Gluten-free Research Articles

Pain, dietary habits and physical activity of children with developmental disabilities in Croatia, North Macedonia and Serbia: a cross-sectional study

BackgroundMultiple studies have shown that children with developmental disabilities (CDD) often live with unrecognized and untreated pain, consume inadequate diet and have inadequate levels of physical activity. This study aimed to analyze pain, dietary habits and physical activity of CDD in Croatia, North Macedonia and Serbia.MethodsA cross-sectional study was conducted in Croatia, North Macedonia and Serbia in March–April 2023 within the Erasmus+ SynergyEd project. The study included parents and caregivers of CDD. Data were collected via online survey.ResultsWe included 954 participants from Croatia (N=543; 57%), North Macedonia (N=205; 21%) and Serbia (N=206; 22%). Participants reported that 16% of children suffered from chronic pain related to their condition.The main findings of our study are that chronic pain is prevalent in CDD (16%). Almost half (48%) of participants avoid certain foods for their children. The majority of children (86%) were not on a special diet. Among those that were on a special diet, they were most commonly (60%) on a gluten-free diet. Most (54%) participants stated that their children used nutritional supplements. Less than half participants (45%) stated that the child is involved in some kind of physical activity. Only 17% of CDD engaged in physical activities 5 h or more per week.ConclusionOur findings indicate that chronic pain, inadequate dietary patterns and insufficient physical activity are common in CDD from Croatia, Macedonia and Serbia. Education of parents and caregivers can mitigate their use of interventions that have not been proven effective, such as for example the use of gluten-free diets in CDD.

The cost of coeliac condition: economic availability of gluten-free foods for patients with celiac disease in the Czech Republic

PurposeThis study examines the economic availability of gluten-free foods for people with coeliac condition in the Czech Republic, focusing on the price differences between gluten-free and gluten-containing products.Design/methodology/approachA comprehensive price survey was carried out, analysing almost 7,000 products from different categories. Statistical analysis using IBM SPSS Statistics software was used to calculate average prices and test the significance of price differences between the two groups of products.FindingsThe results show that most gluten-free products are more expensive than their gluten-containing counterparts, with significant price differences between product categories, particularly in bakery products. This economic burden is a barrier to adherence to a gluten-free diet, which is essential for the management of celiac disease.Practical implicationsPolicymakers, healthcare providers and other members of the public can use these findings to develop the policies needed to promote the accessibility of gluten-free products.Originality/valueThis research provides unique insights into the economic availability of gluten-free foods for people with coeliac disease in the Czech Republic, a topic that has not been extensively studied in this specific context. While literature exists on the pricing of gluten-free products in other countries, our comprehensive price survey highlights significant price differences between gluten-free and gluten-containing products in the Czech market. The data reflect current market conditions and highlight the economic burden for people with celiac disease, contributing to the discourse on public health and dietary accessibility in the Czech Republic.

Arsenic Exposure in Celiac Disease: The Hidden Cost of a Gluten-Free Diet.

Arsenic Exposure in Celiac Disease: The Hidden Cost of a Gluten-Free Diet.

Gluten-free diets for metabolic control of type 1 diabetes mellitus in children and adolescents: a systematic review and meta-analysis

Gluten-free diets for metabolic control of type 1 diabetes mellitus in children and adolescents: a systematic review and meta-analysis

Role of Millets in prevention and management of lifestyle disorders

To study the role of Millets in prevention and & management & lifestyle disorders. Ayurveda is recognized as the foremost life science & describes ways to prevent & manage lifestyle disorders. Ayurveda provides better solution in the forms of proper dietary management and lifestyle advisor. Millets are gluten free diet they have considerable potential in foods and beverages and can meet the growing demand of gluten free diet.

Oligomerization of 33-mer Gliadin Peptides: Supramolecular Assemblies in Celiac Disease.

