2 1NY, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Institute of Global Health Innovation, St Mary's Hospital, Imperial College London, 10th Floor, Queen Elizabeth the Queen Mother WingSouth Wharf Road, London, W2 1NY, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Institute of Global Health Innovation, St Mary's Hospital, Imperial College London, 10th Floor, Queen Elizabeth the Queen Mother WingSouth Wharf Road, London, W2 1NY, UK
| | - Alex J Thompson
- Department of Surgery and Cancer, Institute of Global Health Innovation, St Mary's Hospital, Imperial College London, 10th Floor, Queen Elizabeth the Queen Mother WingSouth Wharf Road, London, W2 1NY, UK
- Hamlyn Centre for Robotic Surgery, St Mary's Hospital, Imperial College London, Level 3 Paterson BuildingSouth Wharf Road, London, W2 1NY, UK
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Mehrotra I, Serena G, Cetinbas M, Kenyon V, Martin VM, Harshman SG, Zomorrodi AR, Sadreyev RI, Fasano A, Leonard MM. Characterization of the blood microbiota in children with Celiac disease. Curr Res Microb Sci 2021; 2:100069. [PMID: 34841359 PMCID: PMC8610358 DOI: 10.1016/j.crmicr.2021.100069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 11/11/2022] Open
Abstract
Celiac Disease (CD) is an autoimmune disorder triggered by gluten ingestion that can develop in genetically predisposed individuals. Alterations in the gut microbiota have been suggested to contribute to development of autoimmune conditions including CD. Recent work suggests the existence of a blood microbiota. Evidence that alterations in the blood microbiota potentially influence the development of chronic immune based diseases is increasing. However, there is no published literature regarding the blood microbiota in children, including those with CD. This study aimed to characterize the diversity and taxonomic composition of the blood microbiota of children with CD compared to controls. Whole blood samples were collected from children with active CD, CD in remission, and control subjects and 16S rRNA sequencing was utilized to analyze the blood microbiota. We found 16s rRNA present throughout all pediatric blood samples, providing evidence for the presence of a pediatric blood microbiota. We found significant differences in beta diversity and in abundance of certain taxa (Campylobacterales order, Odoribacteraceae and Helicobacteraceae families, Odoribacter genus and species, and Bacteroides acidifaciens species) between subjects with active CD and controls. These taxa have been previously reported to be associated with immune response and gut-inflammatory diseases. We did not find significant differences between subjects with active and remission CD or between remission CD and controls. Conclusions: We provide evidence for a pediatric blood microbiota and identified higher beta diversity and alterations in the composition of blood microbiota in subjects with active CD compared to controls.
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Affiliation(s)
- Isha Mehrotra
- Center for Celiac Research and Treatment, MassGeneral Hospital for Children, Yawkey Center for Outpatient Care, Suite 6B, 32 Fruit Street, Boston, MA 02114, USA
| | - Gloria Serena
- Center for Celiac Research and Treatment, MassGeneral Hospital for Children, Yawkey Center for Outpatient Care, Suite 6B, 32 Fruit Street, Boston, MA 02114, USA
- Mucosal Immunology and Biology Research Center, MassGeneral Hospital for Children, Jackson, 55 Fruit Street, Boston, MA 02114, USA
- Celiac Research Program, Harvard Medical School, Boston, MA, USA
| | - Murat Cetinbas
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Department of Molecular Biology, Massachusetts General Hospital, Simches Research Center, 185 Cambridge Street, CPZN7250 Boston, MA 02114, USA
| | - Victoria Kenyon
- Center for Celiac Research and Treatment, MassGeneral Hospital for Children, Yawkey Center for Outpatient Care, Suite 6B, 32 Fruit Street, Boston, MA 02114, USA
- Mucosal Immunology and Biology Research Center, MassGeneral Hospital for Children, Jackson, 55 Fruit Street, Boston, MA 02114, USA
- Celiac Research Program, Harvard Medical School, Boston, MA, USA
| | - Victoria M. Martin
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Division of Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children, Yawkey Center for Outpatient Care, Yawkey 6B-6800 Suite, 55 Fruit Street Boston, MA 02114, USA
