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Data on factors governing long-term adherence to a gluten-free diet (GFD) in celiac disease (CD) are scarce. We aimed to determine trends and clinical predictors of long-term GFD adherence in adult CD.Initial and long-term (3 years) GFD adherence, clinical characteristics at baseline and follow-up were collected retrospectively from celiac patients followed-up over 20 years (2000-2020). Predictors of long-term GFD adherence at diagnosis, and follow-up were evaluated by multivariate logistic regression.248 patients (37 ± 12 years, 186F, median time on a GFD 90 months) were included. Twenty-five (10.1%) had only short-term follow-up (3 years) while 223 (89.9%) had initial and long-term dietary assessment. 187/223 (83.9%) patients were initially adherent and 36/223 (16.1%) were not. 17/36 (47.2%) patients initially not adherent become adherent, while only 4/187 (2.1%) initially adherent patients became not adherent. In the long-term, 200/223 (89.7%) were adherent and 21/223 (9.4%) patients were not. Adherence improved more frequently than worsened (OR, 39.5; 95% CI, 11.4-178.5; P.01). Classical symptoms (diarrhea, weight loss) at diagnosis of CD predicted stricter long-term GFD adherence (OR, 3.27; 95% CI, 1.21-8.81; P = .02), while anemia (OR, 0.31; 95% CI, 0.12-0.82; P = .02) and dermatitis herpetiformis (OR, 0.23; 95% CI, 0.06-0.91; P = .04) predicted poorer long-term adherence. At follow-up, initial GFD adherence (OR, 42.70; 95% CI, 10.70-171.00; P = .04) was the major determinant of long-term GFD adherence.GFD adherence changes over time in10% of patients, generally improving when it does. Major determinants of long-term GFD adherence are classical symptoms at diagnosis and initial adherence to a GFD. Patients with anemia or dermatitis herpetiformis at diagnosis require stricter dietetic input.

Tef is a highly nutritious gluten-free Ethiopian cereal with food-feed potential. However, its productivity is affected by lodging, weed infestation, terminal drought, small seed size, and shattering. Following the recent availability of tef genome sequences, we highlight the need to harness the benefits that this underutilised crop offers to improve food security.

We studied the prevalence of functional abdominal pain disorders (FAPDs) and functional constipation (FC) in a large prospective cohort of children with celiac disease on a strict gluten-free diet (GFD).We performed a prospective cohort study, from 2016 through 2018, in a tertiary care center in Italy, of 417 patients (37% male; mean age, 13.7 y) with a diagnosis of celiac disease (European Society for Paediatric Gastroenterology Hepatology, and Nutrition criteria) who had been on a strict GFD for more than 1 year and had negative results from serologic tests after being on the GFD. Parents and children (10 y) were asked to fill in a questionnaire on pediatric gastrointestinal symptoms, according to Rome IV criteria. Patients' closest siblings (or cousins) who had negative results from serologic test for celiac disease were used as controls (n = 373; 39% male; mean age, 13.5 y).We found a higher prevalence of FAPDs among patients with celiac disease (11.5%) than controls (6.7%) (P.05); the relative risk (RR) was 1.8 (95% CI, 1.1-3.0). Irritable bowel syndrome (IBS) and FC defined by the Rome IV criteria were more prevalent in patients with celiac disease (7.2% for IBS and 19.9% for FC) than controls (3.2% for IBS and 10.5% for FC) (P.05 and P.001, respectively); the RR for IBS was 2.3 (95% CI, 1.1-4.6) and the RR for functional constipation was 2.1 (95% CI, 1.4-3.2). We found no differences in the prevalence of other subtypes of FAPDs. A logistic regression showed that younger age (P.05) and a higher level of anti-transglutaminase IgA at diagnosis (P.04) were associated with FAPDs (in particular for IBS) irrespective of GFD duration.Celiac disease is associated with an increased risk of IBS and FC. Strategies are needed to manage IBS and FC in patients with celiac disease.

Background Excipients are widely used in pharmaceuticals, detergents, food, and drink because of their properties of low toxicity and hypoallergenicity. The excipient carboxymethylcellulose is used extensively as a thickener in foods such as baked goods, ice cream, gluten free, and reduced fat products, where it may be labeled as e-number E466. However, excipients can rarely cause type 1 hypersensitivity reactions. Several publications have described systemic allergy following carboxymethylcellulose exposure in pharmaceuticals, particularly systemic corticosteroids. Furthermore, there is one reported case in the literature of anaphylaxis following food containing carboxymethylcellulose. Case presentation We identify a case of anaphylaxis in a 45-year-old atopic Caucasian woman on receiving an injectable suspension of the corticosteroid triamcinolone acetonide containing carboxymethylcellulose, and subsequent allergic symptoms on reexposure to carboxymethylcellulose in a commercial drink. Diagnosis of carboxymethylcellulose excipient allergy was confirmed through skin prick testing using Celluvisc carmellose 0.5% eye drops, which contain carboxymethylcellulose as the active ingredient. Conclusion This case highlights the importance of identifying excipients such as carboxymethylcellulose as causes of allergy, to reduce burden of further hypersensitivity reactions, not just to drugs but to other consumables.

While intensification of farming systems is essential for achieving the Millennium Development Goal of “Zero hunger”, issues such as availability of nutritious foods would demand increased attention if any long-term form of food security is to be achieved. Since wheat, rice and maize have reached near to 80 percent of their yield potential and reliance on these crops alone would not be sufficient to close the gap between demand and supply, there is a need to bring other climate-resilient and nutritionally dense crops into agricultural portfolio. Buckwheat (Fagopyrum spp.) has attracted considerable interest amongst global scientific community due to its nutritional and pharmaceutical properties. The gluten free nature of buckwheat, nutritionally balanced amino acid composition of its grain protein, and high levels of anti-oxidants, such as rutin, makes buckwheat an important crop with immense nutraceutical benefits. However, a key challenge in buckwheat cultivation is the variation in yield between years, which impacts the entire value chain. Current information on buckwheat indicates existence of significant phenotypic variation for agronomic and nutritional traits. However, genetic bottlenecks in conventional breeding restrict effective utilization of the existing diversity in mainstreaming buckwheat cultivation. Availability of high density buckwheat genome map for both the cultivated species viz. F. esculentum and F. tataricum would add to our understanding of genetic basis of their agronomic traits. The review examines the potential of buckwheat as a strategic crop for human nutrition and prospects of effective exploitation genomic information of common and Tartary buckwheat for genome assisted breeding.

Cerebellar manifestations have been described in patients with gluten sensitivity (GS)-related disorders. A better understanding of the neurological manifestations of GS requires the use of neuroimaging techniques. We performed a systematic review on neuroimaging findings in GS patients with cerebellar symptoms. We also included a specific search on neuroimaging findings in GS patients with cerebellar manifestations on a gluten-free diet (GFD). PubMed, Embase, and Bireme were systematically searched to identify studies assessing neuroimaging features of adults with cerebellar manifestations and GS with or without enteropathy on a GFD. Ten studies with a total of 222 adult-GS patients were included. Magnetic resonance imaging was used in 100% of the studies. Cerebellar atrophy was evaluated in 7 studies and observed in 63% of the patients. White matter abnormalities were described in 2 studies. Single-photon emission computed tomography was used in 2 studies, and decreased cerebellar perfusion was detected in 92% of the included patients. No study employed nuclear medicine after the start of GFD. Magnetic resonance spectroscopy (MRS) was performed in 2 studies before and after GFD. An increase in the Naa/Cr ratio in cerebellar vermis was seen in 98% of the cases on a strict GFD. Cerebellar atrophy was found to be a prevalent condition in GS patients. MRS demonstrated to be useful in the follow-up of GS patients with cerebellar manifestations on a GFD. Prospective studies using nuclear medicine imaging are needed to study brain changes in GS patients on a GFD.

