Gluten-containing Counterparts Research Articles

Gluten-free foods are expensive and nutritionally imbalanced than their gluten-containing counterparts.

Nutritional quality of gluten-free (GF) food products is very important, as patients with celiac disease consume these products for lifelong. There is paucity of data on the nutritional content and cost of GF food products compared with their gluten-containing (GC) counterparts from India (Asia). After a detailed market survey, packaged and labeled GF food products (n=485) and their packaged GC counterparts (n=790) from the supermarkets of Delhi (India) and e-commerce websites were included. Nutritional content and cost/100 g food (in US dollars) were calculated using the information on food label. Gluten-free food products were 232% (range: 118% to 376%) more expensive than their GC counterparts. Energy content of all GF food products was similar to their GC counterparts, except cereal-based snacks (GF: 445 kcal vs. GC: 510 kcal, p<0.001). The protein content was significantly lower in GF pasta and macaroni products (single-grain: GF: 6.5 g vs. GC:11. 5 g, p-0.002; multigrain: GF:7.6 g vs. GC:11.5 g, p-0.027), cereal flours (single-grain: GF: 7.6 g vs. GC: 12.3 g, p<0.001; multigrain: GF:10.9 g vs. GC: 14.1 g, p-0.009) and nutritional bars (GF: 21.81 g vs. GC:26 g, p-0.028) than their GC counterparts. Similarly, the dietary-fiber content of GF pasta and macaroni products, cereal flours, cereal premix and nutritional bars of GF foods was significantly lower than their GC counterparts. Gluten-free bread and confectionary items, biscuits and cookies and snacks had higher total fats and trans-fat content than their GC counterparts. Gluten-free cereal-based snacks had higher sodium content than their GC counterparts (GF: 820 mg vs. GC:670 mg; p<0.001). GF foods are significantly more expensive, contain less protein and dietary fiber and higher fat, trans-fat and sodium than their GC counterparts. Strategies must be developed to reduce the cost and improve the nutritional profile of GF foods.

Gluten-Free Diet and Other Celiac Disease Therapies: Current Understanding and Emerging Strategies.

A lifelong gluten-free diet (GFD) is the only treatment for celiac disease and other gluten-related disorders. Nevertheless, strict adherence to the GFD is often challenging due to concerns about social isolation, risk of gluten contaminations, high cost, poor quality and the taste of gluten-free products. Moreover, although the GFD is effective in achieving mucosal healing, it may lead to dietary imbalances due to nutrient deficiencies over a long period of time. To overcome these issues, several gluten-free wheat flours have been developed to create products that closely resemble their gluten-containing counterparts. Furthermore, given the critical importance of adhering to the GFD, it becomes essential to promote adherence and monitor possible voluntary or involuntary transgressions. Various methods, including clinical assessment, questionnaires, serology for celiac disease, duodenal biopsies and the detection of Gluten Immunogenic Peptides (GIPs) are employed for this purpose, but none are considered entirely satisfactory. Since adherence to the GFD poses challenges, alternative therapies should be implemented in the coming years to improve treatment efficacy and the quality of life of patients with celiac disease. The aim of this narrative review is to explore current knowledge of the GFD and investigate its future perspectives, focusing on technology advancements, follow-up strategies and insights into a rapidly changing future.

Investigation of cost and availability of gluten-free food in Jeddah, KSA

ObjectiveThe prevalence of celiac disease (CD) in KSA is progressively increasing. Consistent adherence to a gluten-free (GF) diet is the only effective CD treatment. The availability and cost of GF food are important factors in adherence to a GFD. The objective of this study was to investigate the cost and availability of GF food in a sample of local stores and supermarkets across Jeddah province in KSA. MethodEleven supermarkets in Jeddah, KSA, ranging from high budget/quality supermarkets to low-budget stores, were visited. Eight food categories were evaluated, including flour, breakfast cereals, breads, pastas, and snacks (e.g., biscuits, cookies, snack bars, and chips). The availability and cost of GF and gluten containing (GC) items within these food categories were recorded. Each item included in these food categories was counted, and the overall average price was calculated. ResultsA total of 233 GF and 24 GC products were found. Supermarket 1 had the highest availability of GF foods (n = 90), followed by supermarket 2 (n = 34), supermarket 3 (n = 30), supermarket 4 (n = 23), supermarket 5 (n = 21), supermarket 6 (n = 18), supermarket 7 (n = 9), and supermarket 8 (n = 8). The median price per 100 g was significantly greater for GF than GC products (p < 0.05). The cost of GF products was significantly higher than that of GC products (p < 0.05); consequently, GF foods were twice as expensive as their GC counterparts. ConclusionThe availability of GF products was limited, and GF products were more expensive than standard GC products. High cost and limited availability are major roadblocks to GFD adherence among people with CD. Governmental organizations must cooperate with healthcare providers and food industries to ensure that GF foods are widely available and affordable for people with CD, to minimize financial pressure and improve health quality.