- Food Allergy Center, Massachusetts General Hospital, MGH Professional Office Building, Suite 530, 275 Cambridge Street Boston, MA 02114, USA
| | - Stephanie G. Harshman
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital: West End Apartments 2 Longfellow Place, Suite 200 Boston, MA 02114, USA
- Neuroendocrine Unit, Massachusetts General Hospital, 100 Blossom St, Boston, MA 02114, USA
| | - Ali R. Zomorrodi
- Center for Celiac Research and Treatment, MassGeneral Hospital for Children, Yawkey Center for Outpatient Care, Suite 6B, 32 Fruit Street, Boston, MA 02114, USA
- Mucosal Immunology and Biology Research Center, MassGeneral Hospital for Children, Jackson, 55 Fruit Street, Boston, MA 02114, USA
- Celiac Research Program, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Ruslan I. Sadreyev
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Department of Molecular Biology, Massachusetts General Hospital, Simches Research Center, 185 Cambridge Street, CPZN7250 Boston, MA 02114, USA
| | - Alessio Fasano
- Center for Celiac Research and Treatment, MassGeneral Hospital for Children, Yawkey Center for Outpatient Care, Suite 6B, 32 Fruit Street, Boston, MA 02114, USA
- Mucosal Immunology and Biology Research Center, MassGeneral Hospital for Children, Jackson, 55 Fruit Street, Boston, MA 02114, USA
- Celiac Research Program, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Division of Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children, Yawkey Center for Outpatient Care, Yawkey 6B-6800 Suite, 55 Fruit Street Boston, MA 02114, USA
| | - Maureen M. Leonard
- Center for Celiac Research and Treatment, MassGeneral Hospital for Children, Yawkey Center for Outpatient Care, Suite 6B, 32 Fruit Street, Boston, MA 02114, USA
- Mucosal Immunology and Biology Research Center, MassGeneral Hospital for Children, Jackson, 55 Fruit Street, Boston, MA 02114, USA
- Celiac Research Program, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Division of Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children, Yawkey Center for Outpatient Care, Yawkey 6B-6800 Suite, 55 Fruit Street Boston, MA 02114, USA
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Tjernberg AR, Woksepp H, Sandholm K, Johansson M, Dahle C, Ludvigsson JF, Bonnedahl J, Nilsson P, Ekdahl KN. Celiac disease and complement activation in response to Streptococcus pneumoniae. Eur J Pediatr 2020; 179:133-140. [PMID: 31691001 PMCID: PMC6942560 DOI: 10.1007/s00431-019-03490-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/16/2019] [Accepted: 09/26/2019] [Indexed: 11/29/2022]
Abstract
Individuals with celiac disease (CD) are at increased risk of invasive pneumococcal disease (IPD). The aim of this study was to explore whether the complement response to Streptococcus pneumoniae differed according to CD status, and could serve as an explanation for the excess risk of IPD in CD. Twenty-two children with CD and 18 controls, born 1999-2008, were included at Kalmar County Hospital, Sweden. The degree of complement activation was evaluated by comparing levels of activation products C3a and sC5b-9 in plasma incubated for 30 min with Streptococcus pneumoniae and in non-incubated plasma. Complement analyses were performed with enzyme-linked immunosorbent assay (ELISA). Pneumococcal stimulation caused a statistically significant increase in C3a as well as sC5b-9 in both children with CD and controls but there was no difference in response between the groups. After incubation, C3a increased on average 4.6 times and sC5b-9 22 times in both the CD and the control group (p = 0.497 and p = 0.724 respectively).Conclusion: Complement response to Streptococcus pneumoniae seems to be similar in children with and without CD and is thus unlikely to contribute to the increased susceptibility to invasive pneumococcal disease in CD.What is Known:• An excess risk of pneumococcal infections has been demonstrated in individuals with celiac disease.• Infectious complications can depend on hyposplenism but alternative mechanisms are sparsely examined.What is New:• Complement activation in response to Streptococcus pneumoniae was examined in children with and without celiac disease but no differences could be demonstrated.
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Affiliation(s)
- Anna Röckert Tjernberg
- Department of Pediatrics, Kalmar County Hospital, SE-391 85, Kalmar, Sweden. .,School of Medical Sciences, Örebro University, SE-701 82, Örebro, Sweden.