Context It has been suggested that a gluten-free and casein-free (GFCF) diet may alleviate the symptoms of autism spectrum disorder (ASD) and facilitate neurodevelopment of children with ASD. Studies to date have been inconclusive. Objective This study aimed to evaluate (through quantitative meta-analysis) the efficacy and safety of a GFCF diet for children with ASD. To our knowledge, this is the first time such an analysis has been carried out. Data Sources Eight electronic databases were searched, from the establishment of each database up to March 27, 2020: PubMed, Web of Science, Embase (Ovid), PsycINFO (Ovid), Cochrane Library, CNKI, Wanfang, and VIP databases. Data Extraction Two authors independently performed the data extraction and risk-of-bias assessment. Data Analysis A quantitative meta-analysis was performed with standard procedures by using Stata SE 15 software. Within the total of 8 studies, with 297 participants, 5 studies reported significant reductions in stereotypical behaviors [standard mean difference (SMD) = –0.41, 95% confidence interval (CI): –0.68 to –0.15], and 3 studies reported improvements in cognition (SMD = –0.46, 95% CI: –0.91 to –0.01) following GFCF dietary intervention . No statistically significant changes were observed in other symptomatic categories (all P > 0.05). Conclusion The current meta-analysis showed that a GFCF diet can reduce stereotypical behaviors and improve the cognition of children with ASD. Though most of the included studies were single-blind, the benefits of a GFCF diet that have been indicated are promising. Additional studies on a larger scale are warranted. Systematic Review Registration PROSPERO registration no. CRD42020177619.

The prevalence of celiac disease (CD) and other gluten-intolerant disorders is still growing over time partially attributed to more clinical investigations and improved diagnosis capacity, even mai...

This research aimed to investigated the short- and long-term effects of gluten free diet (GFD) on nutritional intake, glycaemic and insulin response. In a cross-sectional study, participants who consumed a gluten-containing diet (GCD; n=11) and a GFD (n=11) completed a food diary, blood glucose and insulin measurements. In a pre-postn intervention study (n=, 11), glycaemic and insulin responsed were tested individuals completed a food diary, blood glucose and insulin measurements before and after four weeks of a GFD. Food intake was recorded before and after two weeks. No significant differences in nutrient intake, glycaemic or insulin responses were found in the cross-sectional study (p>0.05). In the intervention study, there was a significant reduction in body weight (p=0.007) and, body mass index (BMI) (p=0.004) after four weeks and and lower thiamine intake (p=0.021) after two weeks of GFD. Glycaemic response was significantly higher (p

Celiac disease (CD) is a prevalent digestive illness as well as a budding area of research in the field of gastroenterology. While investigations are underway to find new and improved pharmacological therapies for CD, the gluten-free diet (GFD) remains the only option to effectively manage the condition. While the GFD is recommended for patients diagnosed with CD and other gluten-related conditions, studies show the number of individuals on the GFD surpasses the projected number of patients with these medical indications (1). The implications of widespread adoption of this dietary approach are still being determined, with many patients believing this diet will improve overall health and cardiovascular risk. This review analyzes the relationship between a GFD and metabolic syndrome in both non-celiac and celiac patients, concluding that although the diet may slightly improve overall cardiac risk factors, weight, and/or insulin resistance, its use in the absence of a gluten-related disorder is controversial.

Актуальность. Железодефицитная анемия (ЖДА) — это наиболее частый внекишечный симптом при целиакии у взрослых. Исследований наличия или отсутствия железодефицита, в том числе скрытого, у пациентов, имеющих как целиакию, так и непереносимость глютена без цели­акии (НГБЦ), ранее в нашей стране не проводилось. Цель исследования: изучить и проанализировать общеклинические и биохимические показатели крови, отражающие наличие анемии и/или железодефицита у больных целиакией и непереносимостью глютена без целиакии, находящихся на АГД. Материалы и методы. В исследование были включены 38 взрослых с диагностированными ранее основными видами непереносимости злаков — целиакией и НГБЦ. Все они находились на диете с полным исключением глютена. Всем исследуемым определялись гематологические показатели: общая железосвязывающая способность сыворотки, содержание эритроцитов, гемоглобина, ферритина, железа и трансферрина крови. Результаты. В результате обследования 38 пациентов, находящихся на аглиадиновой диете продолжительностью 6,5 (IQR 4–12) года, выявлено наличие ЖДА легкой степени у 13,16 % обследованных, при этом латентный железодефицит выявлялся у 18,42 % обследованных. Снижение концентрации сывороточного железа крови отмечено у 23,08 % больных общей группы, но частота железодефицита (в том числе латентного) в обследованной группе по анализу показателей концентрации сывороточного ферритина достигла 31,58 %, превалируя над частотой выявления ЖДА почти вдвое. При этом содержание эритроцитов было нормальным у 100 % обследованных. Среди пациентов с железодефицитом лица с целиакией встречаются чаще, чем среди пациентов с НГБЦ (83,3 и 16,7 % соответственно). Выводы. Больные целиакией и НГБЦ остаются в группе риска по развитию ЖДА, несмотря на то, что они находятся на аглиадиновой диете. Изолированный показатель эритроцитов не является информативным для диагностики не только скрытого железодефицита, но и ЖДА. Изолированный сывороточный уровень железа также не является показательным для диагностики данных состояний. В этом отношении именно ферритин становится наиболее показательным маркером железодефицита. Необходимо целенаправленное наблюдение за этой группой больных с целью выявления скрытых форм микронутриентного дефицита, в частности железа, и осуществления обоснованной, индивидуализированной коррекции их последствий., Актуальність. Залізодефіцитна анемія (ЗДА) — це найпоширеніший позакишковий симптом при целіакії у дорослих. Досліджень наявності або відсутності залізодефіциту, зокрема прихованого, у пацієнтів, які мають целіакію, так само як і непереносимості глютену без целіакії (НГБЦ), раніше в нашій країні не проводилося. Мета дослідження: вивчити та проаналізувати загальноклінічні та біохімічні показники крові, що відображають наявність анемії та/або залізодефіциту у хворих на целіакію та НГБЦ на агліадиновій дієті (АГД). Матеріали та методи. У дослідження було включено 38 дорослих із діагностованими раніше видами непереносимості злаків — целіакією та НГБЦ. Усі вони перебували на дієті з повним виключенням глютену. Всім досліджуваним визначалися гематологічні показники: загальна залізозв’язуюча здатність крові, вміст еритроцитів, гемоглобіну, феритину, заліза та трансферину крові. Результати. Внаслідок обстеження 38 пацієнтів, які перебували на агліадиновій дієті протягом 6,5 (IQR 4–12) року, ЗДА легкого ступеня була виявлена у 13,16 % обстежених, при цьому латентний залізодефіцит визначався у 18,42 % обстежених. Зниження концентрації сироваткового заліза крові відзначено у 23,08 % хворих загальної групи, але частота залізодефіциту (зокрема латентного) в обстеженій групі за аналізом показників концентрації сироваткового феритину досягла 31,58 %, превалюючи над частотою виявлення ЗДА майже вдвічі. При цьому вміст еритроцитів був нормальним у 100 % обстежених. Серед пацієнтів із залізодефіцитом частіше зустрічаються особи з целіакію, ніж із НГБЦ (83,3 і 16,7 % відповідно). Висновки. Хворі на целіакію та НГБЦ залишаються в групі ризику з розвитку ЗДА, незважаючи на те, що вони знаходяться на агліадиновій дієті. Ізольований показник еритроцитів не є інформативним для діагностики не тільки прихованого залізодефіциту, але і ЗДА. Ізольований сироватковий рівень заліза також не є показовим для діагностики цих станів. Щодо цього саме феритин стає найбільш показовим маркером залізодефіциту. Необхідно цілеспрямовано спостерігати за цією групою хворих з метою виявлення прихованих форм мікронутрієнтного дефіциту, зокрема заліза, і здійснення обґрунтованої, індивідуалізованої корекції їх наслідків., Background. Iron deficiency anemia (IDA) is the most common extraintestinal symptom of celiac disease in adults. Stu­dies of the presence or absence of iron deficiency, including cases of latent anemia, in patients with both celiac disease and non-celiac gluten sensitivity (NCGS) has not been previously carried out in our country. The purpose was to study and analyze general clinical and biochemical blood parameters of patients who are on a gluten-free diet with regards to the pre­sence of anemia and/or iron deficiency. Materials and methods. The study included 38 adults previously diagnosed with one of the major types of cereal intolerance — celiac disease or NCGS. All of them were on a gluten-free diet. The following hematological parameters were studied and analyzed for each subject: erythrocyte count, hemoglobin, ferritin, total iron-binding capacity, iron, and blood transferrin levels. Results. The analysis revealed that 13.16 % of 38 patients had mild IDA as measured by hemoglobin levels, and latent iron deficiency was found in 18.42 % patients. In general, analysis of serum ferritin concentrations revealed the rate of iron deficiency of 31.58 % despite follo­wing a gluten-free diet for 6.5 (interquartile range of 4–12) years, suggesting that the rate of all iron deficiency cases (including the latent ones) almost twice exceeds the rate of IDA detected by hemoglobin analysis. Withal, the red blood cell count was normal in 100 % of the examined people, but a decrease in the concentration of serum iron in the blood was observed in 23.08 % of patients. Among individuals with iron deficiency, people with celiac disease are more likely to be found than those with NCGS (83.3 and 16.7 %, respectively). Conclusions. Patients with celiac disease and NCGS remain at risk for the deve­lopment of IDA despite following a gluten-free diet. The isolated indicator of red blood cells is not informative for the diagnosis of not only latent iron deficiency but IDA as well. Isolated serum iron levels are also not indicative for the diagnosis of these conditions. In this regard, ferritin becomes the most significant marker of iron deficiency. Thus, it is necessary to carefully monitor this group of patients to identify latent forms of nutritional deficiency, in particular, iron deficiency, and to carry out the well-grounded individualized correction of their consequences.