Experiences with Gluten-Free Bread: A Qualitative Study Amongst People with Coeliac Disease Participating in a Randomised Controlled Trial.

Whole-grain bread can be an important source of fibre for people with coeliac disease (CeD) who must adhere to a gluten-free diet and avoid consuming wheat, rye and barley. Gluten-free bread frequently has a lower nutritional quality and different texture relative to gluten-containing counterparts. The aim was to investigate experiences with gluten-free bread amongst people with CeD prior to and during a randomised controlled trial (RCT). We conducted individual interviews with 10 people with CeD participating in a RCT that aimed to investigate the effects of fibre-rich gluten-free products on metabolic regulation in people with CeD compared with benchmark gluten-free products. Five participants were in the control group (benchmark gluten-free bread) and five participants in the intervention group (fibre-rich gluten-free bread). The fibre-rich gluten free bread was formulated and prepared by the project group. The benchmark gluten-free bread was commercially available. The RCT lasted for four weeks. Interviews were conducted digitally between October 2021 and January 2022 and were thematically analysed. Participants in both groups appeared to avoid bread prior to the study, primarily due to the poor taste and chewy consistency of the available bread in food stores and bakeries. Participants preferred the fibre-rich intervention bread as opposed to the available bread in the food market. However, participants had to become accustomed to eating the fibre-rich whole-grain bread during the study, since they avoided eating store-bought bread that they experienced chewy and not filling. Participants asked for fibre-rich gluten-free bread products that are satiating and have a good texture. Palatable gluten-free bread products might be an important source of fibre for people with CeD.

Nutritional content and quality of processed gluten-free products

The present work aimed to compare the macro- and micronutrient contents of gluten-free (GF) and gluten-containing (GC) products from a wide range of stores in Jeddah, Saudi Arabia. A case-control study was conducted. Twelve major supermarkets in Jeddah, Saudi Arabia were visited, and the nutritional information labels of 92 GF and 46 GC products were compared. Results showed that GF products were significantly lower in protein (p = 0.004), total sugar (p = 0.01), calcium (p = 0.02), iron (p = 0.002), and vitamin D (p = 0.01) than GC products. Furthermore, GF breads, flours, and pastas had significantly lower amounts of protein than their GC counterparts (p &lt; 0.001, p = 0.03, and p &lt; 0.001, respectively). Fibre was significantly higher in GF than GC biscuits and breads (p = 0.04 and p = 0.01, respectively). However, GF pastas had significantly lower content of fibre per 100 g than GC pastas (p = 0.02). Overall, the nutritional quality of GF products was not significantly different from GC products. Although GF and GC biscuits and cookies were considered low nutritional value products, the nutritional quality scores of GF biscuits and cookies were significantly higher than their GC counterparts. GF products were lower in protein, total sugar, vitamin D, calcium, and iron than GC products. The nutritional quality of GF products did not differ from GC products. Food manufacturers should pay more attention to the nutritional content of GF products. Future studies are needed for the nutritional assessment of GF products, and how nutritional content may influence the diet quality of individuals with celiac disease who follow gluten-free diets.

Nutritional Composition of Breakfast in Children and Adolescents with and without Celiac Disease in Spain-Role of Gluten-Free Commercial Products.

