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Tiainen M, Kurppa K, Jääskeläinen T, Kaartinen N, Huhtala H, Kaukinen K, Taavela J. Prevalence and characteristics of adults avoiding gluten without celiac disease: a long-term population-based follow-up study. BMC Gastroenterol 2025; 25:199. [PMID: 40133823 PMCID: PMC11938570 DOI: 10.1186/s12876-025-03799-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Accepted: 03/18/2025] [Indexed: 03/27/2025] Open
Abstract
OBJECTIVE Nationwide prevalence studies on people avoiding gluten without celiac disease (PWAG) are lacking, and in particular, long-term follow-up studies are unavailable. We aimed to evaluate the prevalence, incidence, and characteristics of PWAG in a population-based cohort in 2000 and 2011. METHODS Health and diet-related data were collected in nationwide Health 2000 and 2011 surveys, which comprised 5,777 and 3,866 individuals, respectively, representing 2,682,733 and 1,967,876 Finnish adults. Serum samples were taken for the measurement of transglutaminase autoantibodies. In total 3,296 individuals participated in both surveys, forming a prospective cohort. PWAG refers to subjects avoiding gluten without celiac disease or positive autoantibodies. Psychological health was assessed with General Health Questionnaire and the Beck Depression Inventory. RESULTS The prevalence of PWAG increased significantly from 0.2% (2000) to 0.7% (2011) (p < 0.001), with the highest prevalence (1.3%) detected in individuals > 70 years old. An annual incidence rate of 42 (95% confidence interval 25-71) per 100,000 persons was noted. The PWAG group was more likely to maintain additional special diets than those not avoiding gluten, including e.g. lactose-free diet (41.7% vs. 12.0% in 2011, p < 0.001) and food restriction for allergy (12.5% vs. 3.0%, p = 0.007). Beck Depression Inventory indicated more depression (p = 0.023) among PWAG in 2000, while no difference was seen in 2011 or in General Health Questionnaire. Celiac disease-related risk factors, including female gender, anemia, autoimmune diseases or antibody levels near the upper limit of normal in 2000, did not predict later gluten avoidance. CONCLUSIONS The prevalence of PWAG multiplied over a decade, reaching 0.7% in 2011 in Finland. The PWAG group maintained more likely additional dietary restrictions than those not avoiding gluten and had signs of psychosocial burden. No predicting factors for the condition were identified.
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Affiliation(s)
- Miska Tiainen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Elämänaukio 2, Tampere, Finland
| | - Kalle Kurppa
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Elämänaukio 2, Tampere, Finland
- Tampere Center for Child, Adolescent, and Maternal Health Research, Department of Pediatrics, Tampere University, Tampere University Hospital, Tampere, Finland
- University Consortium of Seinäjoki, Seinäjoki, Finland
| | | | | | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Katri Kaukinen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Elämänaukio 2, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Juha Taavela
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Elämänaukio 2, Tampere, Finland.
- Department of Gastroenterology, Tampere University Hospital, Tampere, Finland.
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Manza F, Lungaro L, Costanzini A, Caputo F, Carroccio A, Mansueto P, Seidita A, Raju SA, Volta U, De Giorgio R, Sanders DS, Caio G. Non-Celiac Gluten/Wheat Sensitivity-State of the Art: A Five-Year Narrative Review. Nutrients 2025; 17:220. [PMID: 39861350 PMCID: PMC11767908 DOI: 10.3390/nu17020220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2024] [Revised: 12/31/2024] [Accepted: 01/03/2025] [Indexed: 01/27/2025] Open
Abstract
Background: Non-celiac gluten/wheat sensitivity (NCGWS) is a syndrome for which pathogenesis and management remain debated. It is described as a condition characterized by gastrointestinal and extra-intestinal symptoms rapidly occurring after gluten ingestion in subjects who have had celiac disease or wheat allergy excluded. To date, the diagnosis of NCGWS is challenging as no universally recognized biomarkers have been yet identified, nor has a predisposing genetic profile been described. However, the research is moving fast, and new data regarding pathogenic pathways, patients' classification, potential candidate biomarkers, and dietary interventions are emerging. Methods: This literature review aims to address the state of the art and summarize the latest updates in this field from 2019 to date. Results and Conclusions: Clinical studies regarding NCGWS in the last five years are reported to shed light on this complex condition and to guide specialists towards a more in-depth, prompt, and objective diagnosis.
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Affiliation(s)
- Francesca Manza
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (F.M.); (A.C.); (F.C.); (R.D.G.); (G.C.)
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AT, UK; (S.A.R.); (D.S.S.)
| | - Lisa Lungaro
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (F.M.); (A.C.); (F.C.); (R.D.G.); (G.C.)
| | - Anna Costanzini
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (F.M.); (A.C.); (F.C.); (R.D.G.); (G.C.)
| | - Fabio Caputo
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (F.M.); (A.C.); (F.C.); (R.D.G.); (G.C.)
| | - Antonio Carroccio
- Unit of Internal Medicine, “V. Cervello” Hospital, Ospedali Riuniti “Villa Sofia-Cervello”, 90146 Palermo, Italy; (A.C.); (A.S.)
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | - Pasquale Mansueto
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | - Aurelio Seidita
- Unit of Internal Medicine, “V. Cervello” Hospital, Ospedali Riuniti “Villa Sofia-Cervello”, 90146 Palermo, Italy; (A.C.); (A.S.)
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
- Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), 90146 Palermo, Italy
| | - Suneil A. Raju
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AT, UK; (S.A.R.); (D.S.S.)
| | - Umberto Volta
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy;
| | - Roberto De Giorgio
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (F.M.); (A.C.); (F.C.); (R.D.G.); (G.C.)
| | - David S. Sanders
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AT, UK; (S.A.R.); (D.S.S.)
| | - Giacomo Caio
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (F.M.); (A.C.); (F.C.); (R.D.G.); (G.C.)
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital—Harvard Medical School, Boston, MA 02114, USA
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Whelan K, Ford AC, Burton-Murray H, Staudacher HM. Dietary management of irritable bowel syndrome: considerations, challenges, and solutions. Lancet Gastroenterol Hepatol 2024; 9:1147-1161. [PMID: 39521003 DOI: 10.1016/s2468-1253(24)00238-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 07/19/2024] [Accepted: 07/23/2024] [Indexed: 11/16/2024]
Abstract
Diet is a cornerstone in the management of irritable bowel syndrome (IBS). There is evidence of efficacy across the spectrum of dietary management strategies, including some supplements (eg, specific fibres), foods, and whole diets (eg, a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols [known as the low-FODMAP diet]). Whole-diet interventions, in particular those that restrict intake, can be challenging to deliver effectively and safely. Factors to consider include patient demographics, food cost and availability, and the acceptability of dietary management and its impact on food-related quality of life. There is concern regarding a potential role of restrictive whole-diet interventions in eating disorder risk. Optimal approaches to delivering dietary management in the health-care setting are unclear. The aim of this Review is to summarise the clinical evidence for the dietary management of IBS; to discuss the challenges, burdens, and risks of dietary management; and to propose how these challenges, burdens, and risks should be mitigated and minimised in clinical practice.
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Affiliation(s)
- Kevin Whelan
- Department of Nutritional Sciences, King's College London, London, UK.
| | - Alexander C Ford
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK; Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Helen Burton-Murray
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Heidi M Staudacher
- Food and Mood Centre, Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
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Zhang L(S, Chan E. Why go gluten‐free? How the feeling of low power increases preferences for free‐from products. PSYCHOLOGY & MARKETING 2024. [DOI: 10.1002/mar.22125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 09/06/2024] [Indexed: 01/03/2025]
Abstract
AbstractGoing gluten‐free and dairy‐free has become increasingly popular in the past 10 years, yet little research has examined the drivers of this dietary preference beyond medical reasons. This research investigates how the feeling of low power contributes to the growing popularity of free‐from products (e.g., gluten‐free, fragrance‐free). Five studies, using various statistical analyses (including regressions, analysis of variance, mediation, and moderation analysis) across both surveys and experiments, provide converging evidence that the feeling of low power increases preferences for free‐from products, driven by heightened perceived threat. Consistent with this account, low‐power individuals’ increased preference for free‐from products is attenuated (1) when their perceived threat is reduced through self‐affirmation, and (2) when advertising appeals highlight health benefits in a gain (vs. loss) frame. This research contributes to both the special diets and power literatures, offering practical implications for marketers of free‐from products by revealing a potential market segment and suggesting message framing strategies to better persuade consumers.
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Affiliation(s)
- Lijun (Shirley) Zhang
- Division of Marketing Leeds University Business School, University of Leeds Leeds UK
| | - Elaine Chan
- Division of Marketing Nanyang Business School, Nanyang Technological University Singapore Singapore
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Lange S, Tsohataridis S, Boland N, Ngo L, Hahad O, Münzel T, Wild P, Daiber A, Schuppan D, Lurz P, Keppeler K, Steven S. Effects of Short-Term Gluten-Free Diet on Cardiovascular Biomarkers and Quality of Life in Healthy Individuals: A Prospective Interventional Study. Nutrients 2024; 16:2265. [PMID: 39064708 PMCID: PMC11279490 DOI: 10.3390/nu16142265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 07/09/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION The exposome concept includes nutrition as it significantly influences human health, impacting the onset and progression of diseases. Gluten-containing wheat products are an essential source of energy for the world's population. However, a rising number of non-celiac healthy individuals tend to reduce or completely avoid gluten-containing cereals for health reasons. AIM AND METHODS This prospective interventional human study aimed to investigate whether short-term gluten avoidance improves cardiovascular endpoints and quality of life (QoL) in healthy volunteers. A cohort of 27 participants followed a strict gluten-free diet (GFD) for four weeks. Endothelial function measured by flow-mediated vasodilation (FMD), blood testing, plasma proteomics (Olink®) and QoL as measured by the World Health Organisation Quality-of-Life (WHOQOL) survey were investigated. RESULTS GFD resulted in decreased leucocyte count and C-reactive protein levels along with a trend of reduced inflammation biomarkers determined by plasma proteomics. A positive trend indicated improvement in FMD, whereas other cardiovascular endpoints remained unchanged. In addition, no improvement in QoL was observed. CONCLUSION In healthy individuals, a short-term GFD demonstrated anti-inflammatory effects but did not result in overall cardiovascular improvement or enhanced quality of life.
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Affiliation(s)
- Simon Lange
- Department of Cardiology, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany (S.T.); (O.H.); (T.M.); (A.D.); (P.L.)
| | - Simeon Tsohataridis
- Department of Cardiology, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany (S.T.); (O.H.); (T.M.); (A.D.); (P.L.)
| | - Niklas Boland
- Department of Cardiology, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany (S.T.); (O.H.); (T.M.); (A.D.); (P.L.)
| | - Lisa Ngo
- Department of Cardiology, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany (S.T.); (O.H.); (T.M.); (A.D.); (P.L.)
| | - Omar Hahad
- Department of Cardiology, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany (S.T.); (O.H.); (T.M.); (A.D.); (P.L.)
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55131 Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany (S.T.); (O.H.); (T.M.); (A.D.); (P.L.)
| | - Philipp Wild
- Department of Preventive Cardiology and Medical Prevention, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany;
| | - Andreas Daiber
- Department of Cardiology, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany (S.T.); (O.H.); (T.M.); (A.D.); (P.L.)
| | - Detlef Schuppan
- Institute of Translational Immunology, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany;
| | - Philipp Lurz
- Department of Cardiology, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany (S.T.); (O.H.); (T.M.); (A.D.); (P.L.)
| | - Karin Keppeler
- Department of Cardiology, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany (S.T.); (O.H.); (T.M.); (A.D.); (P.L.)
| | - Sebastian Steven
- Department of Cardiology, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany (S.T.); (O.H.); (T.M.); (A.D.); (P.L.)