Cereal and pulse combination is considered as the staple food in the diet pattern, whereas refined or processed food consumption plays an important role in the occurrence of chronic lifestyle-related diseases. Cake is a sweet baked food made from refined flour and sugar, egg and fat. Consumers are gaining awareness about the importance of consuming healthy and wholesome foods. Hence, there is a felt need to develop plant-based, gluten-free and lactose-free cupcakes incorporating indigenous kattuyanam rice by completely replacing refined flour. Brown rice (Oryza sativa L.), also recognized as Kattuyanam rice is one of the traditional coloured rice variety which has immense nutrient potentials and improves human health. The present study was intended to formulate a plant-based cupcake that is rich in protein, fibre and calcium. The study also aimed at evaluating its nutritional composition, calculate its cost, and to assess the level of acceptability by subjecting to organoleptic evaluation. The plant-based cupcakes were formulated in three different ratios using each pulse variety and with kattuyanam rice. The two varied pulses used were horse gram dhal [A KHC (50:10), B KHC (40:20), C KHC (30:30)] and green gram dhal [D KGC (50:10), E KGC (40:20), F KGC (30:30)], the cakes were formulated and standardized without the addition of any artificial preservatives. Sensory evaluation of the cupcakes was carried out by a panel comprising of twenty members and the nine-point hedonic scale was used. The results of the sensory evaluation revealed that the kattuyanam rice cupcakes formulated in the ratio 30:30 [C KHC and F KGC] from both the variations had maximum overall acceptability score, these were subjected for further analysis. Results of the nutrient analysis revealed that the cupcakes were rich sources of protein, fibre and iron. The cupcakes were priced at twelve rupees per piece, making it economical. The formulated kattuyanam rice cupcake can be considered a viable solution for people with celiac, lactose intolerance patients, and the population adopting a vegan lifestyle.

Foxtail millet (botanic name Setaria italica) is the second-most widely planted species of millet, and the most important in East Asia have not gain much importance in diet despite their nutritive value and therapeutic use. In this study efforts have been made to develop products like idly, dosa and upma by replacing the rice rawa and the wheat rawa in the recipe with foxtail millet rawa respectively. The study was aimed with objectives of developing products with foxtail millet rawa and their comparison with the traditional recipes of idly, dosa and upma, for their overall acceptability and evaluation of the organoleptic characteristics which was done by 10 semi-trained panelists and also the comparison of the three rawa in terms of their nutritional composition. Gluten content was determined by the method detailed in AACC (2000) method No.38-10. The study revealed that foxtail millet can be easily replaced and (or) incorporated in the local and common recipes for its greater utilization because of its health benefits and therapeutic use.

Context A gluten-free diet (GFD) is the recommended treatment for gluten-dependent disease. In addition, gluten withdrawal is popular and occasionally is suggested as a treatment for other autoimmune diseases (ADs). Objective The current systematic review summarizes those entities and discusses the logic behind using a GFD in classical non–gluten-dependentADs. Data Sources A search for medical articles in PubMed/MEDLINE, Web of Sciences, LILACS, and Scielo published between 1960 and 2020 was conducted, using the key words for various ADs and GFDs. Data Exxtraction Eight-three articles were included in the systematic review (using PRISMA guidelines). Data Analysis Reduction in symptoms of ADs after observance of a GFD was observed in 911 out of 1408 patients (64.7%) and in 66 out of the 83 selected studies (79.5%). The age of the patients ranged from 9 months to 69 years. The duration of the GFD varied from 1 month to 9 years. A GFD can suppress several harmful intraluminal intestinal events. Potential mechanisms and pathways for the action of GFD in the gut – remote organs’ axis have been suggested. Conclusion A GFD might represent a novel nutritional therapeutic strategy for classical non–gluten-dependent autoimmune conditions.

There are currently no universal evidence-based nutrition guidelines that address the gluten-free (GF) diet for children/youth (4–18 years). A GF food guide was created to help children/youth with coeliac disease (CD) and their families navigate the complexities of following a GF diet. Guide formation was based on pre-guide stakeholder consultations and an evaluation of nutrient intake and dietary patterns. The study objective was to conduct an evaluation on guide content, layout, feasibility and dissemination strategies from end-stakeholder users (children/youth with CD, parents/caregivers and health care professionals). This is a cross-sectional study using a multi-method approach of virtual focus groups and an online survey to conduct stakeholder evaluations. Stakeholders included children/youth (4–18 years), their parents/caregivers in the coeliac community (n 273) and health care professionals (n 80) with both paediatric and CD experience from across Canada. Thematic analysis was performed on focus group responses and open-ended survey questions until thematic saturation was achieved. χ2 and Fisher’s exact statistical analyses were performed on demographic and close-ended survey questions. Stakeholders positively perceived the guide for content, layout, feasibility, ethnicity and usability. Stakeholders found the material visually appealing and engaging with belief that it could effectively be used in multi-ethnic community and clinical-based settings. Guide revisions were made in response to stakeholder consultations to improve food selection (e.g. child-friendly foods), language (e.g. clarity) and layout (e.g. organisation). The evaluation by end-stakeholders provided practical and patient-focused feedback on the guide to enable successful uptake in community and clinical-based settings.

