Amount Of Gluten Research Articles

Optimising delivery of care in coeliac disease – comparison of the benefits of repeat biopsy and serological follow‐up

The majority of deleterious health consequences of coeliac disease (CD) are most likely to be secondary to intestinal inflammation; hence, mucosal recovery is a desirable goal of therapy. Follow-up in CD is controversial and serological response is often used as a surrogate for histological recovery. To inform the clinical management of CD using comparative serological and histological data from a biopsy-driven pathway of care. A retrospective analysis of the Cambridge Coeliac Clinic database of 595 patients routinely followed up by biopsy and serology. Paired biopsy results were available for 391 patients (15% seronegative). Persisting villous atrophy (VA) occurred in 182 patients (47%). The sensitivity of anti-tissue transglutaminase (TTG) antibody for ongoing VA was only 43.6%. Information on dietetic management and further biopsy to assess response was available for 94 initially unresponsive patients, in whom targeted dietetic intervention by removal of identified gluten sources or avoidance of trace amounts of gluten led to resolution of persistent VA in 50%. The effects of institution of a formal care pathway are analysed in 298 patients. Discharge to primary care and clinical management was facilitated by the information derived from repeat biopsy. Serology appears to be a poor surrogate marker for mucosal recovery on a gluten-free diet; dietary assessment fails to identify a potential gluten source in many patients with ongoing villous atrophy. The benefits of re-biopsy on diet include stratification of patients with coeliac disease suitable for early discharge from secondary care or those requiring more intensive clinical management.

Rheological Properties of Bread Dough Formulated with Wheat Flour–Organic Calcium Salts–FOS-Enriched Inulin Systems

The objective of this work was to study the effect of organic calcium salts–fructooligosaccharide (FOS)-enriched inulin systems on dough structure and rheological properties of wheat flour dough. Wheat flour was enriched with calcium lactate (CaLa2) or calcium citrate (Ca3Ci2) (from 1,080 to 2,520 ppm Ca) and FOS-enriched inulin (In) (from 0 to 13 %, w/w flour basis). Alveographic, texture, relaxation, and viscoelasticity properties of dough were analyzed. Wet and dry gluten quantity, related to scanning electron microscopy structure, was also determined. Tenacity, extensibility, and deformation energy of dough decreased with the increment of In content. When CaLa2 was employed, they changed mainly with fiber, hiding the effect of lactate; whereas with Ca3Ci2, these parameters were not only affected by the fiber, but also by the salt. At In 6.5 %, high calcium content (2,520 ppm Ca) produces an increase in hardness and a decrease in cohesiveness for citrate ion; the opposite effect was detected with lactate ion. These parameters decreased at high content of In (13 %). Adhesiveness was dependent only on In level; more adhesive dough at In > 6.5 % were obtained, mainly in the case of CaLa2. Ca3Ci2 prevents the decrease in adhesiveness at In > 12 %. At high calcium levels, high In produced more elastic dough only in the presence of citrate; for lactate, the predominant factor was In. Lactate anion destabilizes protein structure, and together with In favors formation of a less elastic gluten network. On the other hand, the stabilizing effect of citrate ion in a firm network was enhanced by FOS-enriched inulin.

Effect of incorporation of decorticated pigeon pea (<em>Cajanus cajan</em>) protein isolate on functional, baking and sensory characteristics of Wheat (<em>Triticum aesitivum</em>) biscuit

This study was undertaken with the objectives of using the decorticated pigeon pea protein isolate in the development of protein rich-biscuit, suitable for general and specific nutritional purposes and to study the effect of incorporation of pigeon pea protein isolate on the sensory evaluation and quality of biscuit produced. Decorticated Pigeon Pea protein Isolate (DPPI) was incorporated in wheat (Triticum aesitivum) flour (WF, extraction rate 72%), for making fortified biscuit. Ratios of DPPI in wheat flour were adjusted to protein levels of 15, 20 and 25%, respectively. Rheological and functional properties as well as proximate composition, nutritive value and sensory characteristics for the biscuit produced were assessed. The gluten quantity (dry and wet) and falling number of wheat flour were significantly (p#0.05) decreased with the incorporation of DPPI from 10.25 to 7.6%; from 31.2 to 22.5% and from 657 to 443 sec., for 0,15, 20 and 25% protein levels, respectively.Water Retention Capacity (WRC), Bulk Density (BD) and Fat Absorption Capacity (FAC) were obtained. Addition of DPPI resulted in an increase in water absorption which was found to be ranged from 66.7 to 71.0%; dough development time from 4.5 to 7.3 min and dough stability 1.7 to 5.8 min. Biscuit supplemented with DPPI showed significant increase (p#0.05) in ash, protein with high level of incorporation and significant decrease (p#0.05) in carbohydrates and caloric values when biscuit wheat was supplemented with high level of DPPI. Incorporation of DPPI showed no significant differences (p#0.05) on biscuit spread ratios compared to wheat biscuit (control). Biscuit with 15% protein level was found to be superior in all its sensory characteristics compared to the other blends.