- Department of Cardiology, Goethe University Frankfurt, 60596 Main, Germany
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Jansson-Knodell CL, Rubio-Tapia A. Gluten-related Disorders From Bench to Bedside. Clin Gastroenterol Hepatol 2024; 22:693-704.e1. [PMID: 37879521 DOI: 10.1016/j.cgh.2023.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 10/27/2023]
Abstract
Celiac disease, non-celiac gluten sensitivity, and wheat allergy comprise 3 of the main conditions with wheat- and gluten-containing foods as the symptom trigger. Distinguishing between these entities can be daunting. In this review, we compare and contrast celiac disease, non-celiac gluten sensitivity, and wheat allergy to allow clinicians to determine which diagnosis fits their patient to facilitate high-quality management and longitudinal care.
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Affiliation(s)
- Claire L Jansson-Knodell
- Celiac Disease Program, Division of Gastroenterology, Hepatology, and Nutrition, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alberto Rubio-Tapia
- Celiac Disease Program, Division of Gastroenterology, Hepatology, and Nutrition, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.
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de Graaf MCG, Lawton CL, Croden F, Smolinska A, Winkens B, Hesselink MAM, van Rooy G, Weegels PL, Shewry PR, Houghton LA, Witteman BJM, Keszthelyi D, Brouns FJPH, Dye L, Jonkers DMAE. The effect of expectancy versus actual gluten intake on gastrointestinal and extra-intestinal symptoms in non-coeliac gluten sensitivity: a randomised, double-blind, placebo-controlled, international, multicentre study. Lancet Gastroenterol Hepatol 2024; 9:110-123. [PMID: 38040019 DOI: 10.1016/s2468-1253(23)00317-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/07/2023] [Accepted: 09/12/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Many individuals without coeliac disease or wheat allergy reduce their gluten intake because they believe that gluten causes their gastrointestinal symptoms. Symptoms could be affected by negative expectancy. Therefore, we aimed to investigate the effects of expectancy versus actual gluten intake on symptoms in people with non-coeliac gluten sensitivity (NCGS). METHODS This randomised, double-blind, placebo-controlled, international, multicentre study was done at the University of Leeds (Leeds, UK), Maastricht University (Maastricht, the Netherlands), and Wageningen University and Research (Wageningen, the Netherlands). People aged 18-70 years with self-reported NCGS (ie, gastrointestinal symptoms within 8 h of gluten consumption) without coeliac disease and wheat allergy were recruited. Participants had to follow a gluten-free or gluten-restricted diet for at least 1 week before (and throughout) study participation and had to be asymptomatic or mildly symptomatic (overall gastrointestinal symptom score ≤30 mm on the Visual Analogue Scale [VAS]) while on the diet. Participants were randomly assigned (1:1:1:1; blocks of eight; stratified by site and gender) to one of four groups based on the expectation to consume gluten-containing (E+) or gluten-free (E-) oat bread for breakfast and lunch (two slices each) and actual intake of gluten-containing (G+) or gluten-free (G-) oat bread. Participants, investigators, and those assessing outcomes were masked to the actual gluten assignment, and participants were also masked to the expectancy part of the study. The primary outcome was overall gastrointestinal symptom score on the VAS, which was measured at and corrected for baseline (before breakfast) and hourly for 8 h, with lunch served after 4 h, and analysed per-protocol. Safety analysis included all participants incorporated in the per-protocol analysis. The study is registered at ClinicalTrials.gov, NCT05779358, and has ended. FINDINGS Between Oct 19, 2018, and Feb 14, 2022, 165 people were screened and 84 were randomly assigned to E+G+ (n=21), E+G- (n=21), E-G+ (n=20), or E-G- (n=22). One person in the E+G+ group was excluded due to not following test day instructions, leaving 83 participants in the per-protocol analysis. Median age was 27·0 years (IQR 21·0-45·0), 71 (86%) of 83 people were women, and 12 (14%) were men. Mean overall gastrointestinal symptom score was significantly higher for E+G+ (16·6 mm [95% CI 13·1 to 20·0]) than for E-G+ (6·9 mm [3·5 to 10·4]; difference 9·6 mm [95% CI 3·0 to 16·2], p=0·0010) and E-G- (7·4 mm [4·2 to 10·7]; difference 9·1 mm [2·7 to 15·6], p=0·0016), but not for E+G- (11·7 mm [8·3 to 15·1]; difference 4·9 mm [-1·7 to 11·5], p=0·28). There was no difference between E+G- and E-G+ (difference 4·7 mm [-1·8 to 11·3], p=0·33), E+G- and E-G- (difference 4·2 mm [-2·2 to 10·7], p=0·47), and E-G+ and E-G- (difference -0·5 mm [-7·0 to 5·9], p=1·0). Adverse events were reported by two participants in the E+G- group (itching jaw [n=1]; feeling lightheaded and stomach rumbling [n=1]) and one participant in the E-G+ group (vomiting). INTERPRETATION The combination of expectancy and actual gluten intake had the largest effect on gastrointestinal symptoms, reflecting a nocebo effect, although an additional effect of gluten cannot be ruled out. Our results necessitate further research into the possible involvement of the gut-brain interaction in NCGS. FUNDING Government of the Netherlands Topsector Agri & Food Top Consortium for Knowledge and Innovation, AB Mauri Global Bakery Ingredients, Baking Industry Research Trust, Borgesius-Albert Heijn, CSM Innovation Centre, the International Maize and Wheat Improvement Center (CIMMYT), DSM Food Specialties, Fazer, Healthgrain Forum, the International Association for Cereal Science and Technology, the International Wheat Gluten Association, Lantmännen, Mondelez International, Nederlands Bakkerij Centrum, Nutrition & Santé, Puratos, Rademaker, Sonneveld Group, and Zeelandia HJ Doeleman.
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Affiliation(s)
- Marlijne C G de Graaf
- Department of Gastroenterology-Hepatology, Maastricht University Medical Center+, Maastricht, Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | | | - Fiona Croden
- School of Psychology, University of Leeds, Leeds, UK
| | - Agnieszka Smolinska
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands; Department of Pharmacology and Toxicology, Maastricht University, Maastricht, Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Martine A M Hesselink
- Department of Gastroenterology-Hepatology, Maastricht University Medical Center+, Maastricht, Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Gonny van Rooy
- Department of Gastroenterology-Hepatology, Maastricht University Medical Center+, Maastricht, Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Peter L Weegels
- Laboratory of Food Chemistry, Wageningen University and Research, Wageningen, Netherlands; European Bakery Innovation Centre, Sonneveld Group, Papendrecht, Netherlands
| | | | - Lesley A Houghton
- Division of Gastroenterology and Surgical Sciences, Leeds Institute of Medical Research, University of Leeds, Leeds, UK; Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Ben J M Witteman
- Division of Human Nutrition, Wageningen University and Research, Wageningen, Netherlands; Division of Gastroenterology-Hepatology, Gelderse Vallei Hospital, Ede, Netherlands
| | - Daniel Keszthelyi
- Department of Gastroenterology-Hepatology, Maastricht University Medical Center+, Maastricht, Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Fred J P H Brouns
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands; Department of Human Biology, Maastricht University, Maastricht, Netherlands
| | - Louise Dye
- School of Psychology, University of Leeds, Leeds, UK; School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Daisy M A E Jonkers
- Department of Gastroenterology-Hepatology, Maastricht University Medical Center+, Maastricht, Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands.
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Dogruer I, Baser F, Gulec S, Tokatli F, Ozen B. Formulation of Gluten-Free Cookies Utilizing Chickpea, Carob, and Hazelnut Flours through Mixture Design. Foods 2023; 12:3689. [PMID: 37835342 PMCID: PMC10572517 DOI: 10.3390/foods12193689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 09/30/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023] Open
Abstract
Legume flours, which offer high nutritional quality, present viable options for gluten-free bakery products. However, they may have an objectionable flavor and taste for some consumers. In this study, it was aimed to improve the gluten-free cookie formulation by incorporating carob and hazelnut flours to pre-cooked chickpea flour and to investigate the techno-functional properties of the formulated cookies. The flours used in the formulations were assessed for their chemical and physical properties. This study employed a mixture design (simplex-centroid) to obtain the proportions of the flours to be used in the cookie formulations. The rheological characteristics of the doughs and the technological attributes of the baked cookies were determined. The addition of the hazelnut and carob flours had the overall effect of reducing the rheological characteristics of the cookie doughs. Furthermore, the textural attribute of the hardness of the baked cookies decreased as the ratio of hazelnut flour in the formulations was raised. The analysed results and sensory evaluation pointed to a formulation consisting of 30% pre-cooked chickpea/30% carob/30% hazelnut flours, which exhibited improved taste and overall acceptability scores. A total of 16.82 g/100 g of rapidly digestible starch, 5.36 g/100 g of slowly digestible starch, and 8.30 g/100 g of resistant starch exist in this particular cookie. As a result, combinations of chickpea, hazelnut, and carob flours hold promise as good alternatives for gluten-free cookie ingredients and warrant further exploration in the development of similar products.
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Affiliation(s)
- Ilgin Dogruer
- Department of Food Engineering, Izmir Institute of Technology, Urla, TR35430 Izmir, Türkiye; (I.D.); (F.B.); (S.G.); (F.T.)
| | - Filiz Baser
- Department of Food Engineering, Izmir Institute of Technology, Urla, TR35430 Izmir, Türkiye; (I.D.); (F.B.); (S.G.); (F.T.)
- Molecular Nutrition & Human Physiology Laboratory, Izmir Institute of Technology, Urla, TR35430 Izmir, Türkiye
| | - Sukru Gulec
- Department of Food Engineering, Izmir Institute of Technology, Urla, TR35430 Izmir, Türkiye; (I.D.); (F.B.); (S.G.); (F.T.)
- Molecular Nutrition & Human Physiology Laboratory, Izmir Institute of Technology, Urla, TR35430 Izmir, Türkiye
| | - Figen Tokatli
- Department of Food Engineering, Izmir Institute of Technology, Urla, TR35430 Izmir, Türkiye; (I.D.); (F.B.); (S.G.); (F.T.)
| | - Banu Ozen
- Department of Food Engineering, Izmir Institute of Technology, Urla, TR35430 Izmir, Türkiye; (I.D.); (F.B.); (S.G.); (F.T.)
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Houghton CA. The Rationale for Sulforaphane Favourably Influencing Gut Homeostasis and Gut-Organ Dysfunction: A Clinician's Hypothesis. Int J Mol Sci 2023; 24:13448. [PMID: 37686253 PMCID: PMC10487861 DOI: 10.3390/ijms241713448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Given the increasing scientific, clinical and consumer interest in highly prevalent functional gastrointestinal disorders, appropriate therapeutic strategies are needed to address the many aspects of digestive dysfunction. Accumulating evidence for the crucifer-derived bioactive molecule sulforaphane in upstream cellular defence mechanisms highlights its potential as a therapeutic candidate in targeting functional gastrointestinal conditions, as well as systemic disorders. This article catalogues the evolution of and rationale for a hypothesis that multifunctional sulforaphane can be utilised as the initial step in restoring the ecology of the gut ecosystem; it can do this primarily by targeting the functions of intestinal epithelial cells. A growing body of work has identified the colonocyte as the driver of dysbiosis, such that targeting gut epithelial function could provide an alternative to targeting the microbes themselves for the remediation of microbial dysbiosis. The hypothesis discussed herein has evolved over several years and is supported by case studies showing the application of sulforaphane in gastrointestinal disorders, related food intolerance, and several systemic conditions. To the best of our knowledge, this is the first time the effects of sulforaphane have been reported in a clinical environment, with several of its key properties within the gut ecosystem appearing to be related to its nutrigenomic effects on gene expression.