The 33-mer gliadin peptide and its deamidated derivative, known as 33-mer DGP, are proteolytically resistant peptides central to the pathomechanism of celiac disease (CeD), the autoimmune presentation of gluten-related disorders (GRD). Both peptides can form spontaneous oligomers in the nanomolar concentration, leading to the formation of nanostructures. In other protein-related diseases, oligomers and aggregates are central in their pathomechanism; therefore, it was hypothesized that the oligomerization of proteolytical-resistant 33-mer gliadin peptides could be an underrecognized disease trigger. This review focuses on the current understanding of 33-mer peptides and their oligomers in vitro and cellular experiments. We intend to give the necessary details that incentivize the chemistry community to get involved in the effort to understand the self-assembly of gliadin peptides and the role of their supramolecular structures in CeD and the other GRD. More research is needed to design effective and safe chemical and/or nutritional interventions beyond the gluten-free diet.

Ultrarare Cause of Childhood Chorea: Celiac Disease.

Chorea, a movement disorder that commonly affects children, may be caused by various diseases with metabolic, structural, pharmacologic, or autoimmune origins. Celiac disease is an autoimmune enteropathy that may rarely cause neurologic symptoms in children, primarily ataxia and peripheral neuropathy, even in the absence of gastrointestinal symptoms. A 9-year-old male patient diagnosed with Sydenham chorea was admitted to our clinic because of valproic acid resistance. He had involuntary, brief, random, and irregular movements in his arms over the past 2 weeks. A low-dose, high-potency dopamine-2 receptor-blocking agent was added to the patient's treatment regimen. After 2 weeks, he had maculopapular rashes on their hands and arms, as well as arthritis in his left hand. Oral prednisone was prescribed, and the patient's arthritis and rashes were completely resolved. Although movement disorder symptoms persisted in the distal left upper extremity, the chorea in the right upper extremity was recovered. Extensive investigations were conducted to rule out possible metabolic, autoimmune, inflammatory, infectious, and paraneoplastic diseases, all of which yielded normal results. Brain magnetic resonance imaging (MRI) results were normal, and genetic analysis results for chorea were negative. The patient's tissue glutaminase IgG levels exceeded 200 U/mL (normal range: 0-10 U/mL) and IgA levels at 24 U/mL (normal range: 0--10 U/mL), leading to a diagnosis of celiac disease. His duodenal biopsies showed changes consistent with gluten-sensitive enteropathy. After the diagnosis of celiac disease, the patient began a gluten-free diet and remained free of chorea at the 6-month follow-up. Chorea is a rare neurologic celiac disease manifestation that can be reversible. The celiac disease should be considered in the diagnostic workup of chorea for all ages, particularly in the treatment-resistant population, even in the absence of gastrointestinal symptoms. This report presents the first known case of chorea caused by celiac disease in a pediatric patient.

FODMAP Diet in Celiac Disease and Gluten-Related Disorders.

Individuals with celiac disease (CD) often report the persistence of gastrointestinal symptoms despite adherence to a gluten-free diet (GFD). A diet rich in fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) could cause symptoms in CD on a GFD, and conversely a low-FODMAP diet could positively influence the therapeutic management of CD and non-celiac gluten sensitivity (NCGS). The aim of this review was to explore the hypothetical impact of the FODMAD diet and the low-FODMAP diet (LFD) in CD and gluten-related disorders. A complete online search for FODMAP related to CD, NCGS, and the GFD was carried out using the Pubmed, Medline, and Cochrane databases. Indeed, an LFD could successfully provide symptom relief in GFD-treated CD patients. Fructans, typical components of FODMAPs, have been associated with digestive symptoms in NCGS, and an LFD could improve the clinical picture. According to some evidence, an LFD could also improve the psychological status both in celiac patients on a GFD and in NCGS. However, an LFD should not have a significant impact on gut microbiota. Recent evidence supports the role of FODMAP restriction in CD patients with persistent symptoms on a GFD and in decreasing gastrointestinal disturbances in NCGS, although the GFD still represents the first-line therapy.