| | - Hanna Woksepp
- Research section, Department of Development and Public Health, Kalmar County Hospital, SE-391 85 Kalmar, Sweden
| | - Kerstin Sandholm
- Linnaeus Center for Biomaterials Chemistry, Linnaeus University, SE-391 82 Kalmar, Sweden
| | - Marcus Johansson
- Department of Clinical Microbiology, Kalmar County Hospital, SE-391 85 Kalmar, Sweden ,Department of Clinical and Experimental Medicine, Linköping University, SE-581 85 Linköping, Sweden
| | - Charlotte Dahle
- Department of Clinical and Experimental Medicine, Linköping University, SE-581 85 Linköping, Sweden ,Department of Clinical Immunology and Transfusion Medicine, Linköping University Hospital, SE-581 85 Linköping, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-171 77 Stockholm, Sweden ,Department of Pediatrics, Örebro University Hospital, SE-701 85 Örebro, Sweden
| | - Jonas Bonnedahl
- Department of Clinical and Experimental Medicine, Linköping University, SE-581 85 Linköping, Sweden
| | - Per Nilsson
- Linnaeus Center for Biomaterials Chemistry, Linnaeus University, SE-391 82 Kalmar, Sweden ,Department of Immunology, Oslo University Hospital, University of Oslo, 0424 Oslo, Norway
| | - Kristina Nilsson Ekdahl
- Linnaeus Center for Biomaterials Chemistry, Linnaeus University, SE-391 82 Kalmar, Sweden ,Department of Immunology, Genetics and Pathology, Uppsala University, SE-751 85 Uppsala, Sweden
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7
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Coburn S, Rose M, Streisand R, Sady M, Parker M, Suslovic W, Weisbrod V, Kerzner B, Kahn I. Psychological Needs and Services in a Pediatric Multidisciplinary Celiac Disease Clinic. J Clin Psychol Med Settings 2019. [PMID: 31673859 DOI: 10.1007/s10880-019-09673-9.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
This study aims to describe the psychological needs in children with celiac disease (CD) and to examine the feasibility of psychological consultation in a multidisciplinary clinic. Participants (N = 69) included children with CD and their parents who completed a pre-clinic mental health survey and a 30-min psychological consultation as part of a multidisciplinary clinic (including gastroenterology, nutrition, education, neurology, and neuropsychology). Quantitative and qualitative analyses examined psychological needs, experiences, and satisfaction. The psychologist identified clinically significant symptoms and provided referrals in 49% of children. There were no significant differences by time since CD diagnosis. During the psychology consultation, families discussed emotional adjustment, impact on life and physical well-being, and management of the gluten-free diet. Parents reported high levels of satisfaction from the clinic visit. We identified frequent psychological needs in pediatric CD. The multidisciplinary approach may be a feasible model for specialized, optimal treatment in this population.
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Affiliation(s)
- Shayna Coburn
- Children's National Hospital, Washington, DC, USA. .,George Washington School of Medicine, Washington, DC, USA. .,Attn: Gastroenterology, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA.
| | | | - Randi Streisand
- Children's National Hospital, Washington, DC, USA.,George Washington School of Medicine, Washington, DC, USA
| | - Maegan Sady
- Children's National Hospital, Washington, DC, USA.,George Washington School of Medicine, Washington, DC, USA
| | | | | | | | - Benny Kerzner
- Children's National Hospital, Washington, DC, USA.,George Washington School of Medicine, Washington, DC, USA
| | - Ilana Kahn
- Children's National Hospital, Washington, DC, USA.,George Washington School of Medicine, Washington, DC, USA
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Liu X, Mu T, Sun H, Zhang M, Chen J, Fauconnier ML. Effect of ingredients on the quality of gluten-free steamed bread based on potato flour. J Food Sci Technol 2019; 56:2863-2873. [PMID: 31205342 DOI: 10.1007/s13197-019-03730-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 03/14/2019] [Accepted: 03/18/2019] [Indexed: 01/19/2023]
Abstract
Response surface methodology was used to analyze effects of the amounts of pregelatinized potato flour (PGPF), hydroxypropylmethylcellulose (HPMC), egg white protein (EWP), and water on the dough fermentation and physical properties of gluten-free (GF) steamed bread based on potato flour. The results showed that PGPF, HPMC, EWP, and water at the appropriate amounts improved the maximum dough height (H m), specific volume (SV) and hardness, as well as H m correlated with SV (R 2 = 0.6993) and hardness (R 2 = 0.7273). Moreover, the optimal formulation contained 4.84 g/100 g PGPF, 1.68 g/100 g HPMC, 5.87 g/100 g EWP, and 69.69 g/100 g water, potato flour basis. Furthermore, the dietary fiber, total polyphenol content, antioxidant activity, and estimated glycemic index of the steamed GF bread were, respectively, 3.17-, 1.56-, 1.44-, and 0.75-fold of those of steamed wheat bread. The optimized steamed GF bread was found to be acceptable according to the results of sensory analysis. Information collected within this study may provide further insight for optimizing the formulation of steamed GF bread based on potato flour.