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Affiliation(s)
- Christine A. Houghton
- Institute for Nutrigenomic Medicine, Cleveland, QLD 4163, Australia; ; Tel.: +617-3488-0385
- Cell-Logic, 132-140 Ross Court, Cleveland, QLD 4163, Australia
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10
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Jansson-Knodell CL, White M, Lockett C, Xu H, Rubio-Tapia A, Shin A. Self-Reported Gluten Intolerance Is Prevalent, but Not All Gluten-Containing Foods Are Equal. Dig Dis Sci 2023; 68:1364-1368. [PMID: 36662341 DOI: 10.1007/s10620-022-07800-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 12/16/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Celiac disease prevalence approaches 1%; more suffer from non-celiac gluten sensitivity. AIMS Our goal was to estimate the prevalence of gluten intolerance. METHODS We invited US adults (18-80 years) via Amazon's mechanical Turk to complete an online survey. Gluten intolerance was defined as self-reported intolerance to wheat, barley, rye, flour, or pasta. Those with celiac disease were not excluded. RESULTS We collected 2133 responses. Rate of gluten intolerance was 5.1% (95% CI 4.2-6.1%). Each food had different rates: wheat 4.8%, flour 1.2%, pasta 0.9%, barley 0.8%, and rye 0.8%. Among 108 adults reporting any gluten intolerance, 62.0% selected only wheat, 10.2% selected all gluten-containing grains excluding pasta and flour, and 5.6% selected all gluten-containing products. Overall intolerance to any food was 24.8% (95% CI 23.0-26.6%). Wheat was second only to lactose. CONCLUSIONS Self-reported intolerance to wheat, but not all gluten-containing foods, is common. Findings may suggest poor knowledge of gluten-containing foods or that self-perceived non-celiac gluten sensitivity is prevalent.
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Affiliation(s)
- Claire L Jansson-Knodell
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, 702 Rotary Circle, Suite 225, Indianapolis, IN, 46202, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Mattie White
- Internal Medicine, Department of Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Carolyn Lockett
- Roudebush VA Medical Center, 1481 W 10Th St, Indianapolis, IN, 46202, USA
| | - Huiping Xu
- Department of Biostatistics, Indiana University School of Medicine, 410 W 10th Street, Indianapolis, IN, 46202, USA
| | - Alberto Rubio-Tapia
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Andrea Shin
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, 702 Rotary Circle, Suite 225, Indianapolis, IN, 46202, USA.
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11
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Aydin E. Investigation of some bioactive compounds, in vitro bioaccessibility, and sensory acceptability of couscous produced by pre-gelatinized rice flour. JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2023; 103:2207-2214. [PMID: 36357184 DOI: 10.1002/jsfa.12330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/04/2022] [Accepted: 11/11/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the sensory properties, antioxidant capacities, total phenolic content, and their bioaccessibility in gluten-free rice couscous that is produced without additives. Since rice does not contain gluten, pre-gelatinized rice flour (GRF) was added instead of gum and enzymes in order to provide the desired structure in the couscous samples. RESULTS According to the results, the total phenolic content of couscous samples was increased with GRF addition. The highest extractable and hydrolyzable antioxidant capacity values were observed in the couscous samples supplemented with 30% GRF using the 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) radical cation, cupric-reducing antioxidant capacity, and ferric reducing antioxidant capacity methods. The bioaccessibility of antioxidant capacity was found to be significantly higher (P < 0.05) than the control sample in all methods except the 1,1-diphenyl-2-picrylhydrazyl free radical method in the couscous samples. CONCLUSION According to the data obtained, it has been determined that couscous, which has a very small round shape, can be produced with GRF without additives. In this context, gluten-free rice couscous could be used as an alternative valuable food in terms of nutrition and can be an alternative traditional food for celiac diseases as well as for individuals preferring the consumption of gluten-free products. © 2022 Society of Chemical Industry.
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Affiliation(s)
- Emine Aydin
- Duzce University, Faculty of Agriculture, Department of Agricultural Biotechnology, Konuralp-Duzce, Türkiye
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12
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Pessarelli T, Sorge A, Elli L, Costantino A. The low-FODMAP diet and the gluten-free diet in the management of functional abdominal bloating and distension. Front Nutr 2022; 9:1007716. [PMID: 36424920 PMCID: PMC9678936 DOI: 10.3389/fnut.2022.1007716] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 10/17/2022] [Indexed: 11/15/2023] Open
Abstract
This review summarizes current knowledge on the role of low-FODMAP diet and gluten-free diet in functional abdominal bloating and distension, an emerging disorder of gut-brain interaction characterized by remarkable costs for healthcare systems and a significant impact on the patient's quality of life. Ingested food plays a key role in the pathophysiology of disorders of gut-brain interaction as up to 84% of patients with irritable bowel syndrome (IBS) report food-triggered symptoms. Potential pathogenetic mechanisms of food-related symptoms in these patients are discussed, focusing on bloating and abdominal distension. These mechanisms provide the rationale for dietary treatment in patients with functional abdominal bloating and distension. The role of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) and gluten in functional abdominal bloating and distension is examined. Current literature evaluating the efficacy of the low-FODMAP diet and the gluten-free diet in abdominal bloating and distension is analyzed. Available evidence originates mainly from studies on patients with IBS, since clinical studies on selected cohorts of patients with only functional abdominal bloating and distension have been missing to date. Promising evidence on the potential efficacy of the low-FODMAP diet in functional abdominal bloating and distension is provided by the reduction of the bloating observed in patients with IBS. Regarding the gluten-free diet, there is insufficient evidence to recommend it to reduce bloating and abdominal distension. In conclusion, this review asserts the need for a close collaboration with experts in nutrition to optimize the management of these patients and reduce the risks associated with elimination diets.
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Affiliation(s)
- Tommaso Pessarelli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Andrea Sorge
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Luca Elli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Andrea Costantino
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
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Gluten-free diet adherence and implications for the diagnosis of coeliac disease. Pathology 2022; 54:606-610. [PMID: 35337666 DOI: 10.1016/j.pathol.2021.12.297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/21/2021] [Accepted: 12/06/2021] [Indexed: 12/19/2022]
Abstract
Coeliac disease (CD) is an autoimmune disorder caused by the ingestion of gluten containing foods in genetically susceptible individuals, with a worldwide prevalence of up to 1%. Currently, the only available treatment is a gluten-free diet (GFD). Screening for CD is primarily performed using serum based testing for anti-tissue transglutaminase (tTG) antibodies. Patients must be on a gluten containing diet at the time of testing to ensure an accurate serological result. We investigated the prevalence of a GFD in hospital clinic settings and the general population using survey data to estimate the proportion of CD patients that may be misdiagnosed for CD based on serological tests. Data were collected at clinics of a metropolitan hospital in Sydney, Australia, and the general population. Data from Medicare Benefits Scheme and tTG results from a large Australian private laboratory were reviewed for comparison. Of 778 participants who responded to the survey, 58 (7.5%) were on a GFD. More patients attending the immunology (15.9%) and gastroenterology (12.1%) clinics adopted a GFD than those attending the diabetes (2.6%) or endocrinology (6.1%) clinics, or in the general population (4.3%). More females than males excluded gluten from their diet (p<0.0001). Medicare statistics between 2013 and 2019 demonstrated an increase in CD serological testing; however, tTG data from a private pathology highlighted a stable level of elevated tTG antibodies of 3% of total tests performed. The high number of individuals on a GFD is likely impacting the ability to accurately diagnose CD using serum-based testing.
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Rej A, Sanders DS. Pathomechanism of gluten-related disorders. GLUTEN-RELATED DISORDERS 2022:95-105. [DOI: 10.1016/b978-0-12-821846-4.00014-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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15
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Carroccio A, Mansueto P, Seidita A. Pediatric noncoeliac gluten sensitivity. COELIAC DISEASE AND GLUTEN-RELATED DISORDERS 2022:195-208. [DOI: 10.1016/b978-0-12-821571-5.00006-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Self-reported nonceliac wheat sensitivity in an outpatient digestive endoscopy center: high frequency but insufficient medical approach. Eur J Gastroenterol Hepatol 2021; 33:e789-e795. [PMID: 34334709 DOI: 10.1097/meg.0000000000002257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE 'Self-reported wheat sensitivity' (SRWS) is a self-reported condition caused by wheat ingestion in the absence of celiac disease or wheat allergy. The aim of the study was to investigate the frequency and characteristics of SRWS in outpatients referred for digestive endoscopy. METHODS The study, performed at the University of Palermo, enrolled 496 outpatients. RESULTS Seven individuals (1.4%) had an already established diagnosis of celiac disease. The questionnaire was administered to the other 489 individuals: 98 subjects (20%) were SRWS, the remaining 391 served as controls (i.e. not-SRWS). SRWS patients were younger (P < 0.001), with a higher percentage of females (P = 0.002) than not-SRWS. 'gastroesophageal reflux disease and ulcer-like dyspepsia' and 'chronic unexplained diarrhea' were more frequently the reasons for the endoscopy study in SRWS than in not-SRWS (P = 0.002, and P = 0.05, respectively). Food allergies/intolerances (P = 0.04), milk allergy/intolerance (P = 0.0001), GERD (P = 0.0001), IBS (0.0001), anxiety (P = 0.005) and depression (P = 0.04) were the previous medical diagnoses reported more frequently in SRWS patients than in not-SRWS. In the SRWS group, 38% of the patients had already undergone previous upper endoscopy and 24% colonoscopy. After these investigations, 58% of SRWS patients received no diagnosis, and the other 42% were informed that they 'were not suffering from celiac disease or wheat allergy'. Finally, 28.6% SRWS patients had followed a gluten-free diet (GFD), and 71.4% of them referred being asymptomatic on GFD. CONCLUSIONS Our data showed a high frequency of SRWS in outpatients referred to a digestive endoscopy center and a lack of medical accuracy in identifying a possible gluten-related disease. REGISTRATION The study was registered on Clinicaltrials.gov (registration number: NCT04154137), accessible at: https://clinicaltrials.gov/ct2/show/NCT04154137?term=non+celiac+wheat&draw=2&rank=1.