Clinical features and adherence to a gluten-free diet in patients with celiac sprue in the north-west of Algeria

This study aims to identify the predominant form of celiac sprue and the adherence to a gluten-free diet in northwest Algeria. A retrospective analysis was performed on 128 celiac patients at the Department of Gastroenterology and the association of celiac patients. The results show a female predominance with a sex ratio of 0.4. The most affected age group is the young adults (15-29 years). Lean patients represent 42.2%, normal-weight patients represent 51.6% of the study sample, and 6.3% are overweight. 47.7% of cases have a familial form of the disease. 93% underwent a biopsy for diagnosis. 60.9% of patients were not diagnosed in childhood. The main classic gastrointestinal symptoms such as Diarrhea (89.1%) and bloating (56.3%) were detected. Extraintestinal symptoms included weight loss (64.1%), weakness and fatigue (58.6%). Other biological disorders like anemia (71.1%), thyroiditis (15.6%), and type 1 diabetes (14.8%) were observed. Most celiac patients (84.4%) follow the gluten-free diet but find its application difficult. The adherence of GFD does not depend on any parameter of the study (p>0.05). The classic form predominates through a variety of gastrointestinal symptoms and extra-digestive disorders. The unavailability and high cost of imported gluten-free products are the major barriers to gluten-free diet adherence.

Immune Checkpoint Inhibitor-Associated Celiac Disease: A Retrospective Analysis and Literature Review

Introduction: Immune checkpoint inhibitors (ICI) are used to treat various malignancies. They block the inhibitory signals of tumor cells and enhance the inflammatory cascade, which results in tumor killing. However, this can lead to unchecked inflammation throughout the body, leading to various adverse effects. A rare gastrointestinal adverse effect of ICI therapy is the development of immune-mediated celiac disease. This entity has a similar clinical presentation to the more common ICI-induced enterocolitis. Our study aims to determine the clinical characteristics and optimal treatment strategies for this rare ICI toxicity and differentiate it from ICI-induced enterocolitis. Methods and Material: We conducted a retrospective analysis of eight cases of ICI-induced celiac disease and 24 cases of ICI-induced enterocolitis from the literature. Data on patient demographics, clinical history, therapeutic interventions and outcomes were collected. A comparative analysis was performed to identify the key differences between the two groups. Results: Patients with ICI-induced celiac disease were more likely to have a pre-existing autoimmune condition and HLA-DQ2 positivity. Significant differences in clinical manifestations, histological findings, and treatment outcomes were observed. Notably, weight loss, nutritional deficiencies and electrolyte abnormalities were more commonly associated with ICI-induced celiac disease. Regarding pathology, duodenal villous blunting was noted more commonly with ICI-induced celiac disease. Initiating a gluten-free diet led to a rapid improvement in patients with ICI-induced celiac disease, while immunosuppressive therapy did not have an impact. Conclusion: ICI-induced celiac disease is a rare and underrecognized gastrointestinal adverse effect of ICI therapy, often misdiagnosed as ICI-induced enterocolitis. Early recognition and treatment with a gluten-free diet can lead to rapid symptom resolution, sparing patients from unnecessary systemic immunosuppression and the discontinuation of antineoplastic immunotherapy.

Impact of Price Fairness and Quality on Consumer Satisfaction towards Gluten-free Food: Mediating Role of Perceived Value

The demand for gluten-free products has grown tremendously in the past decade globally. In this regard, the present research aims to examine how consumer satisfaction (CS) toward gluten-free products is influenced by perceived quality (PQ), perceived price fairness (PPF), and perceived value (PV), with the use of the theory of cue utilization, dual entitlement, and S-O-R theory. The hypotheses were tested with maximum-likelihood estimation. The finding of this study revealed that PQ, PPF, and PV positively influence CS. Additionally, the partial meditation impact of PV was observed between PPF, PQ, and CS. Theoretical contribution, managerial implication, and scope for further research are discussed at the end of the paper.

Impact of a Gluten-Free Diet in Adults With Celiac Disease: Nutritional Deficiencies and Challenges

Impact of a Gluten-Free Diet in Adults With Celiac Disease: Nutritional Deficiencies and Challenges

Patient perceptions of the Finnish guidelines enabling coeliac disease diagnosis without biopsies in adults