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

Coeliac disease (CD) is an autoimmune gluten-dependent condition with a prevalence of 1% in the population, if screened. However, approximately only a third of children with CD are diagnosed. When CD is suspected, serological screening with anti-tissue transglutaminase titres should be performed. Children with a positive result should be referred to a specialist in CD for confirmation of the diagnosis. The European Society for Paediatric Gastroenterology Hepatology and Nutrition revised their diagnostic guidance for CD in 2020 and this article discusses the current diagnostic pathways. Lifelong strict adherence to a gluten-free diet is necessary to prevent complications. Nurses and specialist paediatric dietitians have an important role in recognising and diagnosing CD early, as well as offering ongoing dietary and clinical support.

Celiac disease is treated by following a lifelong strict gluten-free diet. It is practically difficult to follow this diet and patient requires appropriate management. Objective. The aim of the study was to assess adherence to the gluten-free diet and the management of celiac disease in patients of Batna city. Population and methods. A descriptive cross-sectional survey was carried out with 110 patients from Batna city. A questionnaire was established to collect socio-demographic and clinical data, and information on gluten-free diet adherence, and on celiac disease management. Results. Good adherence to gluten-free diet was found in most patients (78%). Patients age, socio-professional level, as well as disease duration had a significant positive effect on gluten-free diet adherence. More than half of patients carried out dietetic and medical consultations. All patients inquired about the disease and its diet, even though they were not members of a celiac association. Education about the disease and treatment of complications were the main components of celiac disease management. Conclusion. Despite the good adherence to the gluten-free diet, noted in most patients, awareness and education of patients and their families about the celiac disease and its management is very important.

Introduction Celiac disease (CD) is an autoimmune enteropathy triggered by gluten ingestion in genetically susceptible individuals. In CD, activation of the immune response causes damage of the intestinal mucosa, and a gluten-free diet (GFD) is the only available therapy. Intestinal damage can lead to an increase in the circulation of components of bacteria from the intestinal lumen, such as lipopolysaccharide (LPS). Soluble CD14 (sCD14) and lipopolysaccharide-binding protein (LBP) participate in the recognition of LPS, and their levels are altered in different pathologies. In the present study, the circulating levels of sCD14 and LBP from untreated CD patients were evaluated and compared to CD patients on a GFD and controls. Material and methods In total seventy-two adult patients with CD, twenty-three untreated CD patients and forty-nine on a GFD were included. In addition, fifty-five healthy individuals were included as controls. Additionally, the effect of LPS on sCD14 production by both normal and inflamed intestinal tissue culture was explored. Results Serum levels of sCD14 were found to be significantly increased in untreated CD patients compared to patients on a GFD and controls. In addition, we found that LPS induced the production of sCD14 by biopsies of intestinal tissue from untreated CD patients. Conclusions The data from this study show that circulating levels of sCD14 are increased in the untreated CD patients compared to patients on a GFD. Our data show that LPS induces the production of sCD14 by the intestinal tissue from untreated CD patients.

Patients with celiac disease continue to be exposed to gluten despite efforts to maintain a gluten-free diet (GFD). Gluten exposure in those with celiac disease leads to pathological changes in the small intestine that may or may not be associated with gastrointestinal distress. While several studies have investigated a GFD, little is known about sources of gluten contamination that prevent proper maintenance of such a diet by celiac patients. In this study, we investigate common food practices that could lead to gluten cross-contact. Three different practices were examined for gluten cross-contact: gluten-free foods fried in a fryer also used for gluten containing foods, gluten-free bread toasted in a toaster also used for gluten-containing bread, and popular sandwich spreads applied with a knife used on gluten-containing bread (mayonnaise, jam, and peanut butter). We used the ALLER-TEK™ Gluten ELISA test kit and the sandwich ELISA RIDASCREEN Gliadin test kit, which is endorsed for determination of gluten content and used for the evaluation of food cross-contact. Using both kits gave the advantage of using the 401.2 antibody as well as the better established R5 antibody, providing increased confidence in our results. We found these practices resulted in small amounts of gluten cross-contact, although the majority of the results (93.6%) showed no significant cross-contact. Mayonnaise and peanut butter samples were contaminated with gluten above the limit designated by the FDA as gluten-free20 kg/mg (ppm).

ObjectiveThe analysis of intraepithelial lymphocytes (IELs) by flow cytometry of duodenal biopsies—the ‘IEL’ lymphogram—has been proposed as a diagnostic test for coeliac disease. However, its clinical applicability has been limited due to variability in methods and definitions. This study set out to define useful parameters for the application of the IEL lymphogram to the diagnosis of coeliac disease.DesignFlow cytometry was performed on 117 sets of duodenal biopsies in 107 adult patients with active coeliac disease, long-term coeliac disease on a gluten free diet and a control group. The initial 95 samples were used for hypothesis generation for the subsequent samples comprising 12 patients with coeliac disease and 10 controls.ResultsRather than using single linear cut-offs for CD3 and T-cell receptor γδ (TCRγδ)+ve IELs, a discriminant function was identified as %CD3+ve IELs+2x(%TCRγδ+IELs)>100. This differentiated coeliac disease from control biopsies in the hypothesis generating group. These results were replicated in the validation group and found to be independent of histology in patients on long-term gluten free diet up to 12 years (combined sensitivity, 98.5%; specificity, 97.7%).ConclusionsFlow cytometric analysis of IELs is a highly sensitive and specific adjunct to serology and histological examination for the diagnosis of coeliac disease, even in individuals with coeliac disease following a gluten free diet who exhibit normal duodenal histology.

Background and Objectives: Altered gastrointestinal permeability in celiac disease (CD) is mediated by zonulin. The receptor for zonulin is expressed on podocytes. Therefore, we tested the effect of a gluten-free diet (GFD) on albuminuria in pediatric patients with newly diagnosed CD. Methods: We performed a cohort study comparing urinary albumin (μg): Cr (mg) ratio (ACR) in CD patients versus controls and in response to a GFD. Results: Children with CD (n = 46) had higher ACR than controls (n = 21), 20.2 ± 5.6 versus 8.4 ± 1.1 μg/mg, p = 0.16 and exceeded 30 μg/mg (microalbuminuria cutoff) in 7/46 cases. Seventeen patients had a follow-up assessment (interval 6.1 ± 0.7 months) on a GFD. Baseline ACR was 20.7 ± 5.2 that fell to 10.4 ± 1.5 μg/mg, p = 0.035. Conclusion: Children and adolescents with newly diagnosed CD have low-grade albuminuria that is numerically higher than controls and that declined after implementation of a GFD. CD may be associated with reversible defects in the glomerular barrier.

Aim: The aim of this study was to evaluate the influence of gluten-free (GF) diet on social lives of patients. Subjects and Method: The design of the study was descriptive and cross-sectional. The questionnaire was designed as an online form. The online survey was announced on an online social support network called “Turkey Celiac Association” which has about 6000 members. The patients older than 18 years and diagnosed by a specialist doctor were enrolled in the study. Results: The study was completed with a total of 464 patients (114 males and 350 females). Difficulties often expressed by at least 50% of the respondents include: “limited purchasing power due to the high cost of gluten-free products (59.3%)”, “lack of accessibility to gluten-free products in grocery stores (51.9%)”, “lack of accessibility to gluten-free products in local stores (54.1%)”, and “inability to find shops and restaurants selling gluten-free foods during travelling (49.1%)”. Conclusion: Today, educating patients on a gluten-free diet is the cornerstone of treatment. In this article, the priorities of gluten-free nutrition education by the dietitians and recommendations of solution for the barriers affecting the sustainability of the diet are emphasized.

