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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.

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.

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.

Chenopodium quinoa (quinoa) is considered a superfood with its favourable nutrient composition and being gluten free. Quinoa has high tolerance to abiotic stresses, such as salinity, water deficit (drought) and cold. The tolerance mechanisms are yet to be elucidated. Quinoa has Epidermal Bladder Cells (EBCs) that densely cover the shoot surface, particularly the younger parts of the plant. Here, we report on the EBC's primary and secondary metabolomes, as well as the lipidome in control conditions and in response to abiotic stresses. EBCs were isolated from plants after cold, heat, high-light, water deficit and salt treatments. We used untargeted Gas Chromatography-Mass Spectrometry (GC-MS) to analyse metabolites and untargeted and targeted Liquid Chromatography-MS (LC-MS) for lipids and secondary metabolite analyses. We identified 64 primary metabolites, including sugars, organic acids and amino acids, 19 secondary metabolites, including phenolic compounds, betanin and saponins and 240 lipids categorized in five groups including glycerolipids and phospholipids. We found only few changes in the metabolic composition of EBCs in response to abiotic stresses, these were metabolites related with heat, cold and high-light treatments, but not salt stress. Na+ concentrations were low in EBCs with all treatments, and approximately two orders of magnitude lower than K+ concentrations. This article is protected by copyright. All rights reserved.

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

The food allergy and allergen control are important for global health concerns. Latent allergens are a paramount problem in the specialized food products. Cross-contact and post-cleaning contamination are the main sources of these problems. According to the norms of the Technical Regulation Custom Union N 027/2012 and the Codex Stan 118-79 standard, the gluten content in food products should not exceed 20 mg / kg of the product. The purpose of this study was to analyze raw materials for the gluten-free food products manufacture to justify the HACCP system implementation. The samples of gluten-free flours were selected as research objects to assess the cleanliness of storage, transportation and production facilities in factories producing gluten-free products. In this study, we analyzed the samples of gluten-free flours to assess the cleanliness of storage conditions, transportation and industrial premises in gluten-free factories. The results showed that when using raw materials stored under improper conditions an increase in the gluten content in the final product is observed. We concluded that the gluten-free flours storage conditions in a room with gluten-containing raw materials are unacceptable, because the final product will have high gluten content. Thus, this product cannot be marketed as gluten-free. In addition, we analyzed the washes from the equipment after baking cookies from these flours. We found that in order to comply with regulations, it was necessary to conduct 3 consecutive washing

Aim Gluten-free diets (GFDs) have gained popularity in the general population. Nonetheless, controlled studies are necessary before decisions can be made to promote GFDs. We aimed to evaluate the effects of gluten intake on body weight, body composition, and resting energy expenditure and observe the changes in nutrient intake caused by GFDs. Methods Twenty-three women were kept on a GFD for six weeks and received muffins with 20 g of gluten isolate (gluten period) or muffins without gluten (gluten-free period) in a crossover, single-blind, non-randomized trial. Gastrointestinal symptoms, food frequency questionnaires, body composition, and resting energy expenditure were assessed before the study (habitual or usual diet) and in the third and sixth weeks. Food intake was recorded daily for six weeks. Results Gastrointestinal symptoms, resting energy expenditure, and body weight and composition were similar during the gluten period and gluten-free period. When the diet of the gluten-free period was compared with the habitual diet, we found an increase in the intake of fat and sodium and a reduction in the intake of fiber and vitamins B1, B6, B12, and folate. The nutrient imbalance caused by a GFD led to an increase in the dietary inflammatory index, thus suggesting that this type of diet has high inflammatory potential. Conclusion Gluten intake (20 g/day) did not alter body composition and resting energy expenditure in healthy women without caloric restriction in the diet for a short period (three weeks). However, a GFD led to changes in the composition of the diet, which worsened the quality of the diet and increased its inflammatory potential.

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.