Objectives Diagnosis of coeliac disease based on serology only has been allowed since 2018 in Finland for adults meeting specific criteria. We studied the patient experiences and perceptions of this novel diagnostic option. Methods Altogether 194 adult patients were questioned on socio‐demographic and health-related characteristics, quality of life and various coeliac disease-related issues. The results were compared between patients diagnosed with intestinal biopsy or based on serology only. Results Altogether 69 (36%) of the patients were diagnosed without duodenal biopsies. They were younger (median 43 vs. 51 years, p = 0.046), diagnosed more recently (2021 vs. 2020, p < 0.001) and more often in primary health care (78% vs. 43%, p = 0.001), had fewer esophageal symptoms at diagnosis (17% vs. 30%, p = 0.046) and considered the diagnostic process easier (49% vs. 30%, p = 0.032) than those diagnosed by duodenal biopsy (n = 125). The no-biopsy group received less often dietician follow-up (4% vs. 17%, p = 0.012), reported more persistent symptoms (36% vs. 21%, p = 0.026) and experienced more stress due to the diet (68% vs. 47%, p = 0.039). Symptom persistence or stress were not associated with year of diagnosis or dietician follow-up. The groups were comparable in socio-economic characteristics, general health, quality of life, diagnostic delay, dietician guidance at diagnosis, and dietary adherence. Conclusions The non-invasive approach resulted in de-centralized diagnosis and easier patient-experienced diagnostic process of coeliac disease, but was associated with increased risk for persistent symptoms and stress due to gluten-free diet. These results highlight the significance of appropriate patient guidance and support regardless of the diagnostic strategy.

Genetic variants in the HLA-DQ2 and HLA-DQ8 genes and their involvement in the predisposition to celiac disease

Celiac disease is a multisystem disorder that is triggered by the consumption of gluten in genetically predisposed people, particularly those who carry the HLA-DQ2 and HLA-DQ8 alleles. Environmental factors and certain epigenetic mechanisms play a fundamental role in the manifestation of the disease. It has been shown that the gut microbiome can influence disease progression to some extent. Celiac disease presents with gastrointestinal and extraintestinal symptoms that complicate the diagnosis. Classic symptoms include digestive disorders, while non-classic symptoms include anemia, osteoporosis, and unexplained fatigue. Serological antibody tests and duodenal biopsy are key to a diagnosis, especially in atypical cases. At present, the only treatment is a strict gluten-free diet, although this presents certain problems due to the high cost and nutritional deficiencies. New research is looking for alternatives such as gluten-breaking enzymes as well as immunomodulatory treatments in hopes of more comprehensive options in the future.

Molecular Estimation of IL-15 Gene Effect and H. Pylori Prevalence in Celiac Disease

Remarkable positive associations across IL-15 values and the histopathological severity of celiac disease (CeD) indicate that interleukin (IL)-15 plays an essential part in the immunopathogenesis of the illness. There has been inconsistent evidence in certain research linking Helicobacter pylori to CeD. The goal of this meta-analysis was to measure the connection between CeD and H. pylori. Furthermore, the investigation examined the influence of H. pylori on the indications and categorization of CeD. This study includes 35 patients with CeD. They were fully informed of the study's goals before providing their signed consent. A group of 35 healthy blood donors made up the control group. Blood was drawn, transferred into gel tubes, and centrifuged. Serum specimens from both participants and controls have been obtained and then kept at -20°C in a deep freezer for subsequent use. It have been investigated the molecular relationship between IL-15 gene and CeD. It have been investigated the prevalence of H. pylori and CeD. The result of age and CeD incidence correlation indicates that there is no significance between age samples parameter and CeD incidence (control= 12.83 ± 0.4211, n=35 patients=12.23 ± 0.3358, n=35, p value=0.2692). Results of correlation between gender and CeD incidence indicates that number of male samples (24) and CeD incidence is more than that of female samples (11). Results of correlation between urban-rural residence and CeD incidence indicate that the average CDAT score for those who live in rural was higher in the urban area (good adherence to a gluten-free diet).

Current state of the non-pharmacological management of irritable bowel syndrome: an up-to-date review of the literature.