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17
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Dhoble P, Abraham P, Desai D, Joshi A, Gupta T, Doctor S, Deshpande A, Basavanna R. Self-reported Wheat Sensitivity in Irritable Bowel Syndrome and Healthy Subjects: Prevalence of Celiac Markers and Response to Wheat-free Diet. J Neurogastroenterol Motil 2021; 27:596-601. [PMID: 34642280 PMCID: PMC8521475 DOI: 10.5056/jnm20086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 10/06/2020] [Accepted: 11/24/2020] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Most patients with irritable bowel syndrome (IBS) report food-related aggravation of symptoms. Wheat/gluten is one of the most commonly incriminated. We studied the prevalence of self-reported wheat sensitivity in patients with IBS and in a healthy population from a region in India consuming mixed-cereal diets, correlated it with serological and human leukocyte antigen (HLA) markers of celiac disease, and evaluated the response to a wheat-free diet. Methods We surveyed 204 patients with IBS and 400 healthy persons for self-reported wheat sensitivity. Testing for IgA anti-tissue transglutaminase and HLA DQ2 or DQ8 was done in individuals who reported wheat sensitivity. Consenting persons with wheat sensitivity were put on wheat-free diet and monitored for symptom change. Results Twenty-three of 204 patients with IBS (11.3%) and none of the healthy subjects self-reported wheat sensitivity. Of 23 patients, 14 (60.9%) were positive for HLA DQ2 or DQ8 and none for anti-tissue transglutaminase antibody. After 6 weeks on wheat-free diet, all 19 participating patients reported clinical improvement; fewer patients had bloating, diarrhea, constipation, and easy fatigue. Conclusions Eleven percent of patients with IBS self-reported wheat sensitivity. None of them had positive celiac serology; 60.9% were positive for HLA DQ2 and DQ8, suggesting a possible genetic basis. All of them improved symptomatically on a wheat-free diet.
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Affiliation(s)
- Pavan Dhoble
- Division of Gastroenterology, P D Hinduja Hospital, Mumbai, India
| | - Philip Abraham
- Division of Gastroenterology, P D Hinduja Hospital, Mumbai, India
| | - Devendra Desai
- Division of Gastroenterology, P D Hinduja Hospital, Mumbai, India
| | - Anand Joshi
- Division of Gastroenterology, P D Hinduja Hospital, Mumbai, India
| | - Tarun Gupta
- Division of Gastroenterology, P D Hinduja Hospital, Mumbai, India
| | - Shachish Doctor
- Division of Gastroenterology, P D Hinduja Hospital, Mumbai, India
| | - Anand Deshpande
- Department of Transfusion Medicine, P D Hinduja Hospital, Mumbai, India
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Gao H, Jorgensen R, Raghunath R, Nagisetty S, Ng PKW, Gangur V. Creating hypo-/nonallergenic wheat products using processing methods: Fact or fiction? Compr Rev Food Sci Food Saf 2021; 20:6089-6115. [PMID: 34455695 DOI: 10.1111/1541-4337.12830] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/14/2021] [Accepted: 07/29/2021] [Indexed: 12/29/2022]
Abstract
Wheat allergy is a potentiallylife-threatening disease that affects millions of people around the world. Food processing has been shown to influence the allergenicity of wheat and other major foods. However, a comprehensive review evaluating whether or not food processing can be used to develop hypo-/nonallergenic wheat products is unavailable. There were three objectives for this study: (1) to critically evaluate the evidence on the effect of fermentation, thermal processing, and enzyme or acid hydrolysis on wheat allergenicity so as to identify the potential for and challenges of using these methods to produce hypo-/nonallergenic wheat products; (2) to identify the molecular effects of food processing needed to create such products; and (3) to map the concept questions for future research and development to produce hypo-/nonallergenic wheat products. We performed literature research using PubMed and Google Scholar databases with various combinations of keywords to generate the data to accomplish these objectives. We found that: (1) food processing significantly modulates wheat allergenicity; while some methods can reduce or even abolish the allergenicity, others can create mega allergens; and (2) fermentation and enzymatic hydrolysis hold the most potential to create novel hypo-/nonallergenic wheat products; however, preclinical validation and human clinical trials are currently lacking. We also identify five specific research concepts to advance the research to enable the creation of hypo-/nonallergenic wheat products for application in food, medical, and cosmetic industries.
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Affiliation(s)
- Haoran Gao
- Food Allergy and Immunology Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, Michigan, USA
| | - Rick Jorgensen
- Food Allergy and Immunology Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, Michigan, USA
| | - Rajsri Raghunath
- Food Allergy and Immunology Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, Michigan, USA
| | - Siddharth Nagisetty
- Food Allergy and Immunology Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, Michigan, USA
| | - Perry K W Ng
- Cereal Science Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, Michigan, USA
| | - Venu Gangur
- Food Allergy and Immunology Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, Michigan, USA
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A comparison of the nutritional profile and price of gluten-free products and their gluten-containing counterparts available in the Spanish market. NUTR HOSP 2021; 37:814-822. [PMID: 32686439 DOI: 10.20960/nh.03016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Background: to date, gluten-free (GF) diet is the only treatment available for individuals with celiac disease. Both individual and collective food intake assessments are a challenge because a food composition database of GF products (GFPs) is lacking. Objectives: to describe the process of developing a food composition database of GFPs, and to compare the nutritional profile and price of some GFPs and non-GFPs. Methods: initially, a total of 216 brands of GFPs marketed in Spain were recorded. Nutritional information was collected from nutritional labels and product fact sheets that had been provided by food companies or collected first-hand by researchers. Then, the nutritional profile and price of the cereal and cereal byproducts foodstuff groups, including 19 types of products, were compared. Statistical analyses were performed using the SPSS statistical program (22.0 edition; SPSS, Chicago, IL, USA). Results: a total of 2,247 GFPs from 126 different foodstuff brands were included in the food composition database of GFPs (CELIAC-BASE). We classified these products into 14 foodstuff groups. The protein content of the GFPs studied was significantly lower, and the price was higher, than that of their non-GFP counterparts. Some, but not all, GFPs had a higher content of fat and sugar, and a lower content of dietary fiber as compared to their non-GFP counterparts. Some GFPs were up to 6 times more expensive than the corresponding non-GFPs. Conclusions: CELIAC-BASE is a pioneering tool for dietitians. Many GFPs have poor nutritional profiles and should be consumed only occasionally in a balanced GF diet.
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20
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Conceptualizing “free-from” food consumption determinants: A systematic integrative literature review focused on gluten and lactose. Food Qual Prefer 2021. [DOI: 10.1016/j.foodqual.2020.104170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Abdullah MMH, Hughes J, Grafenauer S. Healthcare Cost Savings Associated with Increased Whole Grain Consumption among Australian Adults. Nutrients 2021; 13:1855. [PMID: 34072326 PMCID: PMC8228843 DOI: 10.3390/nu13061855] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/21/2021] [Accepted: 05/26/2021] [Indexed: 12/12/2022] Open
Abstract
Many dietary guidelines emphasise "mostly" whole grain food choices as part of an overall healthy eating pattern based on evidence for enhancing nutritional status and reducing chronic disease. Still, countries including Australia fall short of their consumption targets. Furthermore, healthcare cost savings associated with increasing the consumption of whole grains in alignment with the Daily Target Intake (DTI) recommendation of 48 g are unknown. The aim of this study was to assess the potential savings in costs of healthcare and lost productivity associated with a reduction in the incidence of Type 2 Diabetes Mellitus (T2DM) and cardiovascular disease (CVD) through meeting the 48 g DTI recommendation for whole grains among the Australian adult population (>20 years). A three-step cost-of-illness analysis was conducted using input parameters from: 1) estimates of proportions of consumers (5%, 15%, 50%, and 100%) who would increase their current intake of whole grains to meet the recommended DTI in Australia; 2) relative reductions in risk of T2DM and CVD associated with specific whole grain consumption, as reported in meta-analysis studies; and 3) data on costs of healthcare and productivity loss based on monetary figures by national healthcare authorities. A very pessimistic (5% of the population) through to universal (100% of the population) adoption of the recommended DTI was shown to potentially yield AUD 37.5 (95% CI 22.3-49.3) to AUD 750.7 (95% CI 445.7-985.2) million, and AUD 35.9 (95% CI 8.3-60.7) to AUD 717.4 (95% CI 165.5-1214.1) million in savings on annual healthcare and lost productivity costs for T2DM and CVD, respectively. Given such economic benefits of the recommended consumption of whole grains, in exchange for refined grains, there is a real opportunity to facilitate relevant socioeconomic cost-savings for Australia and reductions in disease. These results are suggestive of a much greater opportunity to communicate the need for dietary change at all levels, but particularly through food-based dietary guidelines and front-of-pack labelling initiatives.
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Affiliation(s)
| | - Jaimee Hughes
- Grains & Legumes Nutrition Council, 1 Rivett Rd, North Ryde 2113, Australia; (J.H.); (S.G.)
| | - Sara Grafenauer
- Grains & Legumes Nutrition Council, 1 Rivett Rd, North Ryde 2113, Australia; (J.H.); (S.G.)
- School of Medicine, University of Wollongong, Northfields Avenue, Wollongong 2522, Australia
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Organic food consumption and gluten-free diet, is there a link? Results in French adults without coeliac disease. Br J Nutr 2021; 125:1067-1078. [PMID: 32883398 DOI: 10.1017/s0007114520003323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The rising popular belief that gluten is unhealthy has led to growth in gluten avoidance in people without coeliac disease. Little information is available on their dietary profiles and their dietary behaviours. Our aim was to compare the consumption of organic foods between gluten avoiders and non-avoiders, and their places of food purchase. We described their sociodemographic and dietary profiles. The study population included participants of the NutriNet-Santé cohort who completed both a food exclusion questionnaire and an organic semi-quantitative FFQ (n 23 468). Food intake and organic food consumption ratios were compared using multivariable adjusted ANCOVA models. Associations between gluten avoidance and organic food consumption as well as places of food purchase were investigated with multivariable logistic regression. Participants avoiding gluten were more likely to be women and had a healthier dietary profile. Organic food consumption was higher among gluten avoiders (48·50 % of total diet for total avoiders, 17·38 % for non-avoiders). After adjustments for confounders, organic food consumption and purchase in organic stores were positively associated with gluten avoidance: adjusted OR (aOR)Q5 v.Q1 organic food = 4·95; 95 % CI 3·70, 6·63 and aORorganic stores v.supermarkets = 1·82; 95 % CI 1·42, 2·33 for total avoiders. Our study highlights that individuals avoiding gluten are high organic consumers and frequently purchase their foods in organic stores which propose an extended offer of gluten-free food. Further research is needed to determine the underlying common motivations and the temporality of the dietary behaviours of healthy people avoiding gluten.
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Durban R, Groetch M, Meyer R, Coleman Collins S, Elverson W, Friebert A, Kabourek J, Marchand SM, McWilliam V, Netting M, Skypala I, Van Brennan T, Vassilopoulou E, Vlieg-Boerstra B, Venter C. Dietary Management of Food Allergy. Immunol Allergy Clin North Am 2021; 41:233-270. [PMID: 33863482 DOI: 10.1016/j.iac.2021.01.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Worldwide food allergy prevalence is increasing, especially in children. Food allergy management strategies include appropriate avoidance measures and identifying suitable alternatives for a nutritionally sound diet. Individualized dietary intervention begins teaching label reading, which differs among countries or regions. Dietary intervention must result in a nutritionally sound plan including alternatives to support optimal growth and development. Inappropriate or incomplete dietary advice may increase the risk of adverse reactions, growth faltering, and nutrient deficiencies. Evidence indicates input from a registered dietitian improves nutritional outcomes. Nutritional input plays a critical role managing nutritional disorders related to food allergy.