We report on the case of a 61-year-old male who initially presented with a progressive myoclonus and an intention tremor and was subsequently diagnosed with celiac disease. His neurological symptoms improved with anti-epileptic therapy and a gluten-free diet. Possible explanations include a milder disease phenotype or an epileptic component to his myoclonic movement disorder. This case highlights findings of a progressive myoclonic movement disorder, likely linked to celiac disease, and stresses the importance of a gluten-free diet in the management of the neurological manifestations of celiac disease.

Background and Objectives: Due to the high limitations of gluten-free diet, it seems that the diversity of diet in patients with celiac disease is affected. Therefore, in order to provide specific dietary advices to these patients, it is necessary to conduct a study on the diversity of these patients' diets. Therefore, the aim of this study was to investigate the dietary diversity score in adult patients with celiac disease. Material and Methods: In the present cross-sectional study, 130 celiac patients were selected from the celiac disease (CD) registry database of East Azerbaijan province, Iran. The dietary intake data was obtained by an 80-item semi-quantitative food frequency questionnaire. For determining diet diversity score (DDS), food items were categorized in five groups and 23 subgroups. To be counted as a "consumer" for any of the food groups categories, a respondent needed to consume one-half serving. The total score was between 0 and 10 and each subgroup score was between 0 and 2. The higher scores indicate the better diet diversity and the values less than 3, 3-5 and six and over were considered as low, moderate and high diet diversity scores respectively. The data were analysed using SPSS. The DDS was compared between adherences and non-adherents with on-way ANCOVA by adjusting to cofounding factors including age, sex, body mass index, energy intake, disease duration and gluten-free diet duration. Results: The mean age of celiac patients was 36.74±8.61 years. The mean total DDS was 3.97 ±1.36. The highest DDS was related to the fruit group (1.42 ± 0.68) and the lowest score was related to the meat group (0.40 ± 0.68). The result of covariance test showed that there were no significant differences between adherents and non-adherents regarding the DDS total score and subgroups scoes (P>0.05). The total DDS was less than 3 in 22.5% of patients, was between 3 and 5 in 73.3% of patients and six and over in 4.16% of patients. Conclusion: According to the results of the present study, the celiac patients had low DDS in all food groups. So, from the practical point of view, necessary educations should be provided to celiac patients to consume the gluten-free alternative to increase their diet diversity.

One of the most challenging aspects of celiac disease management is lack of awareness in public. Aim of the study was to evaluate public awareness and sensitivity on celiac disease and gluten-free diet. 501 individuals in Manisa, Turkey were subjected to a survey to obtain information on demographics, awareness of celiac disease, celiac and gluten-free diet relationship, effect on social life quality and social awareness and sensitivity. Results were analyzed by chi-square test. 43.9% of the public had never heard of celiac disease before. Females were more aware of the disease and gluten-free diet dependency. Majority of the postgraduates (79.6%) recognized the disease. 44.9% of the respondents remarked that celiac patients had hesitations on dining out, while 32.3% found those people restricted for travel and holiday activities. Above one-third of subjects indicated that gluten-free product variety in the market was inadequate. However, more than half had no idea on these. Over 50% felt that, social awareness and sensitivity towards disease was unsatisfactory. This study was conducted to mirror the society’s approach towards celiac patients. It was demonstrated that public’s awareness and sensitivity about celiac disease was scarce. Knowledge of ‘celiac’ needs to be raised.

Celiac disease, a permanent, irreversible but treatable disease is an autoimmune disease triggered by gluten ingestion in genetically predisposed individuals, also known as celiac sprue and gluten sensitive enteropathy. Recent findingsIntestinal inflammation and villous atrophy in small intestines by permanent intolerance to gluten in celiac disesea leads to seveare malabsorption. About 20%-38% patients were basically nutritionally imbalance secondary malabsorption due to mucosal damage. Nutrition plays a very important role in the management of celiac disease. Gluten free diet must be balanced to cover nutrient requirements to prevent deficiencies and ensure children’s health, growth and development.Conclusion Gluten-free diet is the only accepted and available treatment in CD. It was a life-long treatment, if not carried out with attention, it may lead to nutritional imbalance which can affect children’s growth and development

Article Details: Received: 2020-10-14 | Accepted: 2020-11-27 | Available online: 2021-01-31 https://doi.org/10.15414/afz.2021.24.mi-prap.80-84 The aim of the study was the evaluation of gluten quality of selected meat products. Gluten is a vegetable protein, which, due to its properties, is very often used in various sectors of the food industry and therefore in the production of meat products. Sensory evaluation, microbiological examination and gluten detection were performed in samples of sausages, Poultry frankfurter, Fine salami and Malokarpatska salami. The meat products came from different producers and were purchased from a retail network. Sensory quality was determined by assessing color, aroma, juiciness, fragility and taste using a 5-point rating scale. The microbiological examination included the determination of the total number of microorganisms, the number of psychrotrophic, coliform microorganisms and coagulase-positive staphylococci. The presence of gluten alone was detected using a commercially produced GlutenTox Home test kit as well as a PCR reaction. Individual testing of selected meat products showed minor differences in the overall quality of gluten free and gluten-free meat products. Keywords: meat products, salami, gluten, quality, microbiological examination References Abaffyova, Z. et al. (2015). Cereal grain a little different. Bratislava. Pediatria pre prax . 4, 140–146. Fric, P., Keil, R. (2011). Celiac disease for practice. Olomouc. Medicina pro praxi. 8, 354–359. Hulin, P., Dostalek, P., Hochel, I. (2008). Methods for determination of gluten proteins in food. Metody stanoveni lepkových bilkovin v potravinach. Chemicke listy ,102(5), 327–337. https://www.academia.edu/18759054/Methods_for_determination_of_gluten_proteins_in_food Olexova, L. et al. (2006). Detection of gluten-containing cereals in flours and ‘‘gluten-free’’ bakery products by polymerase chain reaction. Food Control , 17(3), 234–237. https://doi.org/10.1016/j.foodcont.2004.10.009 STN EN ISO 4833-1. Microbiology of food chain. Horizontal method for the enumeration of microorganisms. Part 1: Colony count at 30 degrees C by the pour plate technique. (ISO 4833-1: 2013) STN EN ISO 6888-1. Microbiology of food and animal feeding stuffs. Horizontal method for the enumeration of coagulase-positive staphylococci ( Staphylococcus aureus and other species). Part 1: Technique using Baird-Parker agar medium (ISO 6888-1:1999) STN EN ISO 4832. Microbiology. General guidance for the enumeration of coliforms. Colony count technique Taylor, S. (1992). Chemistry and detection of food allergens. Food Technology , 46(5), 148–152. https://doi.org/10.1080/10408399609527761 Toldra, F. (2002). Fermentation and starter cultures. Dry-cured meat products , Trumbull : Food & Nutrition Press Inc., 89–112. https://doi.org/10.1002/9780470385111 van Hengel, A. J. (2007). Food allergen detection methods and the challenge to protect food-allergic consumers. Analytical and Bioanalytical Chemistry , 389(1), 111–118. https://doi.org/10.1007/s00216-007-1353-5