Irritable bowel syndrome (IBS) is a complex disorder of gut-brain interaction (DGBI) that is thought to affect a significant proportion of the population. As a result of the nature of IBS, it is hard to predict treatment efficacy as all individuals respond differently, and thus multidisciplinary treatment has become increasingly of interest as it targets multiple aspects of IBS at the same time. Here, we aim to review the literature of both multidisciplinary and single-discipline therapy for IBS. Ovid MEDLINE was utilised with a systematic search to find relevant randomised controlled trials. The population included adults with a Rome diagnosis of IBS and an intervention that was either multidisciplinary care, diet, psychotherapy, gut-directed hypnotherapy (GDH) or physiotherapy. Multidisciplinary care studies found an overall significant improvement, while dietary treatment was varied. A low fermentable oligosaccharides, disaccharides, monosaccharides and polyols diet was the only one to improve symptoms, while gluten-free and fibre diets had mixed evidence for their efficacy. Novel diets, including a tritordeum-based diet and low tryptophan diet, significantly improved symptoms. Cognitive behavioural therapy was found to be efficacious when compared to controls, as was psychoeducation. GDH was also found to be efficacious, but 83.3% of studies examined a refractory IBS population. There is a lack of literature looking at how multidisciplinary care and different combinations of disciplines work to treat those with IBS in secondary care. Further studies are required for a greater understanding of how multidisciplinary care may be utilised to better manage IBS.

LINE-1 hypomethylation characterizes the inflammatory response in coeliac disease associated-intestinal mucosa and small bowel adenocarcinomas.

Long interspersed nuclear elements 1 (LINE-1) are the most abundant and the only autonomous mobile elements in the human genome. When their epigenetic repression is removed, it can lead to disease, such as autoimmune diseases and cancer. Coeliac disease (CeD) is an immune-mediated disease triggered by an abnormal T-cell response to dietary gluten and a predisposing condition of small bowel adenocarcinoma (SBA), frequently characterized by epigenetic alterations. The aim of this work was to assess LINE-1 methylation by bisulphite pyrosequencing and NanoString® gene transcription analysis in 38 CeD-SBAs compared with 25 SBAs associated with Crohn's disease (CrD-SBAs) and 25 sporadic SBAs (S-SBA). Both analyses were also performed in duodenal mucosae from 12 untreated CeD patients (UCD) and 19 treated CeD patients (TCD), and in 11 samples of normal intestinal mucosa to better investigate the role of LINE-1 deregulation in CeD and in CeD-SBA. A significant loss of LINE-1 methylation was observed in CeD-SBAs and in mucosae from UCD patients (with very similar methylation levels) compared with controls. By contrast, a restoration of normal LINE-1 methylation levels was found in TCD mucosae after a strict gluten-free diet. LINE-1 hypomethylation does not lead to expression of ORF1 and ORF2, with the only exception being for one CeD-SBA. The expression analysis of enzymes modulating DNA methylation and inflammatory genes confirmed that CeD-SBA shared a very similar expression profile of UCD mucosae showing a strong upregulation of genes involved in inflammation, immune response, and T-cell activity compared with TCD mucosae. For the first time, this work demonstrates that loss of DNA methylation is an intrinsic epigenetic feature of CeD, accompanying the immune response as a reversible mechanism in patients following a strict gluten-free diet, and suggests the possible role of LINE-1 hypomethylation in promoting cell adaptability during the gliadin-related inflammatory process. © 2024 The Author(s). The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.

Celiac disease is common in adults with cryptogenic cirrhosis and responds favourably to gluten-free diet

Introduction: Liver involvement is common in celiac disease (CeD), and upto 4.6% of patients with cryptogenic cirrhosis have CeD. We investigated the prevalence of CeD in patients with cryptogenic cirrhosis and assessed liver-related outcomes in them on GFD when compared to a propensity-score matched (PSM) cohort of patients with cryptogenic cirrhosis without CeD. Methods: Consecutive patients with cryptogenic cirrhosis were screened for CeD using IgA anti-tissue-transglutaminase antibody(anti-tTG) followed by anti-endomysial antibody (AEA) and duodenal and liver biopsies, on which IgA/anti-tTG colocalization studies were performed. These patients and a cohort of patients with cryptogenic cirrhosis without CeD [1:4 CeD: no CeD matched using PSM for age, sex, Child-Turcotte-Pugh(CTP) and model for end-stage-liver-disease(MELD)] were initiated on GFD plus standard of care (SOC) and SOC, respectively and followed up for liver-related outcomes for one year. Results: Of 232 patients with cryptogenic cirrhosis, 14 had high anti-tTG Ab (16.9±10.5 fold rise), with 9 AEA positive and 11(4.7%) biopsy-proven CeD. IgA/ anti-tTG-Ab colocalization was demonstrated in 7/8 liver and 10/11 duodenal biopsies. Patients with cryptogenic cirrhosis with definite CeD (n=11) and matched cohort without CeD (n=44) were similar at baseline [age:31.3±7.7 vs 31.8±9.3 years; 5(45.5%) vs 15(34.1%) females; MELDNa 9 (interquartile-range[IQR]: 8-15.5) vs 12(9-15); CTP 7(6-7.5) vs 6(5.75-7)]. Patients with CeD on GFD improved significantly on follow-up compared to those without CeD [follow-up MELDNa:9 (7.5-10.5) vs 18.5 (12-20);p=0.001 and follow-up CTP: 5 (5-5) vs 8(7-9);p&lt;0.001] with less frequent further decompensations and similar mortality (9.1% vs 18.2%;p=0.67). Conclusion: Approximately 4.7% of patients with cryptogenic cirrhosis have biopsy-proven CeD and their liver-related outcomes improve with GFD.