Eating a nutritionally balanced breakfast can be a challenge when following a gluten-free diet (GFD). We assessed the ingredients and nutrient composition of 364 gluten-free breakfast products (GFPs) and 348 gluten-containing counterparts (GCCs), and we analysed the nutritional quality of breakfast in a group of Spanish children and adolescents with celiac disease (CD) (n = 70), as compared to controls (n = 67). Food intakes were estimated using three 24 h dietary records. The composition of GFPs and GCCs was retrieved from the package labels of commercially available products. Most participants (98.5%) ate breakfast daily, and only one person in each group skipped breakfast once. The breakfast contribution of the total daily energy was 19% in participants with CD and 20% in controls. CD patients managed a balanced breakfast in terms of energy (54% from carbohydrates; 12% from proteins; 34% from lipids) and key food groups (cereals, dairy, fruits), but their intake of fruits needs improvement. Compared to controls, breakfast in the CD group provided less protein and saturated fat, a similar amount of carbohydrates and fibre, and more salt. Fibre is frequently added to GFPs, but these contain less protein because of the flours used in formulation. Gluten-free bread contains more fat and is more saturated than is GCC. Sugars, sweets, and confectionery contribute more to energy and nutrient intakes in participants with CD, while grain products do so in controls. Overall, breakfast on a GFD can be adequate, but can be improved by GFPs reformulation and a lower consumption of processed foods.

Quality Improvement of Green Saba Banana Flour Steamed Cake

Gluten avoidance is becoming a popular diet trend around the world. In this study, green Saba banana flour (GSBF) was used to produce a gluten-free (GF) steamed cake. The effects of soy protein isolate (SPI) (0%, 10%, 15%) and Ovalette (0%, 3.5%, 7%) on the quality of the cake were investigated. Physicochemical properties of the flours were measured. The viscosity and specific gravity of the batters; as well as the specific volume, weight loss and texture profile of the resulting cakes were determined. Sensory evaluation was performed to compare the acceptance of the cake formulations. The macronutrient and resistant starch content of the cakes were determined. The use of an appropriate level of SPI and Ovalette was found to effectively enhance the aeration of the cake batter and improved the specific volume and weight loss of the cake. The presence of Ovalette was essential to soften the texture of the cake. GF cake supplemented with 10% SPI and 3.5% Ovalette obtained the highest sensorial acceptance. The nutritional quality of this sample was significantly improved, whereby it contained higher protein than the gluten-containing counterpart. GSBF also contributed to the high dietary fiber and resistant starch content of the cake.

Gluten-free diet - opportunities and limitations

Objective &#x0D; The aim of the study was to indicate the difficulties associated with gluten-free diet and the point of its use by people without medical indications. Another important aspect of the article was to analyze the impact of this diet on the course of chronic diseases. &#x0D; Methods &#x0D; For the purposes of writing this article, the available literature was reviewed. Using keywords such as gluten, gluten-free, or diet, the database of medical publications - PubMed was searched. &#x0D; Results: The popularity of the gluten-free diet is growing. The reason for this is increased interest in health lifestyle and nutrition as well as the influence of the mass media. Because of that, the number of people on a gluten-free diet without medical indications is increasing. Following a gluten-free diet is associated with many difficulties. Gluten-free products are much more expensive and less available than their gluten-containing counterparts. It is associated with many obstacles in everyday life. An important aspect is also the imbalance of supplied nutrients and the risk of macro and micronutrient deficiencies, such as magnesium, zinc or selenium, as a result of the gluten-free diet. With the increasing popularity of the gluten-free diet, there are more and more studies on the potential benefits of its use in chronic diseases. &#x0D; Conclusion: A gluten-free diet remains the only therapeutic option in the course of diseases such as celiac disease, non-celiac gluten sensitivity or wheat allergy. Due to the insufficient amount of data, its use is not recommended in the course of other chronic diseases and in the population of people without medical indications.

Gluten-Free Products: Do We Need to Update Our Knowledge?

The gluten-free (GF) food market has been growing exponentially in recent years. However, GF products could contribute to imbalanced diets. The main objective of the present work was to perform a temporal nutritional comparison of GF foods over the last nine years. At the same time, the nutritional compositions of 104 GF products currently marketed in Spain were assessed and compared with their gluten-containing counterparts. Diets including GF products and the equivalent diets with homologous products with gluten were compared as well, the subjects being 25 adult celiac patients. A comparison of GF products (GFPs) in 2013 and 2022 showed nutritional differences in the groups of cookies, breakfast cereals, doughs/puff pastries/pizzas, and breads. The pasta group stands out from the rest due to an important decrease in energy, protein, simple carbohydrates, saturated lipids, dietary fiber, and salt. Comparing GF and gluten-containing homologous products in 2022, the major differences were found in protein and salt. Accordingly, GFPs lead to a diet lower in protein and higher in carbohydrates. Despite improvements in the formulation of GF products in recent years, their macronutrient profile maintains marked variation, and they cannot be considered nutritionally equivalent to their gluten-containing counterparts.