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Affiliation(s)
- Raquel Durban
- Carolina Asthma & Allergy Center, 2600 E 7th St unit a, Charlotte, NC 28204, USA
| | - Marion Groetch
- Division of Allergy & Immunology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1198, New York, NY 10029, USA
| | - Rosan Meyer
- Department of Pediatrics, Imperial College, London, UK
| | | | - Wendy Elverson
- Boston Children's Hospital Center for Nutrition, 333 Longwood Avenue, 4th floor, Boston, MA 02115, USA
| | - Alyssa Friebert
- Allergy and Immunology Clinic, 13123 East 16th Avenue Box 270, Aurora, CO 80045, USA
| | - Jamie Kabourek
- University of Nebraska-Lincoln, Food Innovation Center, Room 279c, 1901 North 21 Street, Lincoln, NE 68588, USA
| | - Stephanie M Marchand
- Department of Pediatrics, The Warren Alpert School of Medicine at Brown University, 593 Eddy Street, Providence, RI 02903, USA; Food and Nutrition Services, Hasbro Children's Hospital, 593 Eddy Street, Providence, RI 02903, USA
| | - Vicki McWilliam
- Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Merryn Netting
- Women and Kids Theme, South Australian Health and Medical Research Institute, 72 King William Road, North Adelaide, South Australia 5006, Australia; Department of Pediatrics, University of Adelaide, Adelaide, South Australia, Australia; Nurition Department, Women's and Children's Health Network, North Adelaide 5006, South Australia, Australia
| | - Isabel Skypala
- Imperial College, London, UK; Department of Allergy and Clinical Immunology, Royal Brompton & Harefield NHS Foundation Trust, Royal Brompton Hospital, 4th Floor Fulham Wing, Sydney Street, London SW3 6NP, UK
| | - Taryn Van Brennan
- Children's Hospital of Colorado, 13123 East 16th Avenue Box B518 Anschutz Medical Campus, Aurora CO 80045, USA
| | - Emillia Vassilopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki 57400, Greece
| | - Berber Vlieg-Boerstra
- Department of Pediatrics, OLVG Hospital, PO Box 95500, Amsterdam 1090HM, The Netherlands
| | - Carina Venter
- Children's Hospital of Colorado, 13123 East 16th Avenue Box B518 Anschutz Medical Campus, Aurora CO 80045, USA.
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Jansson-Knodell CL, Rubio-Tapia A. The fashionable gluten-free diet-wear with caution. Am J Clin Nutr 2021; 113:491-492. [PMID: 33515028 DOI: 10.1093/ajcn/nqaa371] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Claire L Jansson-Knodell
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alberto Rubio-Tapia
- Division of Gastroenterology, Hepatology, and Nutrition; Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
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25
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TAŞKIN B, SAVLAK N. Public awareness, knowledge and sensitivity towards celiac disease and gluten-free diet is insufficient: a survey from Turkey. FOOD SCIENCE AND TECHNOLOGY 2021. [DOI: 10.1590/fst.07420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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De Petrillo A, Hughes LD, McGuinness S, Roberts D, Godfrey E. A systematic review of psychological, clinical and psychosocial correlates of perceived food intolerance. J Psychosom Res 2021; 141:110344. [PMID: 33383523 DOI: 10.1016/j.jpsychores.2020.110344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 12/14/2020] [Accepted: 12/14/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Perceived food intolerance (PFI) is a distressing condition reported by 3% - 35% of individuals, whereas prevalence of food allergy is 0.9%-3%. The present paper aims to systematically review the evidence for psychological, clinical and psychosocial factors associated with PFI in order to advance the current understanding. METHODS Articles published from 1970 until October 2020 were identified. Case-control, prospective cohort, cross-sectional and retrospective studies published in English that a) included a subject population of adults over 18 with PFI and b) examined psychological, clinical and/or psychosocial factors of PFI were reviewed against inclusion criteria. Methodological quality was assessed, data extracted, and a narrative synthesis conducted. RESULTS Of 2864 abstracts identified, thirty-six articles met inclusion criteria. Evidence consistently found PFI is associated with female sex, and individuals with PFI often report physical health complaints including gastrointestinal and extraintestinal symptoms, and gastrointestinal and atopic conditions. Evidence for an association between psychological factors and PFI was inconsistent, although some suggested increased levels of common mental disorders and distress. Findings regarding psychosocial factors were mixed and sociodemographic data were infrequently collected. CONCLUSIONS PFI is associated with female sex and gastrointestinal and extraintestinal complaints. Limited high-quality evidence supports the role of psychological factors associated with PFI. High-quality research using prospective and longitudinal designs with multivariate analyses is needed. Future research should explore modifiable psychological factors as potential targets for intervention and identify clinical and psychosocial risk factors of PFI to aid in formulating a biopsychosocial model of PFI.
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Affiliation(s)
- Alessandra De Petrillo
- King's College London, Department of Psychology, Institute of Psychiatry Psychology & Neuroscience, De Crespigny Park, London SE5 8AF, United Kingdom.
| | - Lyndsay D Hughes
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5th floor Bermondsey Wing, Guy's Hospital Campus London Bridge, London SE1 9RT, United Kingdom
| | - Serena McGuinness
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5th floor Bermondsey Wing, Guy's Hospital Campus London Bridge, London SE1 9RT, United Kingdom
| | - Danniella Roberts
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5th floor Bermondsey Wing, Guy's Hospital Campus London Bridge, London SE1 9RT, United Kingdom
| | - Emma Godfrey
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5th floor Bermondsey Wing, Guy's Hospital Campus London Bridge, London SE1 9RT, United Kingdom.
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Sharma R, Gupta A, Sharma S. Flour Modification for the Development of Gluten Free Bread. GLUTEN-FREE BREAD TECHNOLOGY 2021:199-226. [DOI: 10.1007/978-3-030-73898-3_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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28
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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: 23] [Impact Index Per Article: 4.6] [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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Barbaro MR, Cremon C, Wrona D, Fuschi D, Marasco G, Stanghellini V, Barbara G. Non-Celiac Gluten Sensitivity in the Context of Functional Gastrointestinal Disorders. Nutrients 2020; 12:nu12123735. [PMID: 33291590 PMCID: PMC7761787 DOI: 10.3390/nu12123735] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/27/2020] [Accepted: 12/01/2020] [Indexed: 02/07/2023] Open
Abstract
Gluten-free diets are increasingly chosen in the Western world, even in the absence of a diagnosis of celiac disease. Around 10% of people worldwide self-report gluten-related complaints, including intestinal and extra-intestinal symptoms. In most cases, these subjects would be labeled as patients suffering from irritable bowel syndrome (IBS) who place themselves on a gluten-free diet even in the absence of celiac disease. In some instances, patients report a clear benefit by avoiding gluten from their diet and/or symptom worsening upon gluten reintroduction. This clinical entity has been termed non-celiac gluten sensitivity (NCGS). The symptoms referred by these patients are both intestinal and extra-intestinal, suggesting that similarly to functional gastrointestinal disorders, NCGS is a disorder of gut-brain interaction. It remains unclear if gluten is the only wheat component involved in NCGS. The mechanisms underlying symptom generation in NCGS remain to be fully clarified, although in the past few years, the research has significantly moved forward with new data linking NCGS to changes in gut motility, permeability and innate immunity. The diagnosis is largely based on the self-reported reaction to gluten by the patient, as there are no available biomarkers, and confirmatory double-blind challenge protocols are unfeasible in daily clinical practice. Some studies suggest that a small proportion of patients with IBS have an intolerance to gluten. However, the benefits of gluten-free or low-gluten diets in non-celiac disease-related conditions are limited, and the long-term consequences of this practice may include nutritional and gut microbiota unbalance. Here, we summarize the role of gluten in the clinical features, pathophysiology, and management of NCGS and disorders of gut-brain interaction.
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Affiliation(s)
- Maria Raffaella Barbaro
- IRCCS S. Orsola, 40138 Bologna, Italy; (M.R.B.); (C.C.); (D.W.); (D.F.); (G.M.); (V.S.)
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Cesare Cremon
- IRCCS S. Orsola, 40138 Bologna, Italy; (M.R.B.); (C.C.); (D.W.); (D.F.); (G.M.); (V.S.)
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Diana Wrona
- IRCCS S. Orsola, 40138 Bologna, Italy; (M.R.B.); (C.C.); (D.W.); (D.F.); (G.M.); (V.S.)
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Daniele Fuschi
- IRCCS S. Orsola, 40138 Bologna, Italy; (M.R.B.); (C.C.); (D.W.); (D.F.); (G.M.); (V.S.)
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Giovanni Marasco
- IRCCS S. Orsola, 40138 Bologna, Italy; (M.R.B.); (C.C.); (D.W.); (D.F.); (G.M.); (V.S.)
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Vincenzo Stanghellini
- IRCCS S. Orsola, 40138 Bologna, Italy; (M.R.B.); (C.C.); (D.W.); (D.F.); (G.M.); (V.S.)
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Giovanni Barbara
- IRCCS S. Orsola, 40138 Bologna, Italy; (M.R.B.); (C.C.); (D.W.); (D.F.); (G.M.); (V.S.)
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
- Correspondence: ; Tel.: +39-051-214-4103; Fax: +39-051-392-486
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Rej A, Aziz I, Sanders DS. Coeliac disease and noncoeliac wheat or gluten sensitivity. J Intern Med 2020; 288:537-549. [PMID: 32573000 DOI: 10.1111/joim.13120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/15/2020] [Accepted: 04/21/2020] [Indexed: 12/15/2022]
Abstract
Coeliac disease (CD) and noncoeliac wheat or gluten sensitivity (NCWS/NCGS) are common gluten-related disorders. Both conditions can present with gastrointestinal and extraintestinal manifestations, which can be a challenge for physicians to discern between. Whilst coeliac serology and histological assessment are required for the diagnosis of CD, there are no clear biomarkers for the diagnosis of NCGS. The management of both conditions is with a gluten-free diet (GFD), although the duration, as well as strictness of adherence to a GFD in NCGS, is unclear. Adherence to a GFD in CD can also be challenging, with recent developments of noninvasive assessments, although histological assessment via duodenal biopsies remains the gold standard. The management of refractory coeliac disease remains particularly challenging, often requiring specialist input. Whilst wheat is noted to be a trigger for symptom generation in NCGS, it is unclear which components of wheat are responsible for symptom generation in this group, with further research required to elucidate the pathophysiology.
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Affiliation(s)
- A Rej
- From the, Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - I Aziz
- From the, Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, Academic Unit of Gastroenterology, University of Sheffield, Sheffield, UK
| | - D S Sanders
- From the, Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, Academic Unit of Gastroenterology, University of Sheffield, Sheffield, UK
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31
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Gluten-free muffins versus gluten containing muffins: Ingredients and nutritional differences. Trends Food Sci Technol 2020. [DOI: 10.1016/j.tifs.2020.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Khan A, Suarez MG, Murray JA. Nonceliac Gluten and Wheat Sensitivity. Clin Gastroenterol Hepatol 2020; 18:1913-1922.e1. [PMID: 30978535 DOI: 10.1016/j.cgh.2019.04.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 03/21/2019] [Accepted: 04/03/2019] [Indexed: 02/07/2023]
Abstract
Non-celiac gluten and/or wheat sensitivity (NCGS) is thought to be an immune-mediated reaction to gluten or other components of wheat (eg, fructans or amylase trypsin inhibitors) with intestinal and extraintestinal symptoms which improve once gluten and/or wheat is eliminated from the diet and after a diagnosis of celiac disease and wheat allergy have been excluded with appropriate testing. However, there is a great deal of skepticism within the scientific community questioning the existence of NCGS as a distinct clinical disorder. There are no strict diagnostic criteria and a placebo-controlled rechallenge trial has been recommended for diagnosis. In research settings, a double-blind placebo-controlled rechallenge trial has been recommended for diagnosis. There are limited studies estimating the prevalence of NCGS using this study design. The existing studies have variable results likely due to the lack of a uniform diagnostic criterion, a great deal of dependence on the patient's perception of symptoms and a large nocebo effect in existing studies. In clinical practice, a single blind placebo-controlled rechallenge trial has been recommended for diagnosis. The pathogenesis of NCGS is unclear and there is no known biomarker or diagnostic histologic lesion for this condition. It is important to adopt a multidisciplinary team approach to patients with suspected NCGS with involvement of the primary care doctor, gastroenterologist, pathologist and nutritionist who may play an important role in diagnosis and treatment. There may especially be a role in elimination of food containing high quantity of both gluten and fructans. Furthermore, patients should be educated on the nutritional implications of consuming a long-term gluten-free diet.