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Affiliation(s)
- Xingli Liu
- 1School of Food and Biological Engineering, Zhengzhou University of Light Industry, Zhengzhou, 450000 People's Republic of China
| | - Taihua Mu
- 2Key Laboratory of Agro-Products Processing, Ministry of Agriculture and Rural Affairs; Institute of Food Science and Technology, Chinese Academy of Agricultural Sciences, 2 Yuanmingyuan west road, Haidian, Beijing, 100193 People's Republic of China
| | - Hongnan Sun
- 2Key Laboratory of Agro-Products Processing, Ministry of Agriculture and Rural Affairs; Institute of Food Science and Technology, Chinese Academy of Agricultural Sciences, 2 Yuanmingyuan west road, Haidian, Beijing, 100193 People's Republic of China
| | - Miao Zhang
- 2Key Laboratory of Agro-Products Processing, Ministry of Agriculture and Rural Affairs; Institute of Food Science and Technology, Chinese Academy of Agricultural Sciences, 2 Yuanmingyuan west road, Haidian, Beijing, 100193 People's Republic of China
| | - Jingwang Chen
- 2Key Laboratory of Agro-Products Processing, Ministry of Agriculture and Rural Affairs; Institute of Food Science and Technology, Chinese Academy of Agricultural Sciences, 2 Yuanmingyuan west road, Haidian, Beijing, 100193 People's Republic of China
- 3Laboratory of General and Organic Chemistry, University of Liege, Gembloux Agro-Bio Tech, Passage des Déportés, 2-5030 Gembloux, Belgium
| | - Marie Laure Fauconnier
- 3Laboratory of General and Organic Chemistry, University of Liege, Gembloux Agro-Bio Tech, Passage des Déportés, 2-5030 Gembloux, Belgium
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Leonard MM, Camhi S, Kenyon V, Betensky RA, Sturgeon C, Yan S, Fasano A. Targeted genotyping for the prediction of celiac disease autoimmunity development in patients with type 1 diabetes and their family members. World J Diabetes 2019; 10:189-199. [PMID: 30891154 PMCID: PMC6422857 DOI: 10.4239/wjd.v10.i3.189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/04/2019] [Accepted: 03/09/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Patients with type 1 diabetes (T1D) and their first-degree relatives (FDRs) have an increased risk of developing celiac disease (CD) compared to the general population. This is largely explained by the shared association with major histocompatibility class II human leukocyte antigen (HLA) DQ2 and/or DQ8 between the two disease states.
AIM To describe the frequency of CD autoimmunity (CDA) and the distribution of HLA and haptoglobin genotypes in patients with T1D and their FDRs. Additionally, we aimed at identifying predictors associated with an increased risk of developing CDA in patients with T1D and their family members.
METHODS We obtained clinical information and blood samples from 1027 participants (302 with T1D and 725 FDRs) over a five-year period. Samples were tested for autoantibodies associated with CD, HLA-DQ alleles, and haptoglobin genotype. We fit univariate and multiple logistic regression models for CDA separately for subjects with T1D and for FDRs of subjects with T1D.
RESULTS Implementation of a screening program increased the frequency of CDA by 2-fold in participants with T1D and 2.8-fold in their FDRs. Multivariate analysis found that, in participants with T1D, having both DR7-DQ2 and DR4-DQ8 was associated with an increased frequency of CDA. In FDRs of T1D patients, reported CD in the family was associated with an increased frequency of CDA during screening. Haptoglobin 2 genotype was not associated with developing CDA in the multivariate analysis.
CONCLUSION Patients with T1D and their FDRs have a high frequency of CDA. Carrying both DR7-DQ2 and DR4-DQ8 was associated with development of CDA in patients with T1D.