The costs of eating gluten-free

ABSTRACT We leverage a large dataset of U.S. bakery products to comprehensively study price and nutritional composition of gluten-free products in comparison with gluten-containing items. Using data from 2013 to 2022, and controlling for time and manufacturer fixed effects as well as other product claims such as ‘all natural’, our findings suggest that gluten-free products are up to 85% more expensive than gluten-containing ones. In addition, gluten-free products have a different nutrient profile. Across product subcategories, they contain more total fat than gluten-containing products – as much as 113% more in the bread subcategory. However, compared to their gluten-containing counterparts, gluten-free breads contain less sodium, gluten-free cookies contain more fibre and gluten-free pastries contain more fibre and less sugar. We conclude that unless gluten-free products are medically prescribed, consumers should carefully weigh all product characteristics when choosing between gluten-free and gluten-containing versions of the same product.

Use of discrimination analysis to identify differences during cooking of novel pasta formulations

Given the great innovation in pasta formulations, elucidating factors that will impact pasta behaviour during cooking is essential when alternative ingredients are incorporated. Whole wheat (W), vegetable (V) and gluten free (GF) pastas (from raw to overcooked) were analysed using a multiscale approach and compared with a standard (STD) formulation. Macroscopic (moisture content and hardness), mesoscopic (viscoelastic properties and degree of gelatinization) and molecular ( 1 H NMR relaxometry) properties were evaluated and coupled with discrimination analysis (by means of principal components analysis and partial least square). Results from 2-ways ANOVA indicated that the cooking time (CT) was the main factor influencing the studied properties overlapping the effect of pasta formulation (PF). The application of partial least square analysis was effective in indicating viscoelastic properties and several molecular mobility indicators as typifying features able to describe pasta behaviour during cooking and discriminating GF from their gluten-containing counterparts. • Impact of pasta formulation during cooking time was studied. • Macroscopic, mesoscopic, and molecular properties were determined Cooking time has a more pronounced effect than pasta formulation. • Partial least square analysis discriminated the main factors.

Survey-Based Study on Food Insecurity During COVID-19 for Households With Children on a Prescribed Gluten-Free Diet.

Gluten-free (GF) foods are generally costlier than their gluten-containing counterparts. We conducted an anonymous electronic survey to assess food insecurity in households with a child on a prescribed GF diet and how this relates to GF diet adherence during the COVID-19 pandemic. The proportion of households who screened positive using the Hunger Vital Sign was similar to national rates (19%-24%). Approximately 5% of families who screened food secure reported GF food insecurity. Parent-reported intentional gluten consumption due to limited GF food availability in the household increased during the pandemic (7.5%). Food insecurity should be considered in the management of celiac disease.

A193 PERCEIVED BARRIERS TO GLUTEN-FREE FOOD ACCESS ON-CAMPUS EXPERIENCED BY STUDENTS FROM DIFFERENT CANADIAN UNIVERSITIES AND COLLEGES

BackgroundStudents with gluten-related disorders (GRD), a spectrum of conditions including celiac disease (CeD) and non-celiac wheat sensitivity (NCWS), often experience challenges when accessing gluten-free (GF) foods.AimsTo identify barriers perceived by students with GRD to access GF products on-campus of universities and colleges across Canada.MethodsWe conducted a cross sectional survey using the RedCap platform and distributed it to the Canadian Celiac Association community. We included students who reported adopting a GFD for various reasons including CeD and other GRD. We collected data on adherence to the GFD using a validated questionnaire (CDAT), presence of perceived barriers to follow a GFD while dining on campus, persistent symptoms, and altered quality of life. Continuous data are expressed as median (IQR), and categorical data as proportions of patients. Mann-Whitney U and Chi2 with Fisher correction were used to assess differences between groups.ResultsSeventy nine students responded to the survey (5% male and median age = 25 yrs) and 78 had complete data for analysis. Of the 78 students, 52 (66.6%) reported a diagnosis of CeD, while 26 were adopting a GFD for other reasons (non-CeD). The majority were enrolled in university programs (72/78) and 18% were living on-campus. Almost 90% reported difficulties maintaining a GFD while dining on-campus. Similar proportion of CeD and non-CeD reported eating gluten accidentally (75% vs 80%), while 15% reported eating gluten intentionally on-campus at least a few times per week. This was observed more frequently in non-CeD compared with students with CeD (61% vs 17%; p=0.04). Barriers identified in CeD versus non-CeD groups were related to a reduced GF-food variety (48% vs 69%), lack of availability of GF food (21% vs 46%) and increased cost (46% vs 81%) compared with gluten-containing counterparts. The majority of participants were concerned whether the food available on-campus was truly GF (80% vs 54%) as they reported foods not properly labelled. The majority of participants considered their overall health (79%) and quality of life (65%) was fair to terrible while dining on campus. During the pandemic, 76% of them perceived that it was easier to stick to a GF diet.ConclusionsStudents from various universities and colleges across Canada experience barriers to access GF food on-campus. This has a significant impact on their overall health and quality of life. Proper food labeling, GF certification and improving the variety of GF food on-campus are options for improvement.Funding AgenciesNone