Gluten-related disorders (GRDs) including celiac disease have gradually emerged as an epidemiologically relevant global phenomenon with an estimated prevalence around 5%. In India GRDs occur more in the north and north-west, where wheat is the staple, than in the south and east, where rice is the staple. The most common general symptoms of GRDs include bloating, abdominal pain, constipation, diarrhea, headache, tingling and numbness in hands and feet, fatigue and joint pain. GRDs are difficult to diagnose and generally the patients receive symptomatic treatment. The main reason for the increase in GRDs is the increase in area, production, procurement and distribution of wheat, a gluten rich cereal, at a reduced price through Public Distribution System throughout the country. As a consequence, the area under coarse grains, their production and consumption, has largely decreased. Coarse grains (pearl millet, sorghum etc.) are gluten free and their increased production and consumption can help in avoiding an epidemic of GRDs including celiac disease. In the international market there is a growing demand for gluten free foods and if strategically marketed, coarse grains could become an export commodity for India.

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.

This cross-sectional study aimed to evaluate and classify barriers to adherence to the gluten-free diet in 137 Iranian adults with celiac disease. We used a 23-point Likert questionnaire and exploratory factor analysis to identify and classify the barriers. Adherence to gluten-free diet was assessed by measuring the serum level of anti-tTG-IgA. The correlation between the barriers and adherence to gluten-free diet was assessed using logistic regression. A total of 117 subjects completed the study. Seven factors were extracted: "gluten-free diet restrictions," "self-awareness and social awareness," "psychological barriers," "education," "situational barriers and gatherings," "lack of access/labeling," and "cost." There was a significant correlation between the situational barriers and gatherings and nonadherence to the diet in the adjusted model (odds ratio = 1.63; 95% confidence interval [1.03, 2.54], p = .03). Nutritionists and physicians should consider these barriers when consulting patients with celiac disease.

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.

This study aimed to determine an optimum formula for producing gluten-free pasta using banana flour. A mixture design experiment was conducted, and three factors were analyzed, 40-60% banana flour, 7-27% modified starch, and 23-43% water. The most appropriate formula included 40% banana flour, 27% modified starch, and 33% water. The nutritional profile of this gluten-free pasta per 100 grams was 469.29 kilocalories of total energy, 4.71 grams of protein, 7.60 grams of dietary fiber, 26.69 micrograms of vitamin A, 0.039 milligrams of vitamin B, 0.093 milligrams of vitamin B2, 60.30 milligrams of calcium, and 1.33 milligrams of iron. Further, these pasta products exhibited prebiotic properties and their overall preference score was at a moderate level of 7.02. Consequently, the gluten-free pasta made using banana flour differed from the commercial product due to its soft and flexible texture. Altogether, the pasta was nutritious and had prebiotic properties.

PurposeLow glycemic index gluten-free cookies from high amylose rice flour were prepared by modifying baking conditions and ingredient composition.Design/methodology/approachBaking temperature, baking time, and concentration of carboxymethyl cellulose (CMC) were varied between 170 and 190° C, 12–25 min, and 0.2–1%, respectively, using central composite rotatable design. The developed cookies were packed in metalized polyester pouches and stored under ambient conditions for a period of 90 days.FindingsWidth and bulk density of cookies increased significantly (p RPractical implicationsGluten-free (GF) foods are in high demand globally due to the prevalence of celiac disease. Rice lacks gluten protein, and thus, can serve as a potential raw material for the development of GF cookies. In the present study, the ingredient modification and freezing interventions during baking were found to be crucial if the development of low GI gluten-free cookies having good RS content is targeted. Optimized GF cookies prepared via technological intervention and packed in metalized polyester were shelf stable for up to 3 months under ambient conditions. Furthermore, resistant starch content was enhanced while the predicted glycemic index was decreased during storage. Adoption of baking conditions and CMC level optimized in the present study can help to develop shelf-stable GF bakery products for people suffering from comorbidities like celiac disease and diabetes.Originality/valueResistant starch content was enhanced while predicted glycemic index was decreased during storage of gluten-free cookies prepared from high amylose rice flour. The developed cookies can be a complementary diet to people suffering from comorbidities like celiac disease and diabetes.