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Affiliation(s)
- Maureen M Leonard
- Mucosal Immunology and Biology Research Center, Mass General Hospital for Children, Boston, MA 02115, United States
- Center for Celiac Research and Treatment, Mass General Hospital for Children, Boston, MA 02115, United States
- Department of Pediatric Gastroenterology and Nutrition, Mass General Hospital for Children, Boston, MA 02114, United States
| | - Stephanie Camhi
- Mucosal Immunology and Biology Research Center, Mass General Hospital for Children, Boston, MA 02115, United States
- Center for Celiac Research and Treatment, Mass General Hospital for Children, Boston, MA 02115, United States
- Department of Pediatric Gastroenterology and Nutrition, Mass General Hospital for Children, Boston, MA 02114, United States
| | - Victoria Kenyon
- Mucosal Immunology and Biology Research Center, Mass General Hospital for Children, Boston, MA 02115, United States
- Center for Celiac Research and Treatment, Mass General Hospital for Children, Boston, MA 02115, United States
- Department of Pediatric Gastroenterology and Nutrition, Mass General Hospital for Children, Boston, MA 02114, United States
| | - Rebecca A Betensky
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Craig Sturgeon
- Mucosal Immunology and Biology Research Center, Mass General Hospital for Children, Boston, MA 02115, United States
- Center for Celiac Research and Treatment, Mass General Hospital for Children, Boston, MA 02115, United States
- Department of Pediatric Gastroenterology and Nutrition, Mass General Hospital for Children, Boston, MA 02114, United States
| | - Shu Yan
- Mucosal Immunology and Biology Research Center, Mass General Hospital for Children, Boston, MA 02115, United States
- Center for Celiac Research and Treatment, Mass General Hospital for Children, Boston, MA 02115, United States
- Department of Pediatric Gastroenterology and Nutrition, Mass General Hospital for Children, Boston, MA 02114, United States
| | - Alessio Fasano
- Mucosal Immunology and Biology Research Center, Mass General Hospital for Children, Boston, MA 02115, United States
- Center for Celiac Research and Treatment, Mass General Hospital for Children, Boston, MA 02115, United States
- Department of Pediatric Gastroenterology and Nutrition, Mass General Hospital for Children, Boston, MA 02114, United States
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10
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Stewart L, D M Edgar J, Blakely G, Patrick S. Antigenic mimicry of ubiquitin by the gut bacterium Bacteroides fragilis: a potential link with autoimmune disease. Clin Exp Immunol 2018; 194:153-165. [PMID: 30076785 PMCID: PMC6194340 DOI: 10.1111/cei.13195] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/18/2018] [Accepted: 07/28/2018] [Indexed: 01/09/2023] Open
Abstract
Ubiquitin is highly conserved across eukaryotes and is essential for normal eukaryotic cell function. The bacterium Bacteroides fragilis is a member of the normal human gut microbiota, and the only bacterium known to encode a homologue of eukaryotic ubiquitin. The B. fragilis gene sequence indicates a past horizontal gene transfer event from a eukaryotic source. It encodes a protein (BfUbb) with 63% identity to human ubiquitin which is exported from the bacterial cell. The aim of this study was (i) to determine if there was antigenic cross‐reactivity between B. fragilis ubiquitin and human ubiquitin and (ii) to determine if humans produced antibodies to BfUbb. Molecular model comparisons of BfUbb and human ubiquitin predicted a high level (99·8% confidence) of structural similarity. Linear epitope mapping identified epitopes in BfUbb and human ubiquitin that cross‐react. BfUbb also has epitope(s) that do not cross‐react with human ubiquitin. The reaction of human serum (n = 474) to BfUbb and human ubiquitin from the following four groups of subjects was compared by enzyme‐linked immunosorbent assay (ELISA): (1) newly autoantibody‐positive patients, (2) allergen‐specific immunoglobulin (Ig)E‐negative patients, (3) ulcerative colitis patients and (4) healthy volunteers. We show that the immune system of some individuals has been exposed to BfUbb which has resulted in the generation of IgG antibodies. Serum from patients referred for first‐time testing to an immunology laboratory for autoimmune disease are more likely to have a high level of antibodies to BfUbb than healthy volunteers. Molecular mimicry of human ubiquitin by BfUbb could be a trigger for autoimmune disease.
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Affiliation(s)
- L Stewart
- School School of Biological Sciences, Queen's University Belfast, Belfast, UK
| | - J D M Edgar
- Regional Immunology Laboratory, Belfast Health and Social Care Trust, Belfast, UK.,The Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - G Blakely
- School of Biological Sciences, University of Edinburgh, Edinburgh, UK
| | - S Patrick
- School of Biological Sciences, University of Edinburgh, Edinburgh, UK.,The Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
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11
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Abstract
OBJECTIVE The aim of this systematic review was to establish the prevalence of epilepsy in patients with coeliac disease (CD) or gluten sensitivity (GS) and vice versa and to characterise the phenomenology of the epileptic syndromes that these patients present with. METHODOLOGY A systematic computer-based literature search was conducted on the PubMed database. Information regarding prevalence, demographics and epilepsy phenomenology was extracted. RESULTS Epilepsy is 1.8 times more prevalent in patients with CD, compared to the general population. CD is over 2 times more prevalent in patients with epilepsy compared to the general population. Further studies are necessary to assess the prevalence of GS in epilepsy. The data indicate that the prevalence of CD or GS is higher amongst particular epileptic presentations including in childhood partial epilepsy with occipital paroxysms, in adult patients with fixation off sensitivity (FOS) and in those with temporal lobe epilepsy (TLE) with hippocampal sclerosis. A particularly interesting presentation of epilepsy in the context of gluten-related disorders is a syndrome of coeliac disease, epilepsy and cerebral calcification (CEC syndrome) which is frequently described in the literature. Gluten-free diet (GFD) is effective in the management of epilepsy in 53% of cases, either reducing seizure frequency, enabling reduced doses of antiepileptic drugs or even stopping antiepileptic drugs. CONCLUSION Patients with epilepsy of unknown aetiology should be investigated for serological markers of gluten sensitivity as such patients may benefit from a GFD.