Flatbreads on the Rise, What about their Nutritional Quality? The Current State of the Mediterranean Market

Flatbreads are increasingly attracting consumers, driving them to new eating ways. To define and evaluate the nutritional intake provided by these products, flatbreads market of seven Mediterranean countries (France, Spain, Italy, Croatia, Greece, Malta, and Lebanon) were considered. Flatbreads were available in both traditional and gluten-free versions, and in the single and doble layer variety. Wheat flour was the primary ingredient in both types, while sunflower and olive oil were the most used fats. Lebanese flatbread did not contain any fat. The Spanish market mostly featured one-layer flatbreads, such as tortillas and wraps, whereas pita appeared more frequently in Greece. Many Croatian flatbreads were not fermented. In comparison to gluten-containing flatbreads, the gluten-free version had a larger number of components listed on the labels. Blending flours with starches was the most common recipe. Hydrocolloids, emulsifiers, and fibers were added largely for technical reasons, but also to increase nutritional quality. Gluten-free flatbreads, on the other hand, were discovered to have lower fiber and protein content than their gluten-containing counterparts. Furthermore, their calorie value, as well as carbohydrate and salt content, were found to be lower.

Gluten-Free Cereal Products and Beverages: A Review of Their Health Benefits in the Last Five Years.

In the past decades, food products and beverages made from gluten-free cereals were initially created for certain groups of people who experience gluten-related disorders such as wheat allergies, gluten ataxia, non-celiac gluten sensitivity, and the most well-known, celiac disease. Nowadays, the consumption of gluten-free products is not only restricted to targeted groups, but it has become a food trend for normal consumers, especially in countries such as the UK, the US, and some European countries, who believe that consuming a gluten-free product is a healthier choice compared to normal gluten-containing products. However, some research studies have disapproved of this claim because the currently available gluten-free products in the market are generally known to be lower in proteins, vitamins, and minerals and to contain higher lipids, sugar, and salt compared to their gluten-containing counterparts. The use of other gluten-free cereals such as sorghum, millet, and teff as well as pseudo cereals such as buckwheat and quinoa has gained significant interest in research in terms of their various potential health benefits. Hence, this review highlights the potential health benefits of some gluten-free cereals and pseudo cereals apart from corn and rice in the last decade. The potential health benefits of gluten-free products such as bread, pasta, crackers, and cookies and the health benefits of some other non-alcoholic beverages made from gluten-free cereals and pseudo cereals are reported.

Celiac Disease.

Celiac Disease.

Taking advantage of the gluten-free opportunity: Assortment as the key driver for modern grocery retailers

Over recent years, gluten-free products have shown a significant increase in consumption internationally. Retailers from the modern grocery distribution have the opportunity to take advantage of this positive trend, thus benefitting remarkably in terms of sales and store patronage. The present work is based on the analysis of Italian IRI sell-out data from 2015 to 2019 and aims to verify the role of assortment as an effective retail marketing lever in stimulating gluten-free products sales share compared to that of gluten-containing counterparts. Applying different panel data techniques, we obtained that increasing their assortment share can significantly stimulate gluten-free products sales in general and, within this segment, private label sales in particular.

Cost, Nutritional Content and Number of Gluten-Free Staple Foods Available in Winnipeg, Manitoba, Canada.

