Gluten-free Research Articles

The influence of mucilage-rich flours from diverse Australian Plantago species on the pasting, storage, and gluten-free breadmaking properties of rice flour

Plantago seed composition varies with natural variation, particularly regarding their mucilage content and structure, but little is known about how this influences their potential as replacements for conventional food hydrocolloids. We investigated the influence that whole seed flour (WSF) addition from diverse Plantago species had on the pasting, storage and gluten-free (GF) breadmaking properties of rice flour (RF). Despite being starch-less, Plantago WSF significantly altered the pasting profiles of RF with the mucilage conclusively shown to be key. Hastened pasting, stimulation of gelation on cooling and increased storage stability were hypothesised to be related to starch-hydrocolloid interactions. GF RF doughs with WSF added had significantly increased elastic moduli (G’), with tan δ showing a reduced frequency dependence. Improved dough rheology modulated proofing kinetics and led to collapse resistance which produced GF breads with increased specific volume, improved crumb structure, and improved textural characteristics like lower hardness and higher cohesiveness. WSF from the commercial species, P. ovata (psyllium) produced high quality breads but two Australian native relatives, P. turrifera and P. cunninghamii, produced doughs with improved rheological properties and GF breads with greater volume, improved crumb structure and improved texture. Effects of Plantago WSF addition were partly independent of mucilage content suggesting that mucilage polysaccharide structure is influential and might be related to co-polymer network formation. These data show that Plantago WSF can be used as nutritious and sustainable hydrocolloids in starch-based foods and that natural variation in Plantago seed composition is an untapped resource for selectively manipulating their quality.

Adult celiac disease presented with celiac crisis: Report of two cases

Two patients (case 1: 29 years old and case 2: 66 years old. female) with no known medical history of chronic diseases, including celiac disease, presented to the hospital with prolonged diarrhea, weight loss, and severe hypocalcemia at different times. They were admitted to the hospital for hemodynamic instability in the setting of severe dehydration and electrolyte disturbances. Physical examination revealed a positive trousseau sign in Case 1. The typical laboratory features of both cases were low magnesium, low potassium, low vitamin D, low ferritin, and prolonged coagulation tests. In addition to those labs, case 2 also has metabolic acidosis. In both cases, the titers of the tissue transglutaminase IgA and IgG and the anti-endomysium antibody were high, and the histopathology of the duodenal biopsy was consistent with villous atrophy, crypt hyperplasia, and an increase in intraepithelial lymphocytes, suggesting celiac disease. Both cases responded quickly to treatment with a gluten-free diet, fluid, electrolyte, vitamin D, and K replacements, and were discharged. Celiac crisis is a rare presentation of celiac disease characterized by acute, severe metabolic imbalances resulting in high mortality and morbidity, with severe diarrhea, hypoproteinemia, and metabolic and electrolyte disturbances. It is typically seen in children under 2 years of age but can also be encountered in adulthood. Most cases respond to gluten cessation, nutritional support, and rarely steroid treatment.

Food insecurity impacts diet quality and adherence to the gluten-free diet in youth with celiac disease.

Celiac disease (CD) is an autoimmune gastrointestinal disorder that requires a strict lifelong gluten-free diet (GFD). Gluten-free (GF) foods are more expensive and less readily accessible than gluten-containing foods, contributing to an increased risk for food insecurity (FI). The study aimed to determine associations between GF-FI, sociodemographic risk factors and child dietary adherence and diet quality (DQ). A 26-item, cross-country online survey was administered through social media to parents of children with CD on the GFD. The survey elicited household and CD child sociodemographic and clinical characteristics (e.g., duration of CD), measures of household FI, child DQ and GFD adherence, and parents' concerns related to GF food. Household GF-FI was evaluated using the validated Hunger Vital Sign™ and the US Department of Agriculture Six-Item Short Form Household Food Security Survey Module. GF-FI occurred in 47% of households with children with CD with >30% reporting low to very low food security. Sociodemographic risk factors identified included lower income, renters, rural residency, single-parental households, and having children with additional dietary restrictions (p < 0.001). Regardless of FI status, a majority of households reported experiencing significantly higher GF food expenditure. GF-FI was associated with reduced adherence to the GFD, increased consumption of processed GF food, and lower intakes of fresh fruits and vegetables and GF grains among children with CD (p < 0.05). GF-FI is prevalent in this multiethnic cohort of households with CD children and is associated with worsening DQ and GFD adherence. Policy interventions are urgently needed to address GF-FI.