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Affiliation(s)
- Thomas Julian
- Sheffield Institute for Translational Neuroscience, University of Sheffield, 385a Glossop Rd, Sheffield, S10 2HQ UK
| | - Marios Hadjivassiliou
- Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Panagiotis Zis
- Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
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12
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Mahadev S, Laszkowska M, Sundström J, Björkholm M, Lebwohl B, Green PHR, Ludvigsson JF. Prevalence of Celiac Disease in Patients With Iron Deficiency Anemia-A Systematic Review With Meta-analysis. Gastroenterology 2018; 155:374-382.e1. [PMID: 29689265 PMCID: PMC7057414 DOI: 10.1053/j.gastro.2018.04.016] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/10/2018] [Accepted: 04/17/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Anemia is common in patients with celiac disease (CD) and a frequent mode of presentation. Guidelines recommend screening patients with iron-deficiency anemia (IDA) for CD. However, the reported prevalence of CD in patients with IDA varies. We performed a systematic review to determine the prevalence of biopsy-verified CD in patients with IDA. METHODS We performed a systematic review of articles published in PubMed Medline or EMBASE through July 2017 for the term "celiac disease" combined with "anemia" or "iron deficiency." We used fixed-effects inverse variance-weighted models to measure the pooled prevalence of CD. Meta-regression was used to assess subgroup heterogeneity. RESULTS We identified 18 studies composed of 2998 patients with IDA for inclusion in our analysis. Studies originated from the United Kingdom, United States, Italy, Turkey, Iran, and Israel. The crude unweighted prevalence of CD was 4.8% (n = 143). Using a weighted pooled analysis, we found a prevalence of biopsy-confirmed CD of 3.2% (95% confidence interval = 2.6-3.9) in patients with IDA. However, heterogeneity was high (I2 = 67.7%). The prevalence of CD was not significantly higher in studies with a mean participant age older or younger than 18 years or in studies with a mixed-sex vs female-predominant (≥60%) population. On meta-regression, year of publication, female proportion, age at CD testing, and prevalence in the general population were not associated with the prevalence of CD in patients with IDA. In the 8 studies fulfilling all our quality criteria, the pooled prevalence of CD was 5.5% (95% confidence interval = 4.1-6.9). CONCLUSIONS In a systematic review and meta-analysis, we found that approximately 1 in 31 patients with IDA have histologic evidence of CD. This prevalence value justifies the practice of testing patients with IDA for CD.
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Affiliation(s)
- Srihari Mahadev
- Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Monika Laszkowska
- Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, and Uppsala Clinical Research Center, SE-751 85 Uppsala, Sweden
| | - Magnus Björkholm
- Department of Medicine, Division of Hematology, Karolinska University Hospital and Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - Benjamin Lebwohl
- Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Peter HR Green
- Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Jonas F Ludvigsson
- Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
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13
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Ludvigsson JF, Roy A, Lebwohl B, Green PH, Emilsson L. Anxiety and depression in caregivers of individuals with celiac disease - A population-based study. Dig Liver Dis 2017; 49:273-9. [PMID: 27923553 DOI: 10.1016/j.dld.2016.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/07/2016] [Accepted: 11/08/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Partner burden is common in celiac disease (CD), but it is unclear if parents of children with CD have increased burden, and if this may translate into depression and anxiety meriting healthcare. METHODS Nationwide population-based study of 41,753 parents and spouses ("caregivers") to 29,096 celiac patients and 215,752 caregivers to 144,522 matched controls. Caregivers were identified from the Swedish Total Population Register, and linked to data on psychiatric disease in the National Patient Registry. Hazard ratios (HRs) for depression, anxiety, and (as a reference outcome measure) bipolar disorder were examined in a lifetime fashion but also in temporal relationship to date of CD diagnosis using Cox regression. A priori, we focused on parents of individuals diagnosed ≤19 years of age (children at the age of disease onset) and spouses of individuals diagnosed in adulthood, as such parents and spouses ("high-risk caregivers") were most likely to live together with the patient at time of disease onset. RESULTS On Cox analysis, depression was 11% more common in high-risk caregivers (HR=1.11: 95%CI=1.03-1.19) than in control caregivers while anxiety was 7% more common (HR=1.07: 95%CI=0.98-1.16). Combining anxiety and depression into a composite outcome measure, there was an 8% statistically significant risk increase (95%CI=1.02-1.14). The highest excess risks for both depression and anxiety were seen just before and 4-8 years after the CD diagnosis. In contrast, bipolar disorder was not more common in caregivers to CD patients. CONCLUSION Caregivers to patients with CD may be at increased risk of severe burden.