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Affiliation(s)
- Anam Khan
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas.
| | - Milena Gould Suarez
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Joseph A Murray
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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Arámburo-Gálvez JG, Beltrán-Cárdenas CE, Geralda André T, Carvalho Gomes I, Macêdo-Callou MA, Braga-Rocha ÉM, Mye-Takamatu-Watanabe EA, Rahmeier-Fietz V, Figueroa-Salcido OG, Vergara-Jiménez MDJ, Flores-Mendoza LK, Ontiveros N, Cabrera-Chávez F. Prevalence of Adverse Reactions to Gluten and People Going on a Gluten-Free Diet: A Survey Study Conducted in Brazil. ACTA ACUST UNITED AC 2020; 56:medicina56040163. [PMID: 32260408 PMCID: PMC7231032 DOI: 10.3390/medicina56040163] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 03/29/2020] [Accepted: 04/02/2020] [Indexed: 12/11/2022]
Abstract
Background: The prevalence of gluten-related disorders (GRD) and adherence to a gluten-free diet (GFD) remains unknown in Brazilian population and there is no published information on the scientific literature about the proportion of Brazilians that were diagnosed with a gluten-related disorder. Thus, the aim of this work was to estimate the prevalence of GRDs and adherence to a GFD by self-report in adult Brazilian population. Materials and Methods: A questionnaire-based cross-sectional study was conducted in two Brazilian cities. Results: The response rate was 93.2% (1630/1749). The self-reported prevalence rates were (95% CI): adverse reactions to gluten 10.06% (8.64–11.62); gluten sensitivity 2.33% (1.65–3.18); physician-diagnosed celiac disease 0.3% (0.09–0.71); non-celiac gluten sensitivity 1.71% (1.14–2.47); wheat allergy 0.79% (0.42–1.36); adherence to gluten-free diet 7.48% (6.25–8.87); gluten avoiders 15.21% (13.5–17.05). Among those who were following a GFD (n = 122), 65.6% (n = 80) of them reported that they did not develop symptoms after wheat/gluten ingestion and 50% (n = 61) were following the diet without medical/dietitian advice. The main motivation for following a GFD in the self-reported and non-self-reported gluten sensitivity groups were the symptoms triggered after wheat/gluten ingestion (86.8%) and weight control (57.1%), respectively. Conclusions: Implementation of programs to increase awareness about GRDs among healthcare professionals and giving scientifically sound information to the general population about the risks and benefits for following a GFD are desirable actions in Brazil. The results also add to the growing body of evidence for highlighting the under-diagnosis of GRD and the trend for following a GFD in Latin America.
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Affiliation(s)
- Jesús Gilberto Arámburo-Gálvez
- Postgraduate in Health Sciences, Division of Biological and Health Sciences, University of Sonora, Hermosillo, Sonora 83000, Mexico; (J.G.A.-G.); (O.G.F.-S.)
| | | | - Tatiane Geralda André
- Master of Science Program in Nursing, School of Nursing, Los Mochis, Sinaloa 81220, Mexico; (T.G.A.); (I.C.G.)
| | - Itallo Carvalho Gomes
- Master of Science Program in Nursing, School of Nursing, Los Mochis, Sinaloa 81220, Mexico; (T.G.A.); (I.C.G.)
| | | | - Élida Mara Braga-Rocha
- Faculdade de Juazeiro do Norte, Juazeiro do Norte, Ceará 63010-215, Brazil; (M.A.M.-C.); (É.M.B.-R.)
| | | | - Vivian Rahmeier-Fietz
- Curso de Enfermagem, Universidade Estadual de Mato Grosso do Sul, Dourados, Mato Grosso do Sul 79804-970, Brazil; (E.A.M.-T.-W.); (V.R.-F.)
| | - Oscar Gerardo Figueroa-Salcido
- Postgraduate in Health Sciences, Division of Biological and Health Sciences, University of Sonora, Hermosillo, Sonora 83000, Mexico; (J.G.A.-G.); (O.G.F.-S.)
| | | | - Lilian Karem Flores-Mendoza
- Department of Chemical, Biological, and Agricultural Sciences (DC-QB), Division of Sciences and Engineering, Clinical and Research Laboratory (LACIUS, URS), University of Sonora, Navojoa, Sonora 85880, Mexico;
| | - Noé Ontiveros
- Department of Chemical, Biological, and Agricultural Sciences (DC-QB), Division of Sciences and Engineering, Clinical and Research Laboratory (LACIUS, URS), University of Sonora, Navojoa, Sonora 85880, Mexico;
- Correspondence: (N.O.); (F.C.-C.)
| | - Francisco Cabrera-Chávez
- Faculty of Nutrition Sciences, University of Sinaloa, Culiacán, Sinaloa 80019, Mexico; (C.E.B.-C.); (M.d.J.V.-J.)
- Correspondence: (N.O.); (F.C.-C.)
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Abstract
Diet and nutrition play an important role in the development and management of food allergy. The diet of expectant mothers can have an effect on their offspring in terms of allergic outcomes. A host of confounding factors may influence this, with a maternal diet rich in fruits and vegetables, fish, vitamin D-rich foods associated with a lower risk of allergic disease in their children. More surprisingly, the consumption of milk and butter has also been shown to have a protective effect, especially in a farm environment. Similarly, the diet of the infant can also be important, not only in terms of breast feeding, but also the timing of the introduction of complementary foods, the diversity of the diet and the effect of individual foods on the development of allergy. One factor which has clearly been shown not to influence the development of food allergy is allergen avoidance by expectant mothers. In the infant diet, the manipulation of the gut microbiome to prevent the development of atopic disease is clearly an area which promises much, although studies have yet to provide a breakthrough in the prevention of atopic dermatitis. More concrete evidence of the value of diet in prevention has come from studies evaluating infant eating patterns which may protect gut health, through the consumption of large amounts of home-processed fruits and vegetables. The consumption of fish during the first year of life has also been shown to be protective. The importance of nutritional issues in children and adults who have a food allergy has become much more accepted in recent years. The primary allergenic foods in infancy and childhood, milk, egg, wheat and soy are also ones which are present in many foods and thus their avoidance can be problematic from a nutritional perspective. Thus, children with a food allergy can have their growth compromised through avoidance, especially pre-diagnosis, when foods may be excluded without any expert nutritional input. The management of a food allergy largely remains the exclusion of the offending food(s), but it is now clear that in doing so, children in particular can be at nutritional risk if insufficient attention is paid to the rest of the diet. Adults with food allergy are often thought not to need nutritional counselling; however, many will exclude a wide range of foods due to anxiety about trace exposure, or similar foods causing reactions. The avoidance of staple foods such as milk and wheat are common, but substitute foods very often do not have comparable nutritional profiles. Adults may also be more susceptible to on-line promotion of extreme nutritional regimes which can be extremely harmful. All food allergic individuals, whatever their age, should have a nutrition review to ensure they are consuming a healthy, balanced diet, and are not avoiding food groups unnecessarily.
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Affiliation(s)
- Isabel J Skypala
- Royal Brompton and Harefield NHS Foundation Trust, London, UK. .,Imperial College, London, UK.
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Lim SM, Page A, Carragher J, Muhlhausler B. Could High-Amylose Wheat Have Greater Benefits on Diabesity and Gut Health than Standard Whole-wheat? FOOD REVIEWS INTERNATIONAL 2019. [DOI: 10.1080/87559129.2019.1683743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- See Meng Lim
- School of Agriculture, Food and Wine, The University of Adelaide, Glen Osmond, Australia
- Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- Centre for Community Health, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Amanda Page
- Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - John Carragher
- School of Agriculture, Food and Wine, The University of Adelaide, Glen Osmond, Australia
| | - Beverly Muhlhausler
- School of Agriculture, Food and Wine, The University of Adelaide, Glen Osmond, Australia
- Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- Commonwealth Scientific and Industrial Research Organisation, Adelaide, Australia
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Tye-Din JA, Daveson AJM, Ee HC, Goel G, MacDougall J, Acaster S, Goldstein KE, Dzuris JL, Neff KM, Truitt KE, Anderson RP. Elevated serum interleukin-2 after gluten correlates with symptoms and is a potential diagnostic biomarker for coeliac disease. Aliment Pharmacol Ther 2019; 50:901-910. [PMID: 31483515 DOI: 10.1111/apt.15477] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/10/2019] [Accepted: 08/01/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Coeliac disease patients on a gluten-free diet experience reactions to gluten, but these are not well characterised or understood. Systemic cytokine release was recently linked to reactivation of gluten immunity in coeliac disease. AIM To define the nature and time-course of symptoms and interleukin-2 changes specific for coeliac disease patients. METHODS 25 coeliac disease patients on a gluten-free diet and 25 healthy volunteers consumed a standardised 6 gram gluten challenge. Coeliac Disease Patient-Reported Outcome survey and global digestive symptom assessment were completed hourly up to 6 hours after gluten. Adverse events over 48 hours were recorded. Serum interleukin-2 was measured at baseline, and 2, 4 and 6 hours. RESULTS Serum interleukin-2 was always undetectable in healthy controls, whereas it was undetectable at baseline and elevated >0.5 pg/ml at 4 hours in 92% of coeliac disease patients. All patient-reported outcome severity scores increased significantly after gluten in coeliac disease patients (P < .001 Wilcoxon signed rank test), but not in controls. Symptoms began after 1 hour, and peaked in the third. Nausea and vomiting characterised severe reactions, but mild reactions were limited to headache and tiredness. Peak interleukin-2 correlated with symptom severity, particularly for nausea and vomiting. CONCLUSIONS Serum interleukin-2 elevations correlate with timing and severity of symptoms after gluten in coeliac disease. Standardised bolus gluten food challenge and interleukin-2 assessment could provide a valuable clinical test to monitor and diagnose coeliac disease in patients established on a gluten-free diet.
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Affiliation(s)
- Jason A Tye-Din
- Immunology Division, Department of Medical Biology, The Walter and Eliza Hall Institute, University of Melbourne, Parkville, Vic., Australia.,Department of Gastroenterology, The Royal Melbourne Hospital, Parkville, Vic., Australia
| | | | - Hooi C Ee
- Sir Charles Gairdner Hospital, Perth, WA, Australia
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Halmos EP, Gibson PR. Will Science Sway Beliefs About Gluten? Gastroenterology 2019; 157:607-609. [PMID: 31233735 DOI: 10.1053/j.gastro.2019.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/18/2019] [Indexed: 12/02/2022]
Affiliation(s)
- Emma P Halmos
- Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Peter R Gibson
- Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Victoria, Australia.