When toxicity is not just from gluten: a systematic review on financial toxicity and celiac disease

Abstract Background With an incidence of up to ∼2% globally, Celiac Disease (CD) is probably one of the most life-long common chronic conditions. Although ‘Financial toxicity’ (FT) has been mainly linked to oncology, significant financial burdens have been described across all healthcare domains, even in CD and to the unexpected economic effort resulting from illness and the need for treatments. This study aimed to investigate the potential relationship between CD and FT. Methods A systematic literature review was performed according to the PRISMA Statement 2020 guidelines. The search query queried the following databases: PubMed, Scopus, CINAHL and APA PsycInfo. No time and study design limits were included. Results 105 articles were found, and 25 were included in the review. The main results revealed that CD impacts physical health and imposes a significant financial burden on patients and their families. FT in CD is primarily due to the high costs of diagnosis, lifestyle changes, and expenses for gluten-free foods. Several studies highlighted the scarce adherence to the therapeutic diet due to the cost of food and poor acceptance of CD. Furthermore, since 2007, there has been increased attention to the difficulty of finding gluten-free products and their expensive fees. All these aspects, even for low-income countries, were faced differently globally, as documented by the heterogeneity of government subsidy policies highlighting the health inequity. Conclusions Considering the prevalence, a comprehensive health assessment with a global health approach should consider clinical, social, and economic aspects. This regard could improve the quality of life for CD patients and ensure fair and personalised access to care, regardless of their geographical location or financial situation. This review has highlighted the fragmentation of resources available internationally, underlining the relevance from a public health point of view. Key messages • Celiac Disease is one of the most common life-long disorders, and financial toxicity is an aspect that should be taken into account also from a public health point of view to ensure health equity. • The gluten-free diet represents an important therapeutic choice in CD; the related expensive fees could increase scarce adherence and worse health outcomes.

Nutritional, physicochemical, and sensorial characterisation of quinoa-millet enriched gluten-free functional cookies

AbstractThe demand for gluten-free food products is expected to grow in the coming years. Quinoa's versatility allows it to replace traditional grains and adds high nutritional value to grain blends and processed food items. The present study was designed to prepare and evaluate gluten-free cookies by substituting rice with quinoa and keeping pearl and foxtail millet constant. A significant increase in protein (8.0–13.2 g/100 g), crude fibre (2.9–6.2%), ash (0.5–1.7%), and hardness (928.9–1736.9 g) was observed with increasing quinoa supplementation. A positive correlation of crude fibre with protein, hardness, and fracturability was observed at P ≤ 5%. Organoleptic evaluation indicated that cookies with 30% quinoa were overall accepted by the consumer. Also, these cookies had lower acid and peroxide values, thus, had longer shelf-lives. This is the first report for the use of quinoa with the mixture of rice and millet, which could be a decent alternative ingredient for gluten-free cookies formulations.

Development of the celiac disease symptom diary version 2.1© (CDSD 2.1©) patient-reported outcome measure.