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14
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Ludvigsson JF, Lebwohl B, Green PHR, Chung WK, Mårild K. Celiac disease and Down syndrome mortality: a nationwide cohort study. BMC Pediatr 2017; 17:41. [PMID: 28143429 PMCID: PMC5282819 DOI: 10.1186/s12887-017-0801-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 01/26/2017] [Indexed: 12/20/2022] Open
Abstract
Background Individuals with Down syndrome (DS) have increased mortality and are also at increased risk of celiac disease (CD). It is unknown if CD influences mortality in DS. In this study we examined the risk of death in individuals with DS according to celiac status. Methods In this nationwide population-based cohort study, we first identified individuals with CD (diagnosed 1969–2008) through small intestinal biopsy report data showing villous atrophy (Marsh stage III) from Sweden’s 28 pathology departments. Celiac individuals were then matched with up to five reference individuals from the general population. In these cohorts we identified individuals with DS using International Classification of Disease codes (ICD) registered in the Swedish Patient Register (includes inpatients and hospital-based outpatients), the Medical Birth Register, and the Register of Congenital Malformations. Of 29,096 individuals with CD, 201 (0.7%) had DS compared to 124 of the 144,522 reference individuals (0.09%). Data on mortality were obtained from the Swedish Cause of Death Registry. Hazard ratios (HRs) for death were calculated using Cox regression. Results During follow-up, there were seven deaths among individuals with DS and CD (7/201, 3.5%) as compared with 14 deaths among DS individuals without a record of CD (14/124, 11.3%). Adjusting for potential confounders, CD did not influence the risk of death in DS (HR = 1.36; 95%CI = 0.33–5.59). Cardiovascular death occurred in two individuals with CD and three individuals without CD, while death from malignancy occurred in one individual with CD and two individuals without CD. Conclusion While both DS and CD have been linked to increased risk of death, this study found no excess mortality in DS patients with a concurrent diagnosis of CD, however confidence intervals were wide. Electronic supplementary material The online version of this article (doi:10.1186/s12887-017-0801-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77, Stockholm, Sweden. .,Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden. .,Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
| | - Benjamin Lebwohl
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77, Stockholm, Sweden.,Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Peter H R Green
- Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Wendy K Chung
- Division of Molecular Genetics, Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Karl Mårild
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77, Stockholm, Sweden.,Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
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15
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Emilsson L, Abdul Sultan A, Ludvigsson JF. No increased mortality in 109,000 first-degree relatives of celiac individuals. Dig Liver Dis 2016; 48:376-80. [PMID: 26748422 DOI: 10.1016/j.dld.2015.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 11/09/2015] [Accepted: 11/20/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Several studies have shown an excess mortality in individuals with celiac disease (CD). However, it is unknown if also first-degree relatives (FDRs) to celiac patients are at increased risk of death. AIM We aimed to assess mortality in FDRs to celiac patients. METHODS Individuals with CD were identified through biopsy reports (equal to Marsh grade III). Each celiac individual was matched on sex, age, county and calendar year with up to five control individuals. Through Swedish healthcare registries we identified all FDRs (father, mother, sibling, offspring) of CD individuals and controls. Through Cox regression we calculated hazard ratios (HRs) for mortality (all-cause death, circulatory, cancer and other). RESULTS We identified 109,309 FDRs of celiac individuals and 549,098 FDRs of controls. Overall mortality was increased in FDRs to celiac individuals (HR=1.02, 95%CI=1.00-1.04, p=0.03). This corresponded to an excess risk of 5.9 deaths per 100,000 person-years of follow-up. When limiting follow-up to time since celiac diagnosis in the index individual, we found no increased risk of death (HR=1.01; 95%CI=0.98-1.03). CONCLUSION FDRs to individuals with CD are at increased risk of death. This excess risk is however minimal and unlikely to be of any clinical importance to the individual.