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Stocks NP, Gonzalez-Chica D, Hay P. Impact of gastrointestinal conditions, restrictive diets and mental health on health-related quality of life: cross-sectional population-based study in Australia. BMJ Open 2019; 9:e026035. [PMID: 31253614 PMCID: PMC6609067 DOI: 10.1136/bmjopen-2018-026035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 06/04/2019] [Accepted: 06/06/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To assess the relationship between gastrointestinal conditions, restrictive diets, mental health and health-related quality of life (HRQoL). DESIGN Cross-sectional population-based face-to-face survey. SETTING South Australia. PARTICIPANTS A representative sample of 2912 consenting adults (48.9±18.1 years; 50.9% females) investigated in 2015. PRIMARY AND SECONDARY OUTCOME MEASURES Participants self-reported diagnosis of gastrointestinal conditions, mental health and current use of restrictive diets. The physical component score (PCS) and mental component score (MCS) of HRQoL were investigated (Study Short Form 12 V.1 questionnaire). Linear regression models were used to test the associations, adjusting for (1) sociodemographic variables, (2) mental health status and (3) lifestyle and body mass index. RESULTS The prevalence of restrictive diets (36.1%; 95% CI 33.9 to 38.3) was higher among those with any self-reported gastrointestinal condition (60.7% vs 31.3% for those without these conditions; p<0.001). PCS was lower among those with a gastrointestinal condition (mean difference=-3.4; 95% CI -4.5 to -2.4) or on a restrictive diet (mean difference=-1.9; 95% CI -2.7 to -1.1), with a similar pattern, but with a smaller effect, observed for MCS. Being on a restrictive diet did not modify the relationship between having a gastrointestinal condition and reduced HRQoL. However, having a gastrointestinal condition was associated with a 2.4 points lower PCS (95% CI -3.5 to -1.3) among those without a mental health problem, while for those affected by a mental health condition this reduction was greater (mean difference=-5.9; 95% CI -8.7 to -3.1). For MCS, there was no evidence of interaction between mental health and gastrointestinal conditions. CONCLUSIONS One-third of Australian adults are restricting their diet, and this is associated with lower HRQoL. Being on a restrictive diet was not associated with a better HRQoL among individuals with a gastrointestinal condition. Mental health problems were associated with a stronger adverse relationship between gastrointestinal diseases and physical HRQoL. Health professionals should be alert to these associations when trying to improve health outcomes for patients.
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Affiliation(s)
- Nigel P Stocks
- General Practice, University of Adelaide, Adelaide, South Australia, Australia
| | - David Gonzalez-Chica
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
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Gluten-free diet in French adults without coeliac disease: sociodemographic characteristics, motives and dietary profile. Br J Nutr 2019; 122:231-239. [DOI: 10.1017/s0007114519001053] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AbstractThe number of people avoiding gluten is growing in many Western countries. However, little information is available on their sociodemographic and dietary profiles. We aimed to describe sociodemographic, behavioural and dietary profiles of participants avoiding gluten in the NutriNet-Santé cohort. Participants of the NutriNet-Santé cohort – excluding coeliac patients – who completed a questionnaire about food exclusions, with complete data on sociodemographic characteristics and dietary intake were included (n 20 456). Food group consumptions and nutrient intakes according to self-reported avoidance of gluten were estimated using ANCOVA adjusted for age, sex and daily energy intake. Based on principal component analysis, three dietary patterns (DP) were identified. Association between DP and avoidance of gluten was investigated using multivariate logistic regression. All data were weighted on the French census. A total of 10·31 (95 % CI 9·90, 10·73) % of the participants declared avoiding gluten, of which 1·65 % totally. They were more likely to be women, older persons, non-smokers, to have a lower educational level and declared more food intolerances. They had higher consumption of fruit, vegetables and lower consumption of dairy products, salty/sweet and fatty foods and alcohol. After adjustments on confounders, a healthy dietary pattern was positively associated with total gluten avoidance (ORQuintile5vsQuintile1 = 14·44, 95 % CI 8·62, 24·19). Our study highlighted that, in this population, individuals who avoid gluten from their diet tend to have a diet more favourable to health. These results can serve as a basis for future studies investigating the potential consequences of a gluten-free diet in non-coeliac population.
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Tanner GJ, Colgrave ML, Blundell MJ, Howitt CA, Bacic A. Hordein Accumulation in Developing Barley Grains. FRONTIERS IN PLANT SCIENCE 2019; 10:649. [PMID: 31156692 PMCID: PMC6532529 DOI: 10.3389/fpls.2019.00649] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 04/30/2019] [Indexed: 05/14/2023]
Abstract
The temporal pattern of accumulation of hordein storage proteins in developing barley grains was studied by enzyme-linked immunosorbent assay (ELISA), western blot and liquid chromatography tandem mass spectrometry (LC-MS/MS). Hordein accumulation was compared to the pattern seen for two abundant control proteins, serpin Z4 (an early accumulator) and lipid transferase protein (LTP1, a late accumulator). Hordeins were detected from 6 days post-anthesis (DPA) and peaked at 30 DPA. Changes in fresh weight indicate that desiccation begins at 20 DPA and by 37 DPA fresh weight had decreased by 35%. ELISA analysis of hordein content, expressed on a protein basis, increased to a maximum at 30 DPA followed by a 17% decrease by 37 DPA. The accumulation of 39 tryptic and 29 chymotryptic hordein peptides representing all classes of hordein was studied by LC-MS/MS. Most peptides increased to a maximum at 30 DPA, and either remained at the maximum or did not decrease significantly. Only five tryptic peptides, members of the related B1- and γ1-hordeins decreased significantly by 21-51% at 37 DPA. Thus, the concentration of some specific peptides was reduced while remaining members of the same family were not affected. The N-terminal signal region was removed by proteolysis during co-translation. In addition to a suite of previously characterized hordeins, two novel barley B-hordein isoforms mapping to wheat low molecular weight glutenins (LMW-GS-like B-hordeins), and two avenin-like proteins (ALPs) sharing homology with wheat ALPs, were identified. These identified isoforms have not previously been mapped in the barley genome. Cereal storage proteins provide significant nutritional content for human consumption and seed germination. In barley, the bulk of the storage proteins comprise the hordein family and the final hordein concentration affects the quality of baked and brewed products. It is therefore important to study the accumulation of hordeins as this knowledge may assist plant breeding for improved health outcomes (by minimizing triggering of detrimental immune responses), nutrition and food processing properties.
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Affiliation(s)
- Gregory J. Tanner
- School of Biosciences, University of Melbourne, Melbourne, VIC, Australia
| | - Michelle L. Colgrave
- Commonwealth Scientific and Industrial Research Organisation Agriculture and Food, St Lucia, QLD, Australia
- School of Science, Edith Cowan University, Joondalup, WA, Australia
| | - Malcolm J. Blundell
- Commonwealth Scientific and Industrial Research Organisation Agriculture and Food, Canberra, ACT, Australia
| | - Crispin A. Howitt
- Commonwealth Scientific and Industrial Research Organisation Agriculture and Food, Canberra, ACT, Australia
| | - Antony Bacic
- School of Biosciences, University of Melbourne, Melbourne, VIC, Australia
- La Trobe Institute for Agriculture and Food, La Trobe University, Bundoora, VIC, Australia
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Identification of the conditions that complementary medicine practitioners recommend gluten free diets for in Australia. ADVANCES IN INTEGRATIVE MEDICINE 2019. [DOI: 10.1016/j.aimed.2018.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
PURPOSE OF REVIEW There has been significant interest in gluten over the last decade, with an increase in interest of gluten-related disorders outside coeliac disease. Particularly, there has been a focus on the role of gluten in noncoeliac gluten sensitivity (NCGS) and irritable bowel syndrome (IBS). There is significant overlap between both of these conditions, with the aim of this review to explore their complex relationship. RECENT FINDINGS Gluten has been demonstrated to generate symptoms in individuals with NCGS. However, there appears to be an increasing role for gluten in symptom generation in patients with IBS also. Other components of wheat, other than gluten, are now also thought to be contributing factors in symptom generation. SUMMARY There appears to be significant overlap between IBS and NCGS. It is likely that a subset of patients presenting with IBS actually have NCGS. In addition, it is likely that individuals with IBS may also have symptoms triggered by gluten. With the pathophysiology of both conditions not fully understood, as well as increasing knowledge of wheat components in symptom generation, further research is required to help distinguish between both.
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Skypala IJ. Food-Induced Anaphylaxis: Role of Hidden Allergens and Cofactors. Front Immunol 2019; 10:673. [PMID: 31001275 PMCID: PMC6457317 DOI: 10.3389/fimmu.2019.00673] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/12/2019] [Indexed: 12/21/2022] Open
Abstract
Food anaphylaxis is on the increase, with those who have an allergy to peanuts, tree nuts, milk, and seafood at the highest risk of developing such a reaction. However, the diet in many societies is increasingly varied, much of the food consumed is prepared outside the home, and meals are often composed of many different ingredients. Anaphylaxis may occur to a composite food, and it may be unclear whether the reaction is due to contamination or to a culprit allergen present in an added ingredient. Composite foods can contain many allergic proteins present in small amounts, which do not always have to be labeled, unless they feature in European or US labeling regulations. These "hidden" allergens include mustard, celery, spices, lupine, pea, natural food colourings, and preservatives, but can occasionally include allergenic material from contaminants such as cereal mites. Hidden allergens can provoke severe reactions to seemingly unconnected foods which might then lead to a diagnosis of idiopathic anaphylaxis. The same problem can arise with two well-known types of food allergy; wheat-dependant exercise induced anaphylaxis and allergy to non-specific Lipid Transfer Protein allergens, both of which might only manifest when linked to a cofactor such as exercise. Many of these risk factors for food anaphylaxis have a common link; the public's engagement with popular concepts of health and fitness. This includes the development of a food and exercise culture involving the promotion and marketing of foods for their health-giving properties i.e., meat substitutes, wheat substitutes, supplements and alternative, or "natural" remedies for common ailments. Some of these foods have been reported as the cause of severe allergic reactions, but because they are often viewed as benign unlikely causes of severe allergic reactions, could be considered to be hidden allergens. The best resource to elicit the likelihood of a hidden allergen provoking an allergic reaction is to take a detailed history of the allergic reaction, presence of co-factors, foods suspected, type of food and where it was consumed. A good knowledge of commonly used ingredients, and list of potential hidden allergen suspects are essential tools for the food allergy detective.
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Affiliation(s)
- Isabel J. Skypala
- Department of Allergy and Clinical Immunology, Imperial College, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
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Norwood R, Cruwys T, Chachay VS, Sheffield J. The psychological characteristics of people consuming vegetarian, vegan, paleo, gluten free and weight loss dietary patterns. Obes Sci Pract 2019; 5:148-158. [PMID: 31019732 PMCID: PMC6469437 DOI: 10.1002/osp4.325] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/30/2018] [Accepted: 12/14/2018] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Previous research has identified several psychological factors associated with dietary restriction but has focused almost exclusively on the subcategory of people following a weight loss diet. Little is known about the psychological factors associated with other kinds of restrictive dietary patterns. Furthermore, it remains unclear whether the identified psychological characteristics of dieters (e.g. elevated disordered eating behaviours, poor well-being) are a cause of dieting, follow from calorie restriction or are the result of cognitive restraint. METHODS This study conducted the first direct comparison of people (N = 393) following five different restrictive dietary patterns (vegetarian, vegan, gluten free, paleo and weight loss) as well as a comparison group who were not following a specific dietary pattern. RESULTS The weight loss group had more negative psychological characteristics than all other groups, reporting the highest levels of eating disorder symptoms (M = 1.50), food cravings (M = 69.39), emotional eating (M = 2.97) and negative affect (M = 19.72). By contrast, several of the other restrictive dietary groups showed a number of psychological strengths, relative to the comparison group. This was particularly apparent among the paleo group, who reported the lowest levels of eating disorder symptoms (M = 0.74), food cravings (M = 47.63), emotional eating (M = 2.30) and negative affect (M = 14.81). By contrast, people following vegetarian and gluten free diets were largely the same as the non-restricted comparison group in their psychological characteristics. CONCLUSIONS People adhering to different dietary patterns showed stark differences in their psychological characteristics. Indeed, some restrictive dietary patterns (paleo and vegan) were associated with more positive psychological characteristics than seen in an unrestricted comparison group. This suggests that the psychological risk factors seen in weight loss dieters are not attributable to a restrictive dietary regimen per se.