For patients with celiac disease (CeD), the only current management option is adherence to a strict gluten-free diet (GFD); however, many patients on a GFD continue to experience symptoms with asignificant impact on quality of life. Potential new treatments for CeD are under development and a validated patient-reported outcome measure is required to evaluate their utility in clinical trials. The purpose of this article is to provide a history of the development of the Celiac Disease Symptom Diary (CDSD) 2.1© for use in clinical trials. Qualitative and quantitative studies were conducted from 2010 to 2021, including concept elicitation and cognitive debriefing interviews with adult and adolescent participants with CeD (N = 93) diagnosed via biopsy and/or serology and input from eight interviews with CeD clinical experts. During these studies, different iterations of the CDSD were presented to the US Food and Drug Administration and the European Medicines Agency, and modifications were made in line with their feedback. These studies ultimately led to the development of CDSD 2.1©, a daily diary which focuses on key symptoms of CeD (abdominal pain, bloating, diarrhea, nausea and tiredness). This patient-reported outcome measure was readily understood by adult and adolescent participants with CeD and content validity was demonstrated in both populations. CDSD 2.1© is a content-valid patient-reported outcome measure developed in accordance with best practices and regulatory guidance. A thorough exploration of the psychometric properties of CDSD 2.1© for both adult and adolescent participants with CeDis ongoing to support utilization in clinical trials.

Higher cost of gluten-free products compared to gluten-containing equivalents is mainly attributed to staple foods.

The high cost of gluten-free products (GFPs) is being discussed as a potential barrier to adherence to a gluten-free diet, rendering monitoring of their pricing an ongoing demand in a market subject to continuous fluctuations. The current study aimed to assess the current pricing status of GFPs in the Greek retail market, with a focus on differences between staple and non-staple foods. The retail price and packaging weight of all available GFPs and their gluten-containing (GCPs) counterparts of a GFP-shopping basket (formulated based on the results of a preceding online survey) were recorded by visiting one store of the five most popular reported supermarket chains. The food categories were grouped into staple (e.g. breads, pasta and flours) and non-staple (e.g. chips, sweets and sauces) foods. Adjusting for supermarket chain and product type, a quantile mixed regression model was applied to assess the extent to which median product price (per 100 g) differed between GFPs and GCPs. The unique products recorded were 1058 (of which 408 GFPs), with a total of 2165 retail price recordings. While the overall median price/100 g of GFPs was not found to be significantly different from that of GCPs, the median price of staple GFPs was estimated to be higher than staple GCPs (+€1.03 [95% CI: €0.93; €1.13] per 100 g), whilst that of non-staple GFPs was slightly lower (-€0.20 [95% CI: -€0.37; -€0.02] per 100 g). In conclusion, the persisting higher cost of staple GFPs suggests the need for ongoing financial support for people with coeliac disease.

Gluten Unraveled: Latest Insights on Terminology, Diagnosis, Pathophysiology, Dietary Strategies, and Intestinal Microbiota Modulations-A Decade in Review.

A decade of research on gluten-related disorders (GRDs) is reviewed in this study, with a particular emphasis on celiac disease (CD) and non-celiac gluten sensitivity (NCGS). GRDs are triggered by the ingestion of gluten and gluten-like proteins found in wheat, barley, and rye. These proteins lead to intestinal damage in celiac disease, an autoimmune condition characterized by villous atrophy and a variety of gastrointestinal and extraintestinal symptoms. More enigmatic and less understood, NCGS involves symptoms similar to CD but without the immunological reaction or intestinal damage. Recent years have seen advances in the understanding of GRDs, particularly in connection to how intestinal microbiota influences disease progression and patient outcomes. The gluten-free diet (GFD) is still the standard therapy recommended for GRDs despite significant challenges, as discussed in this article. Precise diagnostic methods, patient education and dietary counseling are critical for improving patients' quality of life. The purpose of this review is to provide a more clear and up-to-date understanding of GRDs, and to help further research on this important topic.

Unlocking the Potential of Teff for Sustainable, Gluten-Free Diets and Unravelling Its Production Challenges to Address Global Food and Nutrition Security: A Review.