Gluten intake in 6-36-month-old Danish infants and children based on a national survey.

Coeliac disease (CD) affects about 1% of the general population. Information concerning gluten intake in the general population is scarce. In particular, variation in gluten intake during the complementary feeding period may be an independent risk factor in CD pathogenesis. We determined the intake of gluten from wheat, barley, rye and oats in a cross-sectional National Danish Survey of Dietary Habits among Infants and Young Children (2006-2007). The study population comprised a random sample of 1743 children aged 6-36 months, recruited from the National Danish Civil Registry. The protein contents from wheat, rye, barley and oats were found in the National Danish Food Composition Table, and multiplied with the amounts in the recipes. The amounts of gluten were calculated as the amount of cereal protein×0·80 for wheat and oats, ×0·65 for rye and ×0·50 for barley. Dietary intake was recorded daily for seven consecutive days in pre-coded food records supplemented with open-answer possibilities. Gluten intake increased with age (P<0·0001). Oats were introduced first, rapidly outpaced by wheat, the intake of which continued to increase with age, whereas oats started to decrease at 12 months. Boys had a higher intake of energy (P≤0·0001) and all types of gluten, except for barley (P≤0·87). In 8-10-month-old (P<0·0001) and 10-12-month-old (P=0·007), but not in 6-8-month-old infants (P=0·331), non-breast-fed infants had higher total gluten intake than partially breast-fed infants. In conclusion, this study presents representative population-based data on gluten intake in Danish infants and young children.

Celiac Disease: A Challenging Disease for Pharmaceutical Scientists

Celiac disease (CD) is an immune-mediated enteropathy triggered by the ingestion of gluten-containing grains that affects ~1% of the white ethnic population. In the last decades, a rise in prevalence of CD has been observed that cannot be fully explained by improved diagnostics. Genetic predisposition greatly influences the susceptibility of individuals towards CD, though environmental factors also play a role. With no pharmacological treatments available, the only option to keep CD in remission is a strict and permanent exclusion of dietary gluten. Such a gluten-free diet is difficult to maintain because of gluten's omnipresence in food (e.g., additive in processed food). The development of adjuvant therapies which would permit the intake of small amounts of gluten would be desirable to improve the quality of life of patients on a gluten-free diet. Such therapies include gluten-degrading enzymes, polymeric binders, desensitizing vaccines, anti-inflammatory drugs, transglutaminase 2 inhibitors, and HLA-DQ2 blockers. However, many of these approaches pose pharmaceutical challenges with respect to drug formulation and stability, or application route and dosing interval. This perspective article discusses how pharmaceutical scientists may deal with these challenges and contribute to the implementation of novel therapeutic options for patients with CD.

Early infections are associated with increased risk for celiac disease: an incident case-referent study