Introduction A substantial proportion of adult patients with celiac disease on a gluten-free diet exhibit persistent villous atrophy, and inadvertent gluten exposure may be one of the causes. The aim of the present study was to evaluate villous atrophy persistence after 2 years on a gluten-free diet in de novo adult patients with celiac disease with strict control of gluten exposure. Methods Symptomatic de novo adult patients with celiac disease were prospectively included. Clinical visits and dietary surveillance were scheduled every 6 months during a 2-year follow-up period. At each visit, fecal samples were collected and stored at -20 °C until analysis for gluten immunogenic peptides (f-GIPs). A follow-up duodenal biopsy was performed at 2 years. We evaluated the variables associated with persistent villous atrophy. Results Seventy-six patients completed the study (36.5 ± 1.6 years, 73% women); persistent villous atrophy was observed in 40 (53%), whereas 72.5% were asymptomatic and 75% had negative serology. Detectable f-GIP >0.08 μg/g in at least 1 fecal sample was seen in 69% of patients. There were no significant differences in the median f-GIP at each visit and median area under the curve over the serial measurements between patients with persistent villous atrophy and those who recovered. On multivariate analysis, only older age was associated with persistent villous atrophy (32% for 16-30 years; 67% for >30 years; P = 0.016). Discussion The rate of persistent villous atrophy after 2 years was high in adult patients with celiac disease on an intentionally strict gluten-free diet. Low-level ongoing inadvertent gluten exposure could be a contributing factor to persistent villous atrophy.

OBJECTIVE Gluten-free (GF) diet is the only reliable treatment for patients with celiac disease (CeD), but data on the extent of gluten contamination in GF food available in India is scanty. We evaluated gluten content in labeled, imported, and non-labeled GF food products currently available in the Indian market. METHODS Overall, 794 processed and commercially available packaged GF products (labeled GF (n = 360), imported GF (n = 80), and non-labeled/naturally GF (n = 354)) were collected from supermarkets of National Capital Region of India. Those unavailable in stores were purchased from e-commerce sites or directly from the manufacturers. Gluten level in them was determined by Ridascreen Gliadin sandwich R5 enzyme-linked immunosorbent assay (R-Biopharm AG, Germany). As per Codex Alimentarius and Food Safety and Standard Authority of India, "gluten free" labeled products must not contain > 20 mg/kg of gluten. RESULTS Overall, 10.1% of 794 GF products including 38 (10.8%) of 360 labeled and 42 (11.8%) of 354 non-labeled/naturally GF food products had gluten content > 20 mg/kg (range: 24.43-355 and 23.2-463.8 mg/kg, respectively). None of the imported GF products had gluten more than the recommended limits. Contaminated products most commonly belonged to cereal and their products (flours, coarse grains, pasta/macaroni, snack foods) pulse flours, spices, and bakery items. CONCLUSIONS A substantial proportion (10.1%) of GF food products (both labeled and non-labeled) available in India have gluten content greater than the prescribed limits of

Celiac disease is a common chronic autoimmune condition for which the only therapy currently available is strict adherence to a gluten-free diet for life. Although the diet is effective in reversing the intestinal mucosal changes, it is cumbersome to follow, is associated with some dietary deficiencies, is less palatable, and has significant quality of life implications. For all these reasons, alternatives to the gluten-free diet would greatly benefit people with celiac disease. A better understanding of the pathophysiology of celiac disease has led to possible new treatments that target various steps in the development of the disease. These include intraluminal digestive enzymes and peptide-binding agents that render gluten non-toxic, drugs that modulate tight junctions between enterocytes or interfere with the inflammatory cascade that causes mucosal destruction, and agents designed to induce immune tolerance to gluten. Although several of these new therapeutic agents currently under investigation are showing some promise, they still need to demonstrate they are as effective and safe as the gluten-free diet before they can be recommended as an acceptable alternative for treatment of people with celiac disease. The gluten-free diet remains the only proven safe and effective treatment for celiac disease.

The article presents the results of a study on the development of a recipe for semi‑finished custard based on gluten‑free raw materials. The ratio of components in the gluten‑free mixture was optimized using the regression analysis method. The influence of gluten‑free raw materials on the rheological properties of the semi‑ finished product is studied. The variants of the experiment differed in the composition of the composite mixture (the ratio of corn, rice flour and corn starch). The chemical composition and the ratio of the components of the mixture determine the rheological properties of the semi‑finished product. The experimental version with the ratio of rice flour, corn flour and corn starch 50:40:10 most corresponds to the rheological properties of the control version and is characterized by high consumer properties.

Celiac disease (CD) is a multisystemic autoimmune disorder triggered by gluten, and the only known remedy available for this malady is a gluten-free diet (GFD). Therefore, we performed a systematic review to correlate the influence of different factors in compliance to a GFD. We searched PubMed database, from inception to April 2019. As inclusion criteria we considered population under 18 years, confirmed diagnosis of CD without related comorbidities and the study objective being the factors affecting compliance to a GFD. The variables compared were age, parent's education level, parental knowledge about CD, family type, celiac association membership, quality of life, and perception of difficulties in maintaining a GFD. We identified 1,414 articles, 35 articles were eligible for full text assessment and 12 were included in the study since they studied similar variables. Our work has found some limitations namely a variety of methods to assess GFD compliance, a limiting definition of compliance, a parental bias in data, an absence of standardization in age categories, and a majority of studies being observational in their nature. Age as well as parental knowledge of CD and family type are key factors in pediatric GFD compliance. Nevertheless environmental, social, and family factors were also related with compliance. Further studies are needed to fully disclose the causality relation between these factors and compliance.

The research in the field of technology of gluten-free butter biscuits of functional purpose for nutrition of schoolchildren of junior and middle age using rice, millet, corn flour and carrot puree is presented. The quality indicators of biscuit dough and biscuit were investigated, the nutritional value and caloric content of the product were calculated. Experimental studies have shown that with a complete replacement of wheat flour with gluten-free flour of various types, the quality of biscuit dough and biscuit improves: the density of the dough decreases, its effective viscosity decreases, the products have a pleasant pronounced taste and aroma, the correct shape, the porosity of products and their specific volume increase. The developed sample of gluten-free sponge cake in terms of the content of potassium, magnesium, vitamins of groups B, A and E can be attributed to functional foods for schoolchildren's nutrition.

This study determined the gluten content of foods and meals consumed by coeliac disease (CD) patients who adhere to a gluten-free diet, and to estimate the total daily intake of gluten of these patients. CD patients fulfilling defined inclusion criteria were preselected and approached for participation in the study. Duplicate portions (DP) of foods and mixed dishes were collected from the CD patients for evaluating complete daily food intake during two individual days. Also, for these days, written food records were completed by the participants. From each DP, a laboratory sample was prepared and analysed for its gluten concentration and total daily gluten intake was calculated. Each individual’s total daily intakes of energy and macronutrients were calculated using the Dutch food composition database. In total, twenty-seven CD patients participated, seven males and twenty females, aged between 21 and 64 years. In thirty-two (6 %) of 499 food samples collected in total, more than 3 mg/kg gluten was present. In four of these thirty-two samples, the gluten concentration was above the European legal limit of 20 mg/kg and three of the four samples had a gluten-free label. The maximal gluten intake was 3·3 mg gluten/d. The gluten tolerance for sensitive CD patients (>0·75 mg/d) was exceeded on at least six out of fifty-four study days. To also protect these sensitive CD patients, legal thresholds should be re-evaluated and the detection limit of analytical methods for gluten analysis lowered.