Sustainable diets, as defined by the Food and Agriculture Organisation, aim to be nutritionally adequate, safe, and healthy, while optimising natural and human resources. Teff (Eragrostis tef), a gluten-free grain primarily grown in Ethiopia, has emerged as a key contender in this context. Widely regarded as a "supergrain", teff offers an outstanding nutrition profile, making it an excellent choice for people with gluten-related disorders. Rich with protein, essential amino acids, polyunsaturated fats, and fibre, and abundant in minerals like calcium and iron, teff rivals other popular grains like quinoa and durum wheat in promoting human health. Beyond its nutritional benefits, teff is a hardy crop that thrives in diverse climates, tolerating both drought and waterlogged conditions. Due to its resilience and rich nutrient content, teff holds the potential to address nine of the 17 United Nations' Sustainable Development Goals (SDGs), including SDG 1 (no poverty), SDG 2 (zero hunger), and SDG 3 (good health and wellbeing), which are tied to improving food and nutrition security. However, teff production in Ethiopia faces significant issues. Traditional farming practices, insufficient storage infrastructure, and food safety challenges, including adulteration, hinder teff's full potential. This review explores teff's dual role as a nutritious, sustainable food source and outlines the key challenges in its production to conclude on what needs to be done for its adoption as a golden crop to address global food and nutrition security.

Psychological flexibility and celiac disease in adolescents: Understanding adherence and well-being for enhanced care. A rapid narrative review

Abstract Background Psychological flexibility (PF) has been approached as a mediator between health conditions and outcomes by promoting positive responses and healthier behavior repertoires. Purpose This rapid narrative review examines studies exploring the role of PF in influencing celiac disease outcomes among adolescents, with a particular focus on adherence to dietary management practices. Method Online databases were searched for studies exploring possible connections between PF, celiac manifestation, and management presented by adolescents. Selected articles have entered the analysis to highlight whether PF mediates or affects celiac-related outcomes in adolescents. Conclusions Adolescents demonstrate a greater capacity to organize their daily routines effectively while adhering to gluten-free diets. However, the emphasis on PF can significantly impact their social interactions. Although there is much research to be conducted on this possible connection, there are still primary assumptions that support the idea that PF can also be a factor in helping adolescents with celiac disease navigate the challenges of their illness and maintain a quality of life. Healthcare professionals can find value in incorporating elements from supporting therapies, health literacy programs, and health promotion strategies. Furthermore, insights from the review suggest the importance of standardizing interventions and measurements including counseling practices at the primary care level.

Enhancement of Corn Flour with Carob Bean for Innovative Gluten-Free Extruded Products.

The aim of this work is to study new, extruded products based on corn flour enriched with carob bean and the evaluation of its functional quality to develop novel gluten-free food products. Five samples based on corn flour with added carob bean flour (5 to 12.5%) were formulated. Extrusion was performed using a single-screw laboratory extruder at pilot plant scale. Extrusion parameters such as color and carbohydrate content (fiber, sucrose, and starch) were evaluated. Carob bean addition led to an increase in starch, soluble fiber, and insoluble fiber. Texture parameters related to hardness (crunchiness) were significantly reduced with the addition of CB (p < 0.05), detectable from a 5% addition of CB and not significant with more CB content. Samples became browner with the addition of CB; however, when the concentrations of CB are high (>5%) no major differences in color were observed. The extrusion process reduced the content of soluble and insoluble fiber, and sucrose in all formulated samples. Extruded samples with 5-7.5% CB seem to be the best formulation in terms of fiber content, color, and texture parameters. These innovative gluten-free foods could be considered as a source of fiber, and a healthier alternative to some commercially available snacks.