BackgroundCeliac disease is defined as a ‘chronic small intestinal immune-mediated enteropathy precipitated by exposure to dietary gluten in genetically predisposed individuals’. Sweden has experienced an “epidemic” of celiac disease in children below two years of age. Celiac disease etiology is considered multifactorial; however, little is known regarding potential risk- or protecting factors. We present data on the possible association between early infectious episodes and celiac disease, including their possible contribution to the Swedish celiac disease epidemic.MethodsA population-based incident case-referent study (475 cases, 950 referents) with exposure information obtained via a questionnaire (including family characteristics, infant feeding, and the child’s general health) was performed. Celiac disease cases were diagnosed before two years of age, fulfilling the diagnostic criteria of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition. Referents were randomly selected from the national population register after fulfilling matching criteria. The final analyses included 954 children, 373 (79%) cases and 581 (61%) referents, with complete information on main variables of interest in a matched set of one case with one or two referents.ResultsHaving three or more parental-reported infectious episodes, regardless of type of infection, during the first six months of life was associated with a significantly increased risk for later celiac disease, and this remained after adjusting for infant feeding and socioeconomic status (odds ratio [OR] 1.5; 95% confidence interval [CI], 1.1-2.0; P=0.014). The celiac disease risk increased synergistically if, in addition to having several infectious episodes, infants were introduced to dietary gluten in large amounts, compared to small or medium amounts, after breastfeeding was discontinued (OR 5.6; 95% CI, 3.1-10; P<0.001).ConclusionThis study suggests that having repeated infectious episodes early in life increases the risk for later celiac disease. In addition, we found a synergistic effect between early infections and daily amount of gluten intake, more pronounced among infants for whom breastfeeding had been discontinued prior to gluten introduction. Regarding contribution to the Swedish celiac disease epidemic, which partly was attributed to concurrent changes in infant feeding, early infections probably made a minor contribution via the synergistic effect with gluten amount.

Systematic review: early infant feeding and the prevention of coeliac disease

PREVENTCD, Prevent Coeliac Disease, is an international project investigating the hypothesis of possible induction of tolerance to gluten in genetically predisposed children through introducing small quantities of gluten during the period of breastfeeding. To summarise current knowledge on the possible relationship between early feeding practices and the risk of coeliac disease (CD). The Cochrane Library, MEDLINE, and EMBASE databases were searched in May 2011, and the search was updated in January 2012, and again in July 2012. Breastfeeding (BF) and CD: some studies show a protective effect of BF, while others show no effect. No studies have shown a long-term preventive effect. BF at the time of gluten introduction and CD: Results from a meta-analysis of five observational case-control studies suggest that BF at gluten introduction is associated with a lower risk of CD compared with formula feeding. It is unclear whether BF provides a permanent protection or only delays the onset of CD. Timing of gluten introduction: The data suggest that both early (≤4 months) and late (≥7 months) introduction of gluten may increase the risk of CD. Amount of gluten at weaning (and later) and CD: One incident case-referent study documented that the introduction of gluten in large amounts compared with small or medium amounts increased the risk of CD. In the absence of clear evidence, in order to decrease the risk of later coeliac disease, it is reasonable to avoid both early (<4 months) and late (≥7 months) introduction of gluten, and to introduce gluten while the infant is still being breastfed. Future studies may clarify the remaining uncertainties.

XVIII Latin American Congress

XVIII Latin American Congress

Monitoring of gluten-free diet compliance in celiac patients by assessment of gliadin 33-mer equivalent epitopes in feces

Background: Certain immunotoxic peptides from gluten are resistant to gastrointestinal digestion and can interact with celiac-patient factors to trigger an immunologic response. A gluten-free diet (GFD) is the only effective treatment for celiac disease (CD), and its compliance should be monitored to avoid cumulative damage. However, practical methods to monitor diet compliance and to detect the origin of an outbreak of celiac clinical symptoms are not available.Objective: We assessed the capacity to determine the gluten ingestion and monitor GFD compliance in celiac patients by the detection of gluten and gliadin 33-mer equivalent peptidic epitopes (33EPs) in human feces.Design: Fecal samples were obtained from healthy subjects, celiac patients, and subjects with other intestinal pathologies with different diet conditions. Gluten and 33EPs were analyzed by using immunochromatography and competitive ELISA with a highly sensitive antigliadin 33-mer monoclonal antibody.Results: The resistance of a significant part of 33EPs to gastrointestinal digestion was shown in vitro and in vivo. We were able to detect gluten peptides in feces of healthy individuals after consumption of a normal gluten-containing diet, after consumption of a GFD combined with controlled ingestion of a fixed amount of gluten, and after ingestion of <100 mg gluten/d. These methods also allowed us to detect GFD infringement in CD patients.Conclusions: Gluten-derived peptides could be sensitively detected in human feces in positive correlation with the amount of gluten intake. These techniques may serve to show GFD compliance or infringement and be used in clinical research in strategies to eliminate gluten immunotoxic peptides during digestion. This trial was registered at clinicaltrials.gov as NCT01478867.