A review of the gluten‑free food market was carried out, which showed that the growth potential of the Russian market is quite high. Three main types of diseases associated with a reaction to gluten have been identified: autoimmune celiac disease (celiac disease), allergic enteropathy (immunological reaction to wheat protein) and non‑ autoimmune non‑allergic gluten intolerance (gluten intolerance without celiac disease). Scientists from P. M. THEM. Sechenov, it was shown that the wheat protease enzyme Triticain‑α‑GM from Triticum aestivum opens up new possibilities for its use in oral therapy of gluten intolerance. The use of this enzyme will be studied in the technology of production of bakery and flour confectionery products, which in the future will make it possible to develop products that are safe for people with various types of gluten intolerance.

Non-celiac gluten or wheat sensitivity (NCWS) is a “clinical entity induced by the ingestion of wheat leading to intestinal and/or extraintestinal symptoms that improve once the wheat-containing foodstuff is removed from the diet, and celiac disease and wheat allergy have been excluded”. This mostly accepted definition raises several points that remain controversial on this condition. In the present review, the authors summarize the most recent advances in the clinic and research on NCWS through an accurate analysis of different studies. We screened PubMed, Medline, Embase, and Scopus using the keywords “non-celiac gluten sensitivity”, “non-celiac wheat sensitivity”, and “diagnosis”. We would like to emphasize two main points, including (A) the controversial clinical and etiological aspects in different trials and experiences with particular attention to the Salerno criteria for the diagnosis of NCWS and (B) the histological aspects. The etiology of NCWS remains controversial, and the relationship with irritable bowel syndrome is obscure. Histologically, the duodenal mucosa may show a variable pattern from unremarkable to a slight increase in the number of T lymphocytes in the superficial epithelium of villi. The endorsement of this disease is based on a positive response to a gluten-free diet for a limited period, followed by the reappearance of symptoms after gluten challenge. The Salerno expert criteria may help to diagnose NCWS accurately. Social media and inaccurate interpretation of websites may jeopardize the diagnostic process if individuals self-label as gluten intolerant.

Globally, celiac disease (CD) affects around 1-2% of the population. Gluten elimination becomes the cornerstone treatment and is also being followed by non-celiac as a healthy dietary habit. However, there is lack of sustainable evidence to understand this view. Adherence to gluten-free diet (GFD) rendered a few to reduced quality of life. Hence, a meta-analysis has been performed to determine interaction of GFD and Health-related Quality of Life (HRQoL). NCBI/MEDLINE, PubMed, Cochrane Library, Google Scholar and Science Direct were combed from date of inception to October 30, 2018 for studies assessing the effect of GFD using validated questionnaires on HRQoL a) between healthy controls and celiac patients b) dietary adherence to GFD in celiac subjects. Random effect model was used for meta-analysis. Twenty-five studies comprising 5148 CD subjects fit in the inclusion criteria. GFD had moderate significant association with HRQoL, for PGWB odds ratio’s (OR) 0.613 [95% CI, 0.449-0.837], SF-36 Mental Component Score (MCS) 0.026 [95% CI, 0.011-0.060], Physical Component Score (PCS) 0.066 95% [CI, 0.032-0.138]. Partial adherence to GFD had lower quality of life when compared to strictly adherent patients for OR’s SF-36 MCS 5.080 [95% CI, 1.885- 13.692], PCS 3.204 [95% CI, 1.579- 6.503] and CDQoL 2.439 [95%CI (1.724- 3.450)]. The results implied moderate significant association between GFD and HRQoL and better compliance leads to favourable HRQoL.

PurposeThe prevalence of celiac disease is increasing alarmingly. The only and effective treatment for this disease is a strict gluten-free diet Efforts have been made by industrialists to produce gluten-free products (GFPs); however, their low availability and high cost, compared to gluten-containing products (GCPs) still remain among the factors that cause gluten-free adherence failure. The objective of this survey is to compare the availability and cost of GFPs in supermarkets in two Moroccan cities, Marrakech and Casablanca, and on e-commerce platforms and see how they compare to GCPs.Design/methodology/approachThis is a cross-sectional study that targets supermarkets and e-commerce websites that sell GFPs food and their GCPs equivalents. The price of each product is recorded per 100 g.FindingsThe study surveys 271 GFPs and their 579 GCPs equivalents that were subsequently divided into six categories. The “GF Cookie and Cakes” category came on top of the list of products. GFPs were more available on e-commerce websites than at supermarkets in two Moroccan cities (p = 0.003). The GFPs are 364% (115–1309%) more expensive than their GCPs counterparts. Also, the authors recorded a significant price difference between GFPs sold in supermarkets and those sold on online.Originality/valueThis study reveals that labeled GFPs are less available and more expensive than their equivalents GCPs in Morocco. This affects GF diet adherence and quality of life of celiac patients. The patients who use GFPs need financial compensation from the national government.

The goal of this review is to address the different reasons individuals adopt a gluten-free diet (GFD), including, but not limited to, celiac disease (CD), gluten ataxia (GA), and dermatitis herpetiformis (DH) and non-celiac gluten sensitivity (NCGS). The perceived health benefits and confusion surrounding gluten and gluten-free (GF) options will be addressed. The benefits and challenges of the diet will be discussed. There will be a specific emphasis on how to avoid and correct potential nutritional deficiencies which are commonly seen in patients on a GFD. Several studies have addressed challenges with the GFD including availability, nutrient quality of GF foods, and cost. Data has shown that nutritional deficiencies are common in patients following a GFD. More patients are starting the GFD for symptoms and conditions. It is important to be aware of the nutritional inadequacies of the diet. Counseling by a registered dietitian for individuals following a GFD with or without a gluten-related diagnosis is essential to achieve best outcomes.

Agriculture faces many challenges such as climate change, droughts, and salinity, which requires urgent interventions for fast adaptation and diversification of the sector. In this context, introduction of new crops that tolerate stresses and generate high added value such as quinoa would allow simultaneously to address two interlinked challenges: abiotic stresses that limit agricultural production and poverty that impacts negatively the rural people. The quinoa Rehamna project funded by the International Development Research Centre aims to contribute to the development the quinoa value chain toward achieving food and nutritional security of rural poor communities. The obtained results from the farmer's survey show that 14% of surveyed farmers already grow quinoa and 2/3 never heard about quinoa, among them 96% are interested to grow quinoa. The marketing study reveals that the psychological price that satisfies most of consumers is ranging between 2 and 2.6 USD/500 g of processed quinoa seeds. The findings indicate that quinoa has a great potential for both producers and consumers in Morocco and can be a judicious solution toward achieving food and nutritional security.

The objective of this study is to report the clinical characteristics and treatment of patients with progressive cerebellar ataxia associated with anti-GAD antibodies. We performed a retrospective review of all patients with anti-GAD ataxia managed at the Sheffield Ataxia Centre over the last 25 years. We identified 50 patients (62% females) with anti-GAD ataxia. The prevalence was 2.5% amongst 2000 patients with progressive ataxia of various causes. Mean age at onset was 55 and mean duration 8 years. Gaze-evoked nystagmus was present in 26%, cerebellar dysarthria in 26%, limb ataxia in 44% and gait ataxia in 100%. Nine patients (18%) had severe, 12 (24%) moderate and 29 (58%) mild ataxia. Ninety percent of patients had a history of additional autoimmune diseases. Family history of autoimmune diseases was seen in 52%. Baseline MR spectroscopy of the vermis was abnormal at presentation in 72%. Thirty-five patients (70%) had serological evidence of gluten sensitivity. All 35 went on gluten-free diet (GFD). Eighteen (51%) improved, 13 (37%) stabilised, 3 have started the GFD too recently to draw conclusions and one deteriorated. Mycophenolate was used in 16 patients, 7 (44%) improved, 2 stabilised, 6 have started the medication too recently to draw conclusions and one did not tolerate the drug. There is considerable overlap between anti-GAD ataxia and gluten ataxia. For those patients with both, strict GFD alone can be an effective treatment. Patients with anti-GAD ataxia and no gluten sensitivity respond well to immunosuppression.