Celiac disease in the aspect of comorbidity: facets and boundaries

Celiac disease poses a serious diagnostic problem due to significant clinical polymorphism with a high frequency of atypical forms. The problem of comorbidity for celiac disease is relevant due to the possible involvement of almost all organs and systems in the pathological process. In this regard, the question arises of which symptoms are a manifestation of the disease, which are complications, and which symptoms are associated with comorbid conditions. The clinical polymorphism of celiac disease is obviously associated with damage to many organs in this disease. They all have a common starting point - an immunopathological process leading to malabsorption and secondary metabolic disorders, which are essentially a manifestation of the disease, but not complications, as is sometimes interpreted. A complication can be considered the oncological consequences of the disease, which develop after prolonged non-compliance of a gluten-free diet. The combination of celiac disease with associated diseases, primarily autoimmune diseases, should be considered as a manifestation of comorbidity.

Dual modification of starch: Synergistic effects of ozonation and pulsed electric fields on structural, rheological, and functional attributes

Study evaluated the influence of ozonization (O3) time combined with pulsed electric fields (PEF) on the modification of bean starch structure. O₃ was used at a concentration of 0.045 g/L for 60 min (Oz1) and 120 min (Oz2) both individually and in combination with 30 kV/cm (P30). Carbonyl content was higher than the carboxyl content, especially with prolonged treatment times (Oz2), indicating partial oxidation. Additionally, higher levels of amylose and degrees of polymerization (DP ≥ 37 and DP 25–36) were observed in the oxidized starches, with significant changes only when combined with PEF. The main morphological and structural modifications included the presence of agglomerates, partial gelatinization, reduced crystallinity, and lower IR1047/1022 in the granules treated with PEF + O3. Oxidized starches exhibited higher solubility, resulting in lower values for rheological parameters, with PEF + 2 h of O3 (Oz2P) standing out. It can be used as prebiotics, controlled release agents and a texturizer for gluten-free foods.

Efficacy and Safety of a Low-FODMAP Diet in Combination with a Gluten-Free Diet for Adult Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis.

Common gastrointestinal disease irritable bowel syndrome (IBS) is marked by symptoms like changed bowel habits, bloating, and stomach ache. A low-FODMAP combined gluten-free diet (LF-GFD) has been suggested as a possible therapy for IBS symptoms management. This study sought to investigate whether a LF-GFD would help patients with IBS. Strict inclusion and exclusion criteria from internet databases helped to identify clinical studies evaluating the intervention of LF-GFD in the treatment of IBS patients. Using measurements including the visual analog scale (VAS) for bloating and pain, the IBS symptom severity scale (IBS-SSS), and IBS quality of life (IBS-QoL), the main results evaluated were the efficacy of LF-GFD in reducing IBS symptoms. Furthermore assessed were the psychological impacts of LF-GFD utilizing the self- rating depression scale (SDS) and self- rating anxiety scale (SAS). A total of 437 patients (221 on LF-GFD diet and 216 on GFD) were involved in 4 randomized controlled trials and 4 cohort studies. The combined results indicated that LF-GFD reduced the VAS bloating ratings (RR = -0.58, 95%CI -0.92-0.23, P = 0.0010, I2 = 83%) and the VAS pain scores (RR = -0.42, 95%CI -0.66-0.19, P = 0.005, I2 = 58%). In addition, LF-GFD indicated a substantial enhancement in IBS-SSS scores (MD = -1.42, 95%CI -2.74-0.10, P = 0.03, I2 = 24%) and IBS-QoL ratings (MD = 3.75, 95%CI 0.98-6.53, P = 0.008, I2 = 33%). Moreover, the LF-GFD group showed a substantial drop in SDS (MD = -2.56, 95%CI -3.38-1.74, P < 0.00001, I2 = 65%) and SAS (MD = -4.30, 95%CI -6.53-2.24, P < 0.0001, I2 = 0%) scores compared to the GFD group. LF-GFD therapy significantly enhances clinical symptoms and reduces anxiety and depression in individuals diagnosed with irritable bowel syndrome.

