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Nutrition and Celiac Disease
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Nutrition and Celiac Disease

A special issue of Nutrients (ISSN 2072-6643).

Deadline for manuscript submissions: closed (31 August 2013) | Viewed by 316326

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editors

Prof. Dr. Carlo Catassi

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Guest Editor
1. Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy
2. Italian Society for Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP), Milan, Italy
Interests: celiac disease; gluten-related disorders; gluten sensitivity; pediatric gastroenterology; pediatric nutrition
Special Issues, Collections and Topics in MDPI journals
Professor Alessio Fasano

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Guest Editor
Mucosal Immunology and Biology Research Center, Massachusetts General Hospital East, Building 114, 16th Street (Mail Stop 114-3503), Charlestown, MA 02129-4404, USA.
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Celiac disease (CD) is an autoimmune disorder occurring in genetically predisposed individuals, and triggered by the ingestion of dietary gluten, the major protein component in wheat, barley and rye. In many areas of the world, CD is one of the commonest lifelong disorders affecting approximately 1% of the general population. Treatment of CD is based on the lifelong exclusion of gluten-containing cereals from the diet. The changes needed to begin and maintain a gluten-free diet (GFD) are substantial and have a major impact on daily life. Over the past 30 years the developments in the nutritional aspects of celiac disease have been huge. Nutrient deficiencies have been described in celiac patients both before and after diagnosis, due to intestinal malabsorption and specific limitations of the GFD, respectively. The relationship between the level of gluten intake and intestinal damage has been analyzed leading to new Codex Alimentarius recommendations on the gluten threshold in gluten-free food. Contamination with gluten of the GFD is an important issue in CD management. The spectrum of cereal toxicity for CD patients has been investigated with practical implications on the GFD. The nutritional quality of gluten-free food is constantly improving thanks to the new scientific approach in the technology of gluten-free wheat substitutes. The purpose of this special issue is to provide a summary of contemporary issues and invite contributions that describe new insights into the dietary management of CD.

Professor Carlo Catassi
Professor Alessio Fasano
Guest Editors

Submission

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charges (APC) for publication in this open access journal is 500 CHF (Swiss Francs) for well prepared manuscripts submitted before 30 June 2012. The APC for manuscripts submitted from 1 July 2012 onwards are 1000 CHF per accepted paper. In addition, a fee of 250 CHF may apply if English editing or extensive revisions must be undertaken by the Editorial Office.

Keywords

  • celiac disease
  • gluten sensitivity
  • wheat allergy
  • gluten
  • nutrient intake
  • fiber
  • malnutrition
  • gluten-free diet
  • gluten-free food
  • gluten contamination
  • gluten threshold
  • oats
  • dietary treatment
  • compliance

Published Papers (20 papers)