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 Buckwheat consumption is associated with positive health effects in humans. Buckwheat has diverse nutrients with biological functions. Buckwheat storage protein is gluten free and is a major bio-factor responsible for the functions. The protein can be a source of allergens. It is important to understand the biological properties and food uses of buckwheat protein to develop buckwheat as a “healthy” grain. Scope and approach This review summarizes diverse biological activities of proteins and peptides from both common and Tartary buckwheat seeds. Strategies to reduce the symptoms of buckwheat protein allergy are discussed. The properties of the proteins and peptides in relation to the quality of buckwheat based products are also reviewed. Research gaps in better understanding and using buckwheat proteins and peptides for food applications are identified. Key findings and conclusions The protein isolates from buckwheat have been hydrolyzed into a range of peptides. These peptides showed diverse biological activities in vitro and in vivo. They include trypsin inhibition, antiaging, modulating gut microbiota, prevention of cardiovascular diseases, blood pressure lowering, immunomodulatory, antidiabetic, antimicrobial, anticancer and antioxidant capacities. Buckwheat has been processed into a range of products such as vinegar, beverages and breads. The quality of these products can be significantly affected by the protein and peptide properties. Overall, buckwheat proteins and peptides have potential to be developed into functional food products.

The production of gluten-free (GF) laminated dough pieces is still a challenge in food industry. This work aims to evaluate changes in GF bulk dough characteristics as affected by the addition of hydrocolloids and the process of production of laminated products. Xanthan gum (XG), hydroxypropyl methylcellulose (HPMC) and psyllium (P) were added at 2.5 and 5% in GF dough made with rice and soy flour and cassava starch. Protein fractions were extracted, quantified and analyzed by electrophoresis. Rheology was evaluated by a creep and recovery test and proton mobility was explored by nuclear magnetic resonance. Tests were done on samples before and after the refrigerated rest time to assess the impact of that production step. Extractability of native proteins increased with lower doses of additives, while higher doses reduced it. The opposite behavior was observed on extractability of noncovalent proteins. Under stress, XG (J0: 7.7·10–6 and 4.9·10–6 Pa−1; J1: 7.3·10–6 and 4.9·10–6 Pa−1) and HPMC samples (J0: 7.0·10–6 and 6.5 10–6 Pa−1; J1: 8.2·10–6 and 8.6·10–6 Pa−1) showed lower instantaneous and viscoelastic compliance than control sample (J0: 9.8·10–6 Pa−1; J1: 10.5 10–6 Pa−1), while P had higher values (J0: 10.4·10–6 and 9.8·10–6 Pa−1; J1: 12.5·10–6 and 12.5·10–6 Pa−1). Additives promoted more viscous dough relaxation. After the refrigerated rest time, XG-2.5% elastic recover enhanced, while HPMC showed the opposite. XG decreased water proton mobility and P increased it. The refrigerated rest time enhanced water structuration.

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.

The objective of the present study was to optimize and develop minor millet-based inulin incorporated gluten free instant noodles with seasonings. The noodles were prepared using durum wheat flour (control 1) and multi millet flour (control 2) along with inulin, xanthan gum, salt and water. The noodles were extruded with the thickness of 3 mm and steamed for 5 minutes in a pre-heated steamer. The steamed noodles were dried at 100°C for 20 minutes and then at 40°C until the moisture content decreased to 9-10 %. The sensory, physico-chemical and textural characteristics of the noodles were evaluated. Noodles with 20% inulin incorporation scored high among variations. The moisture, dietary fiber and fat content of the noodles increased significantly (P

Psyllium (from Plantago ovata; ispaghula) is used as a dietary supplement and is supplied in the form of husk, granules, capsules, or powder. Consumers using psyllium-containing laxatives, healthcare workers handling these, and pharmaceutical workers in laxative-manufacturing plants are known to be at risk of sensitization and subsequent rhinitis, asthma, contact urticaria, and even anaphylaxis. To our knowledge, the case we present here is the first of baker's immunoglobulin E (IgE)-mediated occupational allergy due to psyllium exposure. Our patient, a 24-year-old female baker with no previous allergies, was referred to our clinic with suspected occupational rhinitis. After 1 year of baking with cereal flour or gluten-free flour-mix, she began to suffer from rhino-conjunctival symptoms during workdays. Skin prick tests with agents from the patient's workplace revealed allergies not only to wheat and rye flours but also to psyllium, with a remarkable 10 mm wheal. Subsequently, nasal provocation tests confirmed occupational allergic rhinitis to psyllium. We also found work-related sensitization to buckwheat, which she used in gluten-free baking. Due to the increased prevalence of celiac disease and the popularity of gluten-free and vegan food, psyllium has recently become a common ingredient in baking, used as a substitute for gluten or eggs. Bakers handle allergens such as these in high concentrations and this may lie behind the emergence of respiratory and dermal symptoms. It is essential to consider new or recenlty introduced materials as possible allergens if it is suspected that a baker has work-related respiratory or allergic symptoms.