New Insights in Celiac Disease

Celiac disease (CD) is an autoimmune disorder occurring in genetically susceptible subjects. The incidence of CD is around 1%, and it is much more common in first-degree relatives of CD patients, 10%–18%. However, the pattern of the genetic inheritance is still obscure. Environmental factors are undoubtedly affecting the disease’s clinical presentation, time at presentation, and may have an effect on the characteristics of the disease. The clinical presentation of CD has shifted during the previous decades from the classical presentation in which the toddler suffers from diarrhea, constipation, vomiting, failure to thrive, abdominal distension, etc., to the child with a monosymptomatic presentation, such as anemia, as well as an enlarged list of extra-intestinal disorders. The diagnosis of CD is being established by symptoms consistent with CD and positive serology. The ultimate diagnosis should be made upon histological evaluation of the small bowel mucosa. The treatment of CD is a lifelong, strict gluten-free diet (GFD). Compliance with a GFD is quite difficult. Therefore, new strategies for prevention and treatment modalities other than GFD are greatly needed. Recently several promising therapeutic modalities have been developed; these include resuming traditional baking techniques. Another methodology is using probiotic-driven prolylendopeptidase. Another pathway to tackle the therapeutic option in CD is by down-regulation of the activity of zonulin—the active pump enabling gluten to enter the enterocytes. We are facing an era where other modalities beyond a GFD might allow CD patients to be able to tolerate occasionally a small amount of gluten in their diet.

Dermatitis herpetiformis: Novel advances and hypotheses

Dermatitis herpetiformis (DH) is a gluten-sensitive autoimmune blistering disorder with a chronic-relapsing course. Very recently, several Authors reported atypical cases of patients with DH, suggesting that different clinical subsets may exist at least among different ethnicities and that the classical picture of DH probably need a significant revision. Moreover, different pathogenetic aspects of the disease are currently under investigation, including the role of epidermal transglutaminase, apoptosis and inflammatory cells in the occurrence of skin lesions, in order to explain why only a subgroup of celiac patients will develop DH. Finally, although glutenfree diet is still regarded as the only curative approach to the disease, it is very hard to comply with and even small amounts of gluten can re-activate the disease. Therefore, different therapeutical approaches for the spectrum DH/celiac disease are still under investigation. In the present paper, the most recent advances in DH will be discussed, and a novel interpretation of the disease based on the data emerging from the Literature will be proposed.

Small- bowel mucosal changes and antibody responses after low- and moderate-dose gluten challenge in celiac disease

BackgroundDue to the restrictive nature of a gluten-free diet, celiac patients are looking for alternative therapies. While drug-development programs include gluten challenges, knowledge regarding the duration of gluten challenge and gluten dosage is insufficient.We challenged adult celiac patients with gluten with a view to assessing the amount needed to cause some small-bowel mucosal deterioration.MethodsTwenty-five celiac disease adults were challenged with low (1-3 g) or moderate (3-5g) doses of gluten daily for 12 weeks. Symptoms, small-bowel morphology, densities of CD3+ intraepithelial lymphocytes (IELs) and celiac serology were determined.ResultsBoth moderate and low amounts of gluten induced small-bowel morphological damage in 67% of celiac patients. Moderate gluten doses also triggered mucosal inflammation and more gastrointestinal symptoms leading to premature withdrawals in seven cases. In 22% of those who developed significant small- intestinal damage, symptoms remained absent. Celiac antibodies seroconverted in 43% of the patients.ConclusionsLow amounts of gluten can also cause significant mucosal deterioration in the majority of the patients. As there are always some celiac disease patients who will not respond within these conditions, sample sizes must be sufficiently large to attain to statistical power in analysis.