Bifidobacterium infantis NLS super strain (B. infantis NLS-SS) was previously shown to alleviate gastrointestinal symptoms in newly diagnosed coeliac disease (CD) patients consuming gluten. A high proportion of patients following a gluten-free diet experiences symptoms despite dietary compliance. The role of B. infantis in persistently symptomatic CD patients has not been explored. The aim of the study was to evaluate the effect of B. infantis NLS-SS on persistent gastrointestinal symptoms in patients with CD following a long-term GFD. We conducted a randomised, cross-over, double-blind, placebo-controlled trial in symptomatic adult CD patients on a GFD for at least two years. After one-week run-in, patients were randomised to B. infantis NLS-SS or placebo for 3 weeks with cross-over after a 2-week wash-out period. We estimated changes (Δ) in celiac symptom index (CSI) before and after treatment. Stool samples were collected for faecal microbiota analysis (16S rRNA sequencing). Gluten immunogenic peptide (GIP) excretion in stool and urine samples was measured at each study period. Eighteen patients were enrolled; six patients were excluded due violations in protocol. For patients with the highest clinical burden, CD symptoms were lower in probiotic than in placebo treatment (P=0.046). B. infantis and placebo treated groups had different microbiota profiles as assessed by beta diversity clustering. In probiotic treated groups, we observed an increase in abundance of B. infantis. Treatment with B. infantis was associated with decreased abundance of Ruminococcus sp. and Bifidobacterium adolescentis. GIP excretion in stools and urine was similar at each treatment period. There were no differences in adverse effects between the two groups. B. infantis NLS-SS improves specific CD symptoms in a subset of highly symptomatic treated patients (GFD). This is associated with a shift in stool microbiota profile. Larger studies are needed to confirm these findings. ClinicalTrials.gov: NCT03271138

Migraine is common in celiac disease (CD) and usually improves on a gluten-free diet (GFD). The benefit for people impacted by migraine without CD is poorly evidenced. A GFD may have adverse health consequences and is expensive.

Sorghum [Sorghum bicolor (L.) Moench] is one of the most important cereals worldwide with great genetic diversity. Like most small grains it has good adaptation to drought prone and marginal areas were other cereals are not productive. Globally, sorghum has been underutilized compared to other cereal staple crops however, there is growing interest in sorghum and its related products due to its unique nutritional traits, crop physiology and phenology. Given the genetic variability of sorghum there is great scope to use the crop to produce an array of commodities in the food, feed, industrial and bioenergy sector. This review paper presents sorghum genetic diversity and with special reference to bio-based and value added products such as gluten free, high protein, aromatic, syrup, popping, weaning, pet food, baked products and alcohol free malt beverages that can be explored in Africa to popularize it and improve livelihoods. Key words: Small grain, sorghum bicolor, value addition.

BACKGROUND: A major deficit in understanding and improving treatment in coeliac disease (CD) is the lack of empiric data on real world gluten exposure. AIMS: To estimate gluten exposure on a gluten-free diet (GFD) using immunoassays for gluten immunogenic peptides (GIP). Relationships among GIP detection, symptoms and suspected gluten exposures were examined. METHODS: Adults with biopsy-confirmed CD on a GFD for 24 months were recruited from a population-based inception cohort. Participants kept a diary and collected urine samples for 10 days and stools on days 4–10. “Doggie bags” containing ¼ portions of foods consumed were saved during the first 7 days. Gluten in food, stool and urine was quantified using A1/G12 ELISA. RESULTS: Eighteen participants with CD (12 female; age 21–70 years) and 3 participants on a gluten-containing diet enrolled and completed the study. 12/18 CD participants had a median 2.1 mg gluten per exposure (range 0.2 to >80 mg). Most exposures were asymptomatic and unsuspected. There was high intraindividual variability in the interval between gluten ingestion and excretion. Participants were generally unable to identify the food. CONCLUSIONS: Gluten exposure on a GFD is common, intermittent, usually silent, and excretion kinetics are highly variable between individuals. The amount of gluten varied widely, but was typically in the milligram range which was 10–100 times less than was consumed by those on an unrestricted diet. These findings suggest that a strictly gluten free diet is difficult to attain and specific exposures are difficult to detect due to variable time course of excretion.

Background. Serum uric acid (UA) levels are one of the determinants of the cardiovascular disease and metabolic syndrome but none of criteria for that syndrome include serum UA. Consumption of bakery products (with or without gluten) is associated with an increasing prevalence of overweight/obesity and hyperuricemia frequently occurs in subjects with overweight and obesity. Objective. The aim of the study was to find out how 6-weeks consumption of gluten-free bakery products can affect risk factors for cardiovascular disease and metabolic syndrome, and especially uric acid levels. Material and Methods. The group was composed of 27 female volunteers consuming gluten-free bakery products during 6-week period. The biochemical parameters levels were measured by Biolis 24i Premium, the anthropometric parameters by InBody 720 and blood pressure by OMRON Microlife. Results. We found a non-significant increase in total cholesterol and decrease in triglycerides, in the case of LDL cholesterol a significant reduction in values and increase of HDL cholesterol. Glucose level increased significantly, but uric acid has not changed significantly. We found the highest total cholesterol, triglyceride, and LDL concentrations in the third UA quartile. The highest glucose concentrations were found in the lower UA quartiles, while the lowest in the highest quartiles. Linear increases in UA concentrations were not observed in any of the parameters. Evaluation of the anthropometric parameters showed that while values of BMI, VFA, fat mass and waist circumference were the highest at the beginning of the study in the second quartile, after intervention the highest values were shifted to the third quartile. Conclusions. Due to the consumption of gluten-free bakery products the risk values of the monitored parameters shifted to higher UA quartiles.

The aim of this review was to assess the effects of a gluten free diet (GFD) in the management of epilepsy in people with coeliac disease (CD) or gluten sensitivity (GS). A systematic approach was used to undertake a literature review. Five electronic databases (PubMed; Scopus; Google Scholar; Cochrane Epilepsy Group specialised register; Cochrane Register of Controlled Trails (CENTRAL) via the Cochrane Register of Online Trials) were searched using predetermined relevant search terms. In total, 668 articles were identified. Duplicates were removed and predefined inclusion and exclusion criteria were applied, and a PRISMA flow chart was produced. Data was extracted using Covidence software. Twelve studies on Epilepsy and CD involving a total of 70 participants were selected for analysis; narrative synthesis was used owing to the small sample sizes in the selected studies. None of the 12 studies meeting inclusion criteria investigated gluten sensitivity and epilepsy. All the included studies support a link between epilepsy and CD. GFD was effective in 44 out of 70 participants across the studies in terms of a reduction of seizures, reduction of antiepileptic drugs (AEDs) or normalisation of EEG pattern. A total of 44 participants showed a reduction in seizures (across eight studies) and complete cessation of seizures was reported in 22 participants. In general, the earlier the GFD is implemented after the onset of seizures, the better the likelihood of the GFD being successful in supporting control of seizures. Mechanisms linking gluten with epilepsy are not fully understood; possible hypotheses include gluten mediated toxicity, immune-induced cortical damage and malabsorption. Evidence suggests the effectiveness of a GFD in supporting the management of epilepsy in patients with CD, although the quality of evidence is low. There appears to be a growing number of neurologists who are prepared to advocate the use of a GFD. A multidisciplinary approaches and further research are recommended. It could be argued that when balancing potential treatments such as AEDs or surgery, a GFD has a low likelihood of harm.