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

This study aimed to develop a gluten-free cracker by substituting wheat flour (WF) with riceberry flour (RB) combined with cheese’s milk proteins to replace gluten. The effect of substitution of WF with RB at 50 and 100% (RB50 and RB100, respectively) on cracker properties were evaluated. The results showed that water activity, hunter colour value (L(*)), hardness, and thickness decreased with an increase in the RB content. This related to a compact structure and a weaker crystallinity of RB cracker when compared with WF-based cracker. The substitution of WF with RB50 and RB100 in cracker significantly (P

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.

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.

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.

Nowadays there is an increasing demand for healthy biscuits. The reduction in sugar and fat level, as well as the addition of bioactive compounds, is positively associated with a healthy diet. In the present work, low-fat and low-sugar biscuits were prepared with infusions (mate, coffee, and tea) or with Prosopis chilensis pod flour (PPF). Biscuits were made with maize starch and wheat flour (gluten formulations) or with gluten-free ingredients (gluten-free). The colour, texture, and the antioxidant capacity were evaluated in dough and biscuits. Among the formulations prepared with infusions, the mate dough showed the lowest firmness (1.1 N (gluten)-24.3 N (gluten-free)). However, no significant differences were found in the fracture stress of the final products (P > 0.05). Mate gluten biscuits and PPF gluten-free biscuits showed the highest fracture strain (16.2 and 9.4%, respectively) and the lowest Young’s modulus (7.3 and 13.3 MPa, respectively) in their groups. The highest antioxidant activity was found in biscuits with mate (8.7 µmol FeSO₄/g (gluten)-4.3 µmol FeSO₄/g (gluten-free)). These values were three times higher than the ones found in the control biscuits (2.9 µmol FeSO₄/g (gluten)-3.9 µmol FeSO₄/g (gluten-free)). The present results showed that the antioxidant content in biscuits could be successfully increased with infusion addition., Facultad de Ciencias Agrarias y Forestales, Facultad de Ciencias Exactas, Centro de Investigación y Desarrollo en Criotecnología de Alimentos

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.

Special diets are used for the treatment and prevention of diseases of the digestive system, taking into account individual food intolerance and possible allergic reactions. The monotony of the diet due to the limited range of recommended foods and dishes negatively affects both the effectiveness of the treatment of gluten intolerance, and the provision of the body with essential and replaceable nutrients. The aim of this study was to determine the selenium content in the flour of gluten-free crops (rice, corn, buckwheat and amaranth), their mixtures, as well as in dishes (pancakes) from a mixture of amaranth and buckwheat flours. Material and methods. The following raw materials were used in the study: amaranth flour, unboiled buckwheat groats, whole grain rice flour and corn flour. By mixing the components in a laboratory mixer, dry gluten-free compositions were obtained: a mixture of amaranth flour and flour from native buckwheat; a mixture of amaranth and rice flour and a mixture of amaranth and corn flour in the ratio of 1:2 and 1:1; and a mixture of amaranth, buckwheat and corn flour in equal proportions. In laboratory baking of pancakes, mixtures of amaranth flour and flour from native buckwheat were used. The selenium content was determined by atomic absorption spectroscopy with electrothermal atomization after wet mineralization of the samples. Results. The results of the study showed that amaranth, buckwheat and corn are rich sources of selenium. The most valuable source of selenium was amaranth flour (515 μg/kg). Selenium content in native buckwheat flour and corn flour was 405 and 458 μg/kg, respectively. The lowest selenium content among the studied crops was found in rice flour (135 μg/kg). Selenium content in flour mixtures of the studied cultures ranged from 258 to 522 μg/kg. The highest values of selenium content were observed in mixtures of amaranth with corn flour (516-522 μg/kg). The lowest content of this trace element was found in mixtures containing rice flour (from 258 to 325 μg/kg). Selenium content in pancakes made from mixtures of amaranth flour and native buckwheat flour varied from 290 to 326 μg/kg. The calculation showed that the consumption of a portion of pancakes (50 g) by school-age children will satisfy their daily requirement for selenium by 7.3-8.1%. Conclusion. Regular inclusion of amaranth-based foods in the diet of children with gluten intolerance can positively affect the elimination of selenium deficiency.