Evaluation of Strong Wheat Type 650 Flour Parameters with the Farinograph Instrument

SUMMARY In Romania, one of the most popular instruments used to evaluate the rheological properties of the dough is the Farinograph. This de vice gives information regarding the modifications that appear in the rheological proper ties of the dough during the kneading process and allows the evaluation of the critical f actors that influence these properties, such as flour quality and strength (Codina, 2010). The eval uation and interpretation of the Farinograph was reported by several researchers lik e D’Appolonia, 1984; Mani, 1992; Shuey, 1972. The objectives of this study were to determin e some correlations between analytical parameters of wheat flour and Farinograph rheologic al data. The study was carried out on 25 strong wheat flours type 650. The analytical and rheological parameters (with Bra bender Farinograph) were determined according to the SR ISO approved methods (ASRO). The samples’ parameters were in the following range: 24.8-30.8 wet gluten, 10.25-13.65 protein content, 3-5.5, deformation index, 225-446, falling number index 13-14.42 humidity, 0.62-0.67 ash content. The range of the following parameters, determined from the resulting farinogram curves, were: 55-63 water absorption, 1.2-2.2 dough development time, 1.9-8.1 dough stability and 62-84 degree of softening. All results were duplicated. All the dat a was analyzed with the SPSS Inc., v.16. Between the analytical parameters of the analyzed flours an d the farinograph, there is a series of statistical ly determined correlations. The content of protein nat urally correlates with the quantity of wet gluten. A high significant correlation r=0.804 and p=0.01 w as obtained between these two parameters. In terms of parameter stability, this is influenced ma inly by gluten quality and also by the deformation index (r=0.578). The stability parameter is negativ ely correlated with the degree of softening parameter (r=-0.558), similar results being obtaine d by Dap cevic et al., 2009. The dough development time is strongly influenced by protein, starch properties and enzymatic activity, between this parameter and falling number index being a negative significant correlation of r=0.578. REFERENCES

Quand doit-on introduire le gluten dans l’alimentation des nourrissons ?

Celiac disease (CD) is an auto-immune enteropathy, triggered in genetically predisposed individuals by the ingestion of dietary gluten. Gluten is the alcohol-soluble protein component of the cereals wheat, rye and barley. CD is a multifactorial condition, originating from the interplay of genetic and environmental factors. The necessary environmental trigger is gluten, while the genetic predisposition has been identified in the major histocompatibility complex region on chromosome 6, with over 90% of CD patients expressing HLA DQ2 and the remaining celiac patients express DQ8. The fact that only about 4 % of DQ2/8-positive individuals exposed to gluten develop CD, has led to the recognition that other genetic and environmental factors are also necessary. In the last few years, several epidemiological studies have suggested that the timing of the introduction of gluten, as well as the pattern of breastfeeding, may play an important role in the subsequent development of CD. Here, we present and review the most recent evidences regarding the effect of timing of gluten introduction during weaning, the amount of gluten introduced and simultaneous breastfeeding, on the development of CD.

Effect of arabinogalactan isolated from Siberian larch on the baking value of soft wheat flour and bread quality

Using additives of arabinogalactan (AG) isolated from Siberian larch, we examined the soft wheat flour quality and quantity of gluten, physical properties of the dough, and quality of finished bread depending on the quantity of the added polysaccharide. In the case of the addition of 1–3% of AG to flour, its content decreases in the final product. An excess amount of AG inhibits yeast growth, which leads to a decrease in bread quality. The optimum addition of AG to flour is 1%, at which the technological properties of flour and dough do not change significantly, but the quality of bread becomes remarkably better; furthermore, arabinogalactan is fully consumed in the course of bread preparation. The use of AG is recommended in the optimum dose for increasing the quality of baked goods.

Prevention Measures and Exploratory Pharmacological Treatments of Celiac Disease

Increasing prevalence, protean clinical manifestations, and lack of pharmacological therapy make celiac disease (CD) a complex and highly relevant illness in gastroenterology. This chronic inflammatory disorder of the small intestine is caused by the ingestion of gluten containing cereals in genetically susceptible individuals, leading to a variety of gastrointestinal (GI) and non-GI manifestations. Awareness among physicians is growing due to accessible and highly accurate diagnostic and screening methods. Recent evidence suggests a possible rising incidence of CD. Environmental factors such as early life gluten exposure, intestinal infections, short duration of breast-feeding, and changes in intestinal microbiota have been proposed to have a role in CD pathogenesis. Thus, prevention approaches to diminish the rising prevalence of CD are currently being evaluated. Still, the cornerstone treatment of CD remains a strict gluten-free diet. This nutritional regime is demanding, and non-adherence is common because of social isolation, financial issues, or restriction of food diversity. Allowing patients to occasionally consume small amounts of gluten would greatly improve their quality of life. Owing to recent advances in the understanding of the pathogenesis of CD, different targets have been identified and have motivated the development of several experimental therapeutic strategies. The main goal of this review is to discuss the mechanisms that can be exploited therapeutically to prevent or delay CD, disease associations and its complications. Current treatments for complications of CD, including refractory CD and malignancy, are beyond the scope of this review.