Effect of ultrasonic treatment on the structure and functional properties of protein-fortified potato powder

Potato powder has substantial nutritional value and gluten-free protein, making it an ideal ingredient in gluten-free foods that meet the dietary requirements of individuals with gluten allergies. However, the absence of gluten protein limits the processing and utilization of potato powder-based products. Different levels of power density (1–5 W/cm3) was used on potato powder enriched with whey protein and determine the impact of structural and functional characteristics by CLSM, FTIR spectroscopy, X-ray diffraction, low-field nuclear magnetic resonance and thermogravimetric analyses. The results showed that ultrasonic treatment destroyed the structures of starch and protein in protein-fortified potato powder, resulting in smaller starch granules. Compared with the blank group, the amylose content increased by 0.13-fold, relative crystallinity (RC) increased to 15.9%, water absorption capacity increased by 36% and oil absorption capacity increased by 112.5%. Ultrasonic treatment increased the contents of disulfide bonds, α-helices and β-sheets in protein-enhanced potato powder; improved the strength and construction rate of the protein network structure; promote the transformation of immobilized-water to bound-water and reduce the water mobility of dough and increased the hardness of protein-enhanced potato powder gel by 1.5-fold. In contrast, excessive ultrasonic power had a negative effect while consuming energy.

Characterization of sacha inchi (Plukenetia volubilis) and taro (Colocasia esculenta) flours with potential application in the preparation of both gluten-free and high protein foods.

Background Interest in alternative sources of tubers and legumes has increased in recent years because of the constant search for raw materials that provide bioactive compounds with antioxidant potential benefits for consumers. The functionality of new raw materials is sought through physical and/or chemical modifications to develop and innovate new foods. The objective of this study was to characterize taro (TF) (Colocasia esculenta) and sacha inchi (Plukenetia volubilis) flours, obtained by the wet (SIF-WM) and defatted method (SIF-DM), as an alternative for the formulation of new functional foods. Methods The free polyphenols of the different mixtures were analyzed, and the antioxidant properties of the extracts obtained were measured using ABTS.* (2,2′-Azino-bis(3-ethylbenzthiazoline-6-sulfonic acid). The ABTS radical method, which reacts with the phenolic compounds of the food matrix, using Trolox as a standard. The blends were subjected to pasting analysis, flow profile tests, determination of viscoelastic properties (temperature sweep). Characterization of common microorganisms in these foods was performed. Results The highest protein value was obtained in the sacha inchi flour obtained by the defatted method (72.62%). The majority of components in taro were carbohydrates (85.4%). About antioxidant and determination of free polyphenols, taro flour obtained values of 2.71 μmol ET/g and 7.47 mg EAG/g, higher than sacha inchi flours. In the rheological analysis (pasting properties, flow profile, and viscoelasticity), we observed that adding taro flour in different mixtures increases the viscosity peak and a lower breakdown, while there was an increase in setback. Except for defatted sacha flour, the others presented a flow index &gt;1 before heating, showing a dilatant fluid behavior. The presence of taro flour improves gel formation and stability. Staphylococcus aureus and Salmonella were present in the taro flour. Conclusions The flours analyzed represent a raw material with great potential for the development of products such as protein snacks due to the contribution of sacha inchi, with good expansion due to taro starch, and naturally gluten-free for people with celiac disease.