Data has indicated that gluten-free (GF) foods are more expensive and have lower nutritional value than their gluten-containing (GC) counterparts. The aim of the present study was to compare the cost and nutrient content between GF and GC staple foods and determine whether the number and price of GF staple foods differed based on type of store or location within Winnipeg, Canada. Twelve grocery stores (2 chain stores/quadrant;1 local store/quadrant) in the four quadrants (northwest, northeast, southwest, southeast) of Winnipeg were visited to identify GF staple products (bread, flour, cereal, pasta) along with a GC comparator. A total of 819 GF products along with GC comparators were identified. The median cost of GF products ($1.50/100g) was 131 % greater than that of GC ($0.65/100g) (p < 0.0001). The greatest difference in cost was between GF and GC flour, with the least difference occurring between GF and GC cereal. GF products were 58, 36 and 100 % lower in iron, protein and saturated fat (p < 0.0001) than their GC comparators, respectively. The number of GF staple products was 370 % higher (p < 0.007) at chain stores than at local stores, whereas store location did not significantly affect the number of GF products available. The greatest difference in number of different GF foods based on store type was for cereals, with the least being for flours. These results confirm that GF staple foods are more expensive and have lower nutritional value (mainly due to lower iron and protein content) compared to GC foods.

Nutritional quality and costs of gluten-free products: a case-control study of food products on the Norwegian marked.

BackgroundCeliac disease is a chronic autoimmune disease triggered by gluten exposure in genetically predisposed individuals. A life-long intake of a gluten-free (GF) diet is required for its management. Wheat, rye and barley are eliminated in a GF diet and the nutritional adequacy of the diet has been questioned. In Norway, cereals and bread constitute a key role of the diet and are the main source of fiber intake. Gluten restrictions may therefore offer important implications for nutrient adequacy especially linked to fiber intake in people with celiac disease.ObjectiveThe aim of the study was to investigate the nutritional quality and price of GF products and compare with gluten-containing counterparts available at instead of in the Norwegian market.DesignThe macronutrient content of 423 unique GF products were compared with 337 equivalents with gluten. All products were selected from grocery stores and web-based shops, with the aim of including as many GF products as possible. Listed macronutrients content and price in 11 different food categories were compared to gluten-containing counterparts with Wilcoxon signed rank test.ResultsThe GF products contained less protein and fiber, and higher content of saturated fat, carbohydrate and salt compared to the gluten-containing products. The total amount of fat was not different between the groups. A similar pattern was found within several of the food categories. More gluten-containing products met the nutrition claim “high in fiber” (fiber > 6 g/100 g) compared to the GF products. The price of the GF products was higher; ranging from 46%–443% more expensive than the gluten-containing products.ConclusionGF products are less nutritious and have a higher price compared to equivalent gluten-containing products. Knowing that an unhealthy diet is the most important risk factor for developing non-communicable diseases, the nutritional quality of a GF diet needs to be addressed and should be improved.

Analysis of Food Labels to Evaluate the Nutritional Quality of Bread Products and Substitutes Sold in Italy: Results from the Food Labelling of Italian Products (FLIP) Study.

Bread is one of the most common staple foods, despite the increasing consumption of the so-called “bread substitutes”. The aim of the present work is to survey the nutritional quality intended as a nutrition declaration of 339 pre-packed bread products and 1020 bread substitutes sold in the major retailers present on the Italian market. Comparisons of energy, macronutrient, and salt content within product types, and between regular and gluten-free (GF) products and products with or without nutrition claim (NC) and health claim (HC) declarations, were performed. A high inter-product variability was detected. The median energy contents were 274 (interquartile range 255–289) and 412 (380–437) kcal/100 for bread products and substitutes, respectively. Irrespective of the category, GF products had lower amounts of energy than their gluten-containing counterpart (p < 0.001), whereas products carrying NC had lower energy, sugar and salt amounts than the products without these declarations on the pack (p < 0.001 for all). A strong positive correlation was observed between energy and carbohydrate in bread (rho = 0.73, p < 0.001), but not in substitutes (rho = 0.033, p = 0.29). The present work highlighted a high variability in the apparent nutritional quality of bread products and substitutes sold on the Italian market, and suggested that bread alternatives should not be considered tout court as substitutes from a nutritional point of view.