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Affiliation(s)
- Louise Emilsson
- Primary Care Research Unit, Vårdcentralen Värmlands Nysäter, Värmland County, Sweden; Department of Health Management and Health Economy, Institute of Health and Society, University of Oslo, Norway.
| | - Alyshah Abdul Sultan
- Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, City Hospital, Hucknall Road, Nottingham NG5 1PB, UK; National Institute of Health Research Nottingham Digestive Diseases Centre Biomedical Research Unit, Nottingham University Hospital NHS Trust and University of Nottingham, Nottingham, UK
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
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16
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Emilsson L, Lebwohl B, Sundström J, Ludvigsson JF. Cardiovascular disease in patients with coeliac disease: A systematic review and meta-analysis. Dig Liver Dis 2015; 47:847-52. [PMID: 26160499 DOI: 10.1016/j.dld.2015.06.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/05/2015] [Accepted: 06/08/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Coeliac disease has been associated with an increased risk of cardiovascular disease in some studies, whereas other studies have shown no association. We performed a systematic review and meta-analysis of cardiovascular disease in celiac disease. METHODS Pubmed, Cinahl, EMBASE and Medline via Ovid were searched for relevant articles published until January 5, 2015. English-language articles on studies with more than 20 patients were included, and were quality rated using the GRADE risk of bias tool. We used random-effects models and assessed heterogeneity using the I(2) statistic. RESULTS Ten studies were relevant, reporting the risk of myocardial infarction, cardiovascular death and stroke in 33,128/32,903/32,466 coeliac disease patients respectively. Only one study examined celiac disease and a composite measure of cardiovascular disease and this study found a hazard ratio of 1.10 (95%CI 1.03-1.28). In a meta-analysis, we observed an increased risk of stroke (OR 1.11; 95%CI 1.02-1.20). The risks of myocardial infarction (OR 1.12; 95%CI 0.83-1.40) and cardiovascular death (OR 1.12; 95%CI 0.96-1.29) were similar but were estimated with less certainty. Heterogeneity was low for all outcomes except for myocardial infarction where it was moderate. CONCLUSION Coeliac disease was associated with a modestly increased risk of cardiovascular disease, but the evidence base is limited.
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Affiliation(s)
- Louise Emilsson
- Primary Care Research Unit, Vårdcentralen Värmlands Nysäter, Värmland County, Sweden; Department of Health Management and Health Economy, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Benjamin Lebwohl
- Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
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18
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Sarrigiannis PG, Hoggard N, Aeschlimann D, Sanders DS, Grünewald RA, Unwin ZC, Hadjivassiliou M. Myoclonus ataxia and refractory coeliac disease. Cerebellum Ataxias 2014; 1:11. [PMID: 26331035 PMCID: PMC4552176 DOI: 10.1186/2053-8871-1-11] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 06/20/2014] [Indexed: 01/06/2023]
Abstract
Background Cortical myoclonus with ataxia has only rarely been reported in association with Coeliac Disease (CD). Such reports also suggested that it is unresponsive to gluten-free diet. We present detailed electro-clinical characteristics of a new syndrome of progressive cortical hyperexcitability with ataxia and refractory CD. At our gluten/neurology clinic we have assessed and regularly follow up over 600 patients with neurological manifestations due to gluten sensitivity. We have identified 9 patients with this syndrome. Results All 9 patients (6 male, 3 female) experienced asymmetrical irregular myoclonus involving one or more limbs and sometimes face. This was often stimulus sensitive and became more widespread over time. Three patients had a history of Jacksonian march and five had at least one secondarily generalised seizure. Electrophysiology showed evidence of cortical myoclonus. Three had a phenotype of epilepsia partialis continua at onset. There was clinical, imaging and/or pathological evidence of cerebellar involvement in all cases. All patients adhered to a strict gluten-free diet with elimination of gluten-related antibodies in most. However, there was still evidence of enteropathy in all, suggestive of refractory celiac disease. Two died from enteropathy-associated lymphoma and one from status epilepticus. Five patients were treated with mycophenolate and one in addition with rituximab and IV immunoglobulins. Their ataxia and enteropathy improved but myoclonus remained the most disabling feature of their illness. Conclusions This syndrome may well be the commonest neurological manifestation of refractory CD. The clinical involvement, apart from ataxia, covers the whole clinical spectrum of cortical myoclonus. Electronic supplementary material The online version of this article (doi:10.1186/2053-8871-1-11) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Nigel Hoggard
- Neuroradiology, Royal Hallamshire Hospital, Sheffield, S10 2JF UK
| | - Daniel Aeschlimann
- College of Biomedical and Life Sciences, Cardiff University, Cardiff, CF14 4XY UK
| | - David S Sanders
- Gastroenterology, Royal Hallamshire Hospital, Sheffield, S10 2JF UK
| | | | - Zoe C Unwin
- Departments of Neurophysiology, Royal Hallamshire Hospital, Sheffield, S10 2JF UK
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19
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Affiliation(s)
- Sara Winter
- Royal Hospital for Sick Children, , Glasgow, UK
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