Running Title: Gluten-Free Biscuit for Autism Children Gluten-Free Biscuit for Children with Autism Spectrum Disorder Made from Modified Taro Flour and Coconut Pulp Flour

Autism spectrum disorder (ASD) is common in children, many of whom require a gluten-free diet. This study explored gluten-free biscuits made with modified taro flour and coconut pulp flour, which are rich in carbohydrates, fats, fiber, and protein. The goal was to assess the physical, sensory, and chemical properties of biscuits made with different ratios of these flours. The research used four formulations of taro flour to coconut pulp flour: P0 (100:0), P1 (70:30), P2 (50:50), and P3 (30:70), with five replications. Data were analyzed using ANOVA and the Duncan Multiple Range Test (DMRT) at a 5% significance level. Results showed that the P2 (50:50) formulation produced the heaviest biscuits (5.32g) and scored highest in color (3.82) and taste (3.78) in sensory tests. The P3 (30:70) formulation was rated best for aroma (3.56) and texture (3.82). Chemical analysis revealed that P0 (100:0) had the highest water (1.85%), ash (2.22%), and carbohydrate content (61.32%). The P2 (50:50) formulation had the highest protein content (4.42%), while P3 (30:70) had the most fat (49.03%) and fiber (7.96%). This study concluded that modified taro flour and coconut pulp flour are effective in creating nutritious, gluten-free biscuits, offering a suitable alternative for children with ASD.

Beyond the gluten-free diet: Innovations in celiac disease therapeutics

Celiac disease (CD) is an autoimmune disorder exacerbated by the ingestion of gluten in genetically susceptible individuals, leading to intestinal inflammation and damage. This chronic disease affects approximately 1% of the world’s population and is a growing health challenge due to its increasing prevalence. The development of CD is a complex interaction between genetic predispositions and environmental factors, especially gluten, culminating in a dysregulated immune response. The only effective treatment at present is a strict, lifelong gluten-free diet. However, adherence to this diet is challenging and often incomplete, so research into alternative therapies has intensified. Recent advances in understanding the molecular and immunological aspects of CD have spearheaded the development of novel pharmacologic strategies that should provide more effective and manageable treatment options. This review examines the latest innovations in CD therapies. The focus is on drugs in advanced clinical phases and targeting specific signaling pathways critical to the disease pathogenesis. We discuss both quantitative strategies such as enzymatic degradation of gluten, and qualitative approaches including immunomodulation and induction of gluten tolerance. Innovative treatments currently under investigation include transglutaminase inhibitors, which prevent the modification of gluten peptides, and nanoparticle-based therapies to recalibrate the immune response. These new therapies not only promise to improve patient outcomes but are also expected to improve quality of life by reducing the burden of dietary restrictions. The integration of these new therapies could revolutionize the treatment of CD and shift the paradigm from strict dietary restrictions to a more flexible and patient-friendly therapeutic approach. This review provides a comprehensive overview of the future prospects of CD treatment and emphasizes the importance of continued research and multidisciplinary collaboration to integrate these advances into standard clinical practice.

Treatment of anal fissures using the new TRPM8 receptor therapy - own experience.