Mortality in celiac disease

Although the prevalence rates of celiac disease tend to be very similar in different Western populations, mortality rates for this disease vary widely. In this Review we focus on the papers that have addressed this issue so far. We evaluated mortality rates in different forms of celiac disease, such as symptomatic celiac disease, unrecognized celiac disease, dermatitis herpetiformis and refractory celiac disease. We also evaluated the role of possible protective factors, such as adherence to a gluten-free diet, early diagnosis and severity of clinical presentation. Finally, we noticed that the mortality rate for celiac disease seems to be higher in Southern than in Northern Europe and seems to correlate with 'national' gluten consumption. To explain these differences, we propose a hypothesis that links mortality rates to the amount of gluten consumed not only after but also before the diagnosis of celiac disease.

Celiac Disease

Celiac disease is a common multisystemic disorder that may be diagnosed at any age. Owing to the increasing prevalence, prevention strategies, including encouragement of breastfeeding and introduction of small amounts of gluten whereas still on breastfeeding at fourth to sixth month of age, become more important than before. For avoiding complications of celiac disease, a strict gluten-free diet is essential. A lifelong gluten-free diet may bring about difficulties as avoiding gluten completely is problematic owing to the contamination with gluten of presumably gluten free foods. New therapeutic approaches include enzyme supplementation, correction of the intestinal barrier defect against gluten entry, blocking of gliadin presentation by human leukocyte antigen blockers and tissue transglutaminase inhibitors.

Effect of the timing of gluten introduction on the development of celiac disease

Celiac disease (CD) is a permanent auto-immune enteropathy, triggered in genetically predisposed individuals by the ingestion of dietary gluten. Gluten is the alcohol-soluble protein component of the cereals wheat, rye and barley. CD is a multifactorial condition, originating from the interplay of genetic and environmental factors. The necessary environmental trigger is gluten, while the genetic predisposition has been identified in the major histocompatibility complex region on chromosome 6p21, with over 90% of CD patients expressing HLA DQ2 and the remaining celiac patients express DQ8. The fact that only about 4% of DQ2/8-positive individuals exposed to gluten develop CD, has led to the recognition that other genetic and environmental factors are also necessary. In the last few years, several epidemiological studies have suggested that the timing of the introduction of gluten, as well as the pattern of breastfeeding, may play an important role in the subsequent development of CD. Here, we present and review the most recent evidences regarding the effect of timing of gluten introduction during weaning, the amount of gluten introduced and simultaneous breastfeeding, on the development of CD.

Reactivity of gluten detecting monoclonal antibodies to a gliadin reference material

People affected by coeliac disease need to adhere to a life-long gluten-free diet to avoid symptoms. ELISA-tests are seen as the mainstay for the detection of gluten in gluten-free food because of their sensitivity. They can, however, yield different gluten amounts depending on the antibody and reference material used. We compared the reactivity of three prominent mouse anti-gliadin-antibodies to a reference gliadin isolated from 28 common bred European wheat varieties. The reference material proteins were labelled with fluorescent dye Cy3. They were then separated by 2DE and transferred by Western blot onto low fluorescent PVDF-membranes, followed by incubation with the three primary anti-gliadin antibodies one by one. Detection of the reacting proteins used anti-mouse antibody which was labelled with fluorescent dye Cy5. The use of this technique made it possible to co-detect the 2DE-image of the reference material proteins (Cy3) and proteins reacting with the respective antibody (Cy5). The three investigated antibodies had dissimilar reactivities with different proteins of the reference gliadin. Antibodies R5 and PN3 reacted mainly with gliadin fractions, antibody 401.21 mainly with high molecular weight glutenins. The results confirm the individual specificity of these antibodies and demonstrate the importance of validating immunochemical methods for gluten detection.