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Affiliation(s)
- R. Norwood
- School of PsychologyUniversity of QueenslandBrisbaneAustralia
| | - T. Cruwys
- School of PsychologyUniversity of QueenslandBrisbaneAustralia
- Research School of PsychologyAustralian National UniversityCanberraAustralia
| | - V. S. Chachay
- School of Human Movement and Nutrition SciencesUniversity of QueenslandBrisbaneAustralia
| | - J. Sheffield
- School of PsychologyUniversity of QueenslandBrisbaneAustralia
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Roman L, Belorio M, Gomez M. Gluten‐Free Breads: The Gap Between Research and Commercial Reality. Compr Rev Food Sci Food Saf 2019; 18:690-702. [DOI: 10.1111/1541-4337.12437] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/04/2019] [Accepted: 02/04/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Laura Roman
- Food Technology AreaCollege of Agricultural EngineeringUniv. of Valladolid Palencia 34004 Spain
| | - Mayara Belorio
- Food Technology AreaCollege of Agricultural EngineeringUniv. of Valladolid Palencia 34004 Spain
| | - Manuel Gomez
- Food Technology AreaCollege of Agricultural EngineeringUniv. of Valladolid Palencia 34004 Spain
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Soares RLS. IRRITABLE BOWEL SYNDROME, FOOD INTOLERANCE AND NON- CELIAC GLUTEN SENSITIVITY. A NEW CLINICAL CHALLENGE. ARQUIVOS DE GASTROENTEROLOGIA 2019; 55:417-422. [PMID: 30785529 DOI: 10.1590/s0004-2803.201800000-88] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 10/23/2018] [Indexed: 12/21/2022]
Abstract
Approximately 80% of irritable bowel syndrome (IBS) patients report that their symptoms are triggered after ingesting one or specific food groups. Gluten, wheat and related proteins (e.g., amylase-trypsin inhibitors, and fermentable oligo-di-mono-saccharides and polyols (FODMAPs) are the most relevant IBS symptom triggers, although the true 'culprit(s)' is/are still not well established. The concept of causal relationship between gluten intake and the occurrence of symptoms in the absence of celiac disease and wheat allergy was termed non-celiac gluten sensitivity (NCGS). The borderline between celiac disease, wheat allergy, IBS and NCGS is not always clearly distinguishable, and the frequency and clinical identity of NGCS are still unclear. An overlap between IBS and NCGS has been detected. The incomplete knowledge of the etiopathogenesis of these clinical conditions, lack of data on their real epidemiology, as well as the absence of a gold standard for their diagnosis, make the overall picture difficult to understand "It is crucial to well define the interaction between IBS, food intolerance and NGCS, since the role of diet in IBS and its dietary management is an essential tool in the treatment of a large number of these patients". The objective of the present review is to provide an overview highlighting the interaction between IBS, food intolerance and NCGS in order to unravel whether gluten/wheat/FODMAP sensitivity represents 'facts' and not 'fiction' in IBS symptoms.
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Affiliation(s)
- Rosa Leonôra Salerno Soares
- Universidade Federal Fluminense, Faculdade de Medicina, Departamento de Medicina Interna, Niterói, RJ, Brasil
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Golley S, Baird D, Hendrie GA, Mohr P. Thinking about going wheat-free? Evidence of nutritional inadequacies in the dietary practices of wheat avoiders. Nutr Diet 2019; 76:305-312. [PMID: 30873744 DOI: 10.1111/1747-0080.12521] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/10/2018] [Accepted: 01/28/2019] [Indexed: 11/30/2022]
Abstract
AIM To assess dietary intake and nutritional adequacy amongst self-identified symptomatic wheat-avoiders. METHODS Thirty-four self-identified symptomatic avoiders of wheat-based products without a diagnosis of coeliac disease or wheat allergy were recruited to participate in a dietary assessment study. Dietary intake was assessed via a three-day weighed food record. Participants were aged 33 to 83 years, were predominantly women (n = 30) and had been avoiding wheat for a mean of six years. Nutrient intakes were compared with Nutrient Reference Values. Food group intakes were assessed and consumption of wheat-containing and wheat-free cereal-based foods described. RESULTS Inadequate intakes of key protective nutrients such as fibre and calcium were common; many participants reported avoiding dairy as well as wheat. Intakes of total and saturated fat exceeded recommendations. Although 85% of the sample reported avoiding all wheat products, at least one third of cereal products and dishes consumed in this group, comprising mostly discretionary-type foods, were wheat based. CONCLUSIONS Dietary intake patterns and resulting nutrient imbalances in individuals restricting or eliminating wheat to manage symptoms are cause for concern. The situation is likely exacerbated by the tendency for many wheat avoiders to report also avoiding other foods, especially dairy products. A bi-disciplinary approach from medical practitioners and dietitians to individuals experiencing unexplained gastro-intestinal symptoms and strategies to support informed food choice is needed to combat longer-term health consequences of a diet with this nutritional profile.
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Affiliation(s)
- Sinéad Golley
- CSIRO Health and Biosecurity, Adelaide, South Australia, Australia
| | - Danielle Baird
- CSIRO Health and Biosecurity, Adelaide, South Australia, Australia
| | - Gilly A Hendrie
- CSIRO Health and Biosecurity, Adelaide, South Australia, Australia
| | - Philip Mohr
- School of Psychology, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia
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Losurdo G, Principi M, Iannone A, Giangaspero A, Piscitelli D, Ierardi E, Di Leo A, Barone M. Predictivity of Autoimmune Stigmata for Gluten Sensitivity in Subjects with Microscopic Enteritis: A Retrospective Study. Nutrients 2018; 10:nu10122001. [PMID: 30567296 PMCID: PMC6315522 DOI: 10.3390/nu10122001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/10/2018] [Accepted: 12/14/2018] [Indexed: 02/07/2023] Open
Abstract
Non-celiac gluten sensitivity (NCGS) is an emerging gluten-related condition. We investigated whether the presence of autoimmune stigmata in a group of patients with clinical suspicion of NCGS and a histological picture of microscopic enteritis (ME) could be a predictive factor of NCGS. Patients with ME were followed up by periodical examinations. At baseline, we collected data about previous clinical history, including autoimmune diseases. NCGS was diagnosed according to Salerno criteria; other causes of ME were diagnosed according to well-established protocols. Patients with celiac disease were excluded. Student's and chi-square tests were used in univariate analysis. Kaplan-Meier curves and Cox regression were used to estimate hazard ratios (HR). Sixty-three patients were included. Twenty-two had a final diagnosis of NCGS; the remaining 41 had non-gluten-related causes of ME. Prevalence of autoimmune thyroiditis was higher among NCGS patients (40.1%) than in other ME (14.6%; p = 0.03). NCGS showed higher positivity rate for anti-gliadin (27.3% versus 2.5%; p = 0.006) and anti-nucleus (45.4% versus 12.2%; p = 0.005). Autoimmune thyroiditis had a non-significant trend (p = 0.06) for NCGS diagnosis, (HR = 2.4). Both anti-gliadin (HR = 2.4; p = 0.04) and anti-nucleus (HR = 2.7; p = 0.04) were directly associated with NCGS diagnosis. In conclusion, NCGS may have a cohort of autoimmune stigmata that can precede its diagnosis.
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Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari (Italy), Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari (Italy), Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari (Italy), Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Antonio Giangaspero
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari (Italy), Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Domenico Piscitelli
- Section of Pathology, Department of Emergency and Organ Transplantation, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari (Italy), Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari (Italy), Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari (Italy), Piazza G. Cesare 11, 70124 Bari, Italy.
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Nutritional composition of gluten-free food versus regular food sold in the Italian market. Dig Liver Dis 2018; 50:1305-1308. [PMID: 29857960 DOI: 10.1016/j.dld.2018.04.028] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/29/2018] [Accepted: 04/30/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Some concerns have been raised about the nutritional composition of gluten-free (GF) food. AIM To compare the nutritional composition of GF food with regular foods. METHODS This study examined in total 235 GF products and 349 regular products purchased in Italy, from seven categories: biscuits, rusks, snacks, bread, pasta, bread substitutes and wheat flour. The following nutritional facts, have been considered: energy, proteins, total and saturated fats, carbohydrates, simple sugars, fibers and salt. The mean nutrient composition for products of the two groups was compared by independent samples t-test. RESULTS The protein content of GF food is lower in all the categories (P < 0.001). s. Total energy was lower for GF bread (P < 0.001) and higher for GF pasta (P = 0.05). GF biscuits and pasta had higher saturated fats content (P < 0.001 and P = 0.003). No difference was seen for total fat. Sugar content was lower for GF pasta (P < 0.001). Fiber content was lower in GF biscuits, bread substitutes (P < 0.001) and pasta (P = 0.02), higher in bread (P = 0.03). Salt content was higher in GF pasta (P < 0.001) and rusks (P = 0.04), lower in biscuits (P < 0.001). CONCLUSIONS There are some differences in the nutritional composition of GF food and regular food. These differences should be taken into account when planning a balanced GF diet.
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50
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Rej A, Sanders DS. Gluten-Free Diet and Its 'Cousins' in Irritable Bowel Syndrome. Nutrients 2018; 10:nu10111727. [PMID: 30423854 PMCID: PMC6266983 DOI: 10.3390/nu10111727] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/07/2018] [Accepted: 11/08/2018] [Indexed: 02/08/2023] Open
Abstract
Functional disorders are common, with irritable bowel syndrome (IBS) being the commonest and most extensively evaluated functional bowel disorder. It is therefore paramount that effective therapies are available to treat this common condition. Diet appears to play a pivotal role in symptom generation in IBS, with a recent interest in the role of dietary therapies in IBS. Over the last decade, there has been a substantial increase in awareness of the gluten-free diet (GFD), with a recent focus of the role of a GFD in IBS. There appears to be emerging evidence for the use of a GFD in IBS, with studies demonstrating the induction of symptoms following gluten in patients with IBS. However, there are questions with regards to which components of wheat lead to symptom generation, as well as the effect of a GFD on nutritional status, gut microbiota and long-term outcomes. Further studies are required, although the design of dietary studies remain challenging. The implementation of a GFD should be performed by a dietitian with a specialist interest in IBS, which could be achieved via the delivery of group sessions.
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Affiliation(s)
- Anupam Rej
- Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield S10 2JF, UK.
| | - David Surendran Sanders
- Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield S10 2JF, UK.
- Academic Unit of Gastroenterology, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, S10 2RX, UK.
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