&lt;b&gt;Introduction:&lt;/b&gt; Anal fissure, a longitudinal or oval crack in the anal anoderm above the dentate line, is one of the most common diseases of the anal area. The following article shows the effectiveness of anal fissure treatment based on our own experience, using new receptor therapy in the form of Procto-Zac Memethol Barrier Spray [(1R,2S,5R)-2-isopropyl-5-methylcyclohexanol, sodium hydrogen carbonate, 7-(dimethylamino) phenothiazin-3-ylidene]- dimethylazanium; chloride, 1,2-propanediol, purified water], preparation containing soluble fiber and oral probiotic.&lt;b&gt;Aim:&lt;/b&gt; The aim of the following article is to present our experience and observations in the conservative treatment of acute and chronic anal fissure using Procto-Zac Memethol Barrier Spray and preparations containing soluble fiber and oral probiotic.&lt;b&gt;Material and methods:&lt;/b&gt; The study included a group of 120 patients with anal fissure between 18 and 45 years of age. Each patient in the group received a therapy consisting of Procto-Zac Memethol Barrier Spray (8 sprays once a day, 2 packages) and preparation containing fiber and oral probiotic. A high-fiber, gluten-free and lactose-free diet was also recommended. A follow-up was carried out in our clinic after 4 and 8 weeks. If the symptoms do not disappear completely, also after 3 months from the start of treatment.&lt;b&gt;Results:&lt;/b&gt; Complete relief of symptoms was achieved in 62 patients after 4 weeks of treatment. After 8 weeks, complete relief of symptoms was achieved in another 49 people. In 6 people, after 3 months of treatment, the symptoms were partially relieved, but the anal fissure was not completely healed. Three people did not come for a follow-up visit. In 20 patients, skin burning around the anus was observed during the above therapy.The above symptoms did not require discontinuation of Procto-Zac Memethol Barrier Spray therapy and disappeared after completion of treatment. No other side effects of the preparations used were found.&lt;b&gt;Conclusions:&lt;/b&gt; According to our observations, the use of new TRPM8 receptor therapy MemeThol Barrier Spray, a preparation containing soluble fiber and oral probiotic, turned out to be an effective method of treating anal fissure. In the future, it is advisable to conduct further studies, including multicenter studies, to assess the full tolerability and effectiveness of the described therapy.

Improvement and quality evaluation of gluten-free cake supplemented with sweet potato flour and carrot powder

Celiac disease and wheat allergy are immune-responsive small bowel disorders that respond solely to the ingestion of gluten-fortified wheat or wheat flour. As a result, for those who are allergic to wheat flour or gluten, the primary treatment is a gluten-free or wheat-free diet. The goal of this research is to develop a gluten-free cake with sweet potato and carrot powder, as well as to examine the Proximate analysis, mineral content, physical properties, and microbiological qualities determined using standard analytical procedures. To make cakes, instead of wheat flour, a combined formulation of 80 % sweet potato flour and 20 % carrot powder, 60 % sweet potato flour and 40 % carrot powder was incorporated into the cake ingredients. Quality evaluation of sample cakes was performed by physicochemical and storage properties. The proximate analysis of the data revealed that the cakes that were created contained adequate levels of protein, fiber, and carbohydrates with percentages ranging from 8.12 to 8.25 %, 3.19–4.19 %, and 36.03 to 38.25 %, respectively. Additionally, an appreciable amount of potassium, calcium, magnesium, phosphorus, and iron have been found in gluten-free cakes. There was color to the gluten-free cakes; L*, a*, and b* ranged from 42.66 to 43.60, 10.03 to 11.21, and 21.81 to 23.28, respectively. There is an assurance of a good color property because the hue and chroma values varied from 11.74 to 25.83 and from 41.02 to 78.03, respectively. The water activity (aw) value ranged from 0.854 to 0.870, which increased from 0.879 to 0.901 during storage. Furthermore, the microbial analysis revealed that the total viable count of all samples remained within the acceptable range after 8 days of storage. The findings of this study show that carrot powder and sweet potato flour can be used to overcome the limitations of gluten-free cakes and improve their nutritional quality.

Characteristics of Hospitalized Patients With and Without Celiac Disease on a Gluten-Free Diet.