Gluten free (GF) foods, designed and marketed for the needs of people who are unable to metabolize gluten, in recent years have aroused growing interest that has led to the conquest of important market segments, with a strongly growing trend. Given the low protein content of standard GF flours, it is particularly important to fortify GF foods, and to study the effect that this process exerts on functional and sensorial characteristics. In this work, fortification of GF bakery goods was done with the addition of Arthrospira platensis (spirulina) flour. Two different dough formulations (with and without fortification) were fermented by four different processes, including spontaneous, single strains and sourdough starters. The baked products were then subjected to “consumer's tests”. During the process, fermentation performances, prebiotic activity, and the VOC (Volatile Organic Compound) profiles were analyzed and compared through robust multivariate statistics. The results obtained evidenced that fortification led to a product with more abundant (medium organic acids) and exclusive bioactives (thymol, borneol, and nicotinic acid), which were correlated to the prebiotic activity of spirulina breads. This work, for the first time indicates that spirulina can be used to fortify GF bakery, improving also its functional potential.

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 study was carried out with the aim of developing gluten free cookies using rice-chickpea composite flour. Guar and locust bean gum were added to formulations at two test concentrations (0.5 and 1.0%). To study the impact of these hydrocolloids, pasting and rheometry of dough formulations was carried out. The cookies produced were subjected to colour, spread ratio, hardness and antioxidant analysis. Protein (7.56 g/100g), fat (1.78 g/100g), ash (1.25 g/100g) and carbohydrate (80.41 g/100g) content of composite flour varied significantly (p ≤ 0.05) from both rice and chickpea. Higher viscosity, viscoelasticity and antioxidant profile was shown by dough formulations with added gums. Control cookies prepared without gums showed the L*, a* and b* values of 54.62, 3.81 and 35.97, respectively. With the addition of guar and locust bean gum, colour of the cookies became lighter. Spread ratio and hardness of cookies with added gums was higher.

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.

Amaranth, quinoa, and buckwheat, known as pseudocereals, have been consumed since ancient times and are considered sacred in most cultures. Their grains can be used as cereals for breakfast or mixed with other grains in meals and their health-enhancing effects have been investigated more in recent years. They have an antioxidant effect and their nutrient profiles are enriched with processing techniques such as sprouting and fermentation. Their suitability to different processing techniques and the rapid increase in microbiota researches highlighted the probiotic/prebiotic effects of pseudocereals. Using cultures or naturally fermented amaranth, quinoa and buckwheat exhibited good substrate properties for probiotic bacteria, especially for Lactobacillus strains. Studies have found that they reduce the number of pathogen microorganisms, increase the synthesis of short-chain fatty acids due to their prebiotic effects. Also the number of bacterial colonies do not change during the storage period and their organoleptic properties are revealed. It has been determined that pseudocereals decrease Ruminococcacea, Lachnospiraceae, Helicobacteracea, Clostridium, Escherichia and increase Peptoclostridium, Prevotellaceae, Lactobacillus, Bifidobacterium, Enterococcus, and Eubacteriaceae. Due to these effects, they are considered as good sources for synbiotic formulations to be developed for the treatment of dysbiosis, obesity, Celiac Disease, lactose intolerance, inflammatory bowel diseases and inflammation-mediated chronic disorders.

Flaxseed (Linum usitatissimum L.) and yerba mate (Ilex paraguariensis) are particularly interesting as functional ingredients due to their high content of essential omega 3-fatty acids and antioxidant properties, respectively. The objective of this work was to formulate a corn snack enriched with flaxseed flour and yerba mate extract and evaluate its physicochemical and sensory properties. Flaxseed flour, added at three levels 1, 3 and 5%, increased the water activity, moisture content and cohesiveness, and decreased the hardness and plastic deformation of the samples. The flour also changed the superficial colour and made the microstructure more compact. On the contrary, yerba mate extract (1 and 3%) decreased the water activity, moisture content and cohesiveness, counteracting the effect of flaxseed flour. Yerba mate increased the plastic deformation and the antioxidant activity of the snacks. The colour was not modified and the microstructure was more fragmented in the presence of yerba mate. Sensory evaluation suggested that flaxseed flour and yerba mate affected the flavour but did not modify the colour and crunchiness of the product., Centro de Investigación y Desarrollo en Criotecnología de Alimentos, Facultad de Ingeniería