Most people maintaining a gluten-free diet (GFD) do not have celiac disease (CD). Comorbidities and associated conditions in this population are largely unknown. This study identified demographics, dietary patterns, and diagnoses for patients prescribed a GFD during hospitalization and compared patients with CD to those without CD. We performed a retrospective cross-sectional study for hospital admissions with a GFD between Jan 1, 2010 and June 30, 2022, while excluding patients missing demographic data (n = 113). We compared patients with and without a CD diagnosis, including multivariable logistic regression to identify characteristics independently associated with a CD diagnosis. We analyzed 1527 hospitalized patients of all ages. A minority (n = 467, 30.6%) carried a CD diagnosis. Age, sex, body mass index, and Medicare/Medicaid enrollment and additional diagnoses associated with a GFD (e.g., IBS) were not significantly different. The CD cohort was more predominantly white (66.6% vs 58.4%, p = 0.007) and non-Hispanic (62.5% vs. 52.7%, p = 0.001). While hospitalized, patients with CD had fewer additional dietary restrictions (mean 0.33 vs 0.56, p < 0.001) and more frequent micronutrient supplementation (26.6% vs 21.4%, p = 0.03). CD was independently associated with malnutrition (OR 1.86, 95% CI 1.31-2.65) and inversely associated with a vegetarian diet (OR 0.35, 95% CI 0.15-0.81), reduced lactose diet (OR 0.25, 95% CI 0.13-0.50), and Hispanic ethnicity (OR 0.56, 95% CI 0.35-0.90) while controlling for other covariates. Two-thirds of hospitalized patients receiving a GFD do not have a diagnosis of CD. Among GFD inpatients, CD is associated with fewer dietary restrictions and independently associated with malnutrition.

Assessment of Gluten-Free Products' Availability and Satisfaction in a Polish Population of Coeliac Disease Patients and Their Caregivers.

Among the most important challenges associated with the gluten-free diet are the high costs and limited availability of gluten-free products, accompanied by the lower nutritional value of gluten-free products. The aim of the presented study was to assess gluten-free products' availability and satisfaction in a Polish population of coeliac-disease patients and their caregivers. The study was conducted in a population of Polish female coeliac-disease patients and female family members/relatives of patients diagnosed with coeliac disease, being members of the Polish Coeliac Society and purchasing gluten-free products. A population of n = 819 was included in the studied group based on the inclusion and exclusion criteria (n = 547 of patients and n = 272 of family members/relatives of patients). The study was conducted as a part of an international project to assess the opinions of coeliac-disease patients about gluten-free products, as well as the availability and prices of gluten-free products in various countries, while an identical questionnaire was applied in all participating countries, with transcultural adaptation applied. Opinions concerning the availability of and satisfaction with gluten-free products were assessed based on a questionnaire of agreement with fixed statements about the accessibility, range and quality of gluten-free products in Poland, with a five-point Likert scale to declare the agreement. This was stratified by the following variables: age, place of residence, being diagnosed with coeliac disease, place of purchasing major grocery shopping, gluten-free products at least occasionally bought online, declared problem(s) with the availability and quality of gluten-free products. While comparing the studied sub-groups, it may be stated that some of them were more satisfied than the other sub-groups with the gluten-free products, including their availability and quality; namely, older respondents were more satisfied than younger ones (p < 0.05), respondents living in small towns/villages were more satisfied than those living in big cities (p < 0.05), respondents undertaking major grocery shopping in hypermarkets were more satisfied than those not doing this (p < 0.05), and respondents not buying gluten-free products online were more satisfied than those undertaking this at least occasionally (p < 0.05). At the same time, respondents diagnosed with coeliac disease were more satisfied with the availability and less satisfied with the quality of gluten-free products, while respondents with diagnosed family members/relatives were less satisfied with the availability and more satisfied with the quality (p < 0.05). The group of female coeliac-disease patients and female family members/relatives of patients diagnosed with coeliac disease was highly diverse in terms of their satisfaction with gluten-free products' availability and quality, whilst older respondents, respondents living in small towns/villages, respondents doing major grocery shopping in hypermarkets, and respondents not buying gluten-free products online were more satisfied. Respondents with family members/relatives diagnosed with coeliac disease declared serious efforts and sacrifice to purchase gluten-free products, which was associated with their higher satisfaction with quality and lower satisfaction with availability, while respondents diagnosed with coeliac disease chose easier options, resulting in their higher satisfaction with availability and lower satisfaction with quality.