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Research

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247 KiB  
Article
Oats in the Diet of Children with Celiac Disease: Preliminary Results of a Double-Blind, Randomized, Placebo-Controlled Multicenter Italian Study
by Simona Gatti, Nicole Caporelli, Tiziana Galeazzi, Ruggiero Francavilla, Maria Barbato, Paola Roggero, Basilio Malamisura, Giuseppe Iacono, Andrea Budelli, Rosaria Gesuita, Carlo Catassi and Elena Lionetti
Nutrients 2013, 5(11), 4653-4664; https://doi.org/10.3390/nu5114653 - 20 Nov 2013
Cited by 25 | Viewed by 11105
Abstract
A gluten-free diet (GFD) is currently the only available treatment for patients with celiac disease (CD). Several clinical trials have demonstrated that most celiac patients can tolerate a medium-high quantity of oats without any negative clinical effects; however, the inclusion of oats in [...] Read more.
A gluten-free diet (GFD) is currently the only available treatment for patients with celiac disease (CD). Several clinical trials have demonstrated that most celiac patients can tolerate a medium-high quantity of oats without any negative clinical effects; however, the inclusion of oats in GFD is still a matter of debate. In this study, Italian children with CD were enrolled in a 15-month, randomized, double-blind, placebo-controlled multicenter trial. Participants were randomized in two groups following either A-B treatment (6 months of diet “A”, 3 months of standard GFD, 6 months of diet “B”), or B-A treatment (6 months of diet “B”, 3 months of standard GFD, 6 months of diet “A”). A and B diets included gluten-free (GF) products (flour, pasta, biscuits, cakes and crisp toasts) with either purified oats or placebo. Clinical data (Gastrointestinal Symptoms Rate Scale [GSRS] score) and intestinal permeability tests (IPT), were measured through the study period. Although the study is still blinded, no significant differences were found in GSRS score or the urinary lactulose/mannitol (L/M) ratio between the two groups after 6 months of treatment. These preliminary results suggest that the addition of non-contaminated oats from selected varieties in the treatment of children with CD does not determine changes in intestinal permeability and gastrointestinal symptoms. Full article
(This article belongs to the Special Issue Nutrition and Celiac Disease)
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179 KiB  
Article
Assessing Quality Outcome Measures in Children with Coeliac Disease—Experience from Two UK Centres
by Alexander Ross, Helen Shelley, Kim Novell, Elizabeth Ingham, Julia Callan, Robert Heuschkel, Mary-Anne Morris and Matthias Zilbauer
Nutrients 2013, 5(11), 4605-4613; https://doi.org/10.3390/nu5114605 - 19 Nov 2013
Cited by 6 | Viewed by 7142
Abstract
Improved diagnosis of coeliac disease has increased incidence and therefore burden on the health care system. There are no quality outcome measures (QOM) in use nationally to assess hospital management of this condition. This study applied QOM devised by the East of England [...] Read more.
Improved diagnosis of coeliac disease has increased incidence and therefore burden on the health care system. There are no quality outcome measures (QOM) in use nationally to assess hospital management of this condition. This study applied QOM devised by the East of England paediatric gastroenterology network to 99 patients reviewed at two tertiary hospitals in the Network, to assess the quality of care provided by nurse led and doctor led care models. The average performance across all QOM was 96.2% at Addenbrooke’s Hospital (AH), and 98.7% at Norfolk and Norwich Hospital (NNUH), whilst 95% (n = 18) of QOM were met. Patient satisfaction was high at both sites (uptake of questionnaire 53 of 99 patients in the study). The study showed a comparably high level of care delivered by both a nurse and doctor led service. Our quality assessment tools could be applied in the future by other centres to measure standards of care. Full article
(This article belongs to the Special Issue Nutrition and Celiac Disease)
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1056 KiB  
Article
Lectin Staining Shows no Evidence of Involvement of Glycocalyx/Mucous Layer Carbohydrate Structures in Development of Celiac Disease
by Henrik Toft-Hansen, Christian Nielsen, Matteo Biagini, Steffen Husby and Søren T. Lillevang
Nutrients 2013, 5(11), 4540-4552; https://doi.org/10.3390/nu5114540 - 18 Nov 2013
Cited by 3 | Viewed by 7321
Abstract
The presence of unique carbohydrate structures in the glycocalyx/mucous layer of the intestine may be involved in a susceptibility to celiac disease (CD) by serving as attachment sites for bacteria. This host-microbiota interaction may influence the development of CD and possibly other diseases [...] Read more.
The presence of unique carbohydrate structures in the glycocalyx/mucous layer of the intestine may be involved in a susceptibility to celiac disease (CD) by serving as attachment sites for bacteria. This host-microbiota interaction may influence the development of CD and possibly other diseases with autoimmune components. We examined duodenal biopsies from a total of 30 children, of which 10 had both celiac disease (CD) and type 1 diabetes (T1D); 10 had CD alone; and 10 were suspected of having gastrointestinal disease, but had normal duodenal histology (non-CD controls). Patients with both CD and T1D were examined before and after remission following a gluten-free diet. We performed lectin histochemistry using peanut agglutinin (PNA) and Ulex europaeus agglutinin (UEA) staining for Gal-β(1,3)-GalNAc and Fucα1-2Gal-R, respectively, of the glycocalyx/mucous layer. The staining was scored based on dissemination of stained structures on a scale from 0 to 3. Evaluation of the scores revealed no difference between biopsies obtained before and after remission in the group of children with both CD and T1D. A comparison of this pre-remission group with the children who had CD alone or the non-CD controls also showed no significant differences. Based on our material, we found no indication that the presence of Gal-β(1,3)-GalNAc or Fucα1-2Gal-R is involved in the susceptibility to CD, or that the disease process affects the expression of these carbohydrates. Full article
(This article belongs to the Special Issue Nutrition and Celiac Disease)
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291 KiB  
Article
Application of Dairy Proteins as Technological and Nutritional Improvers of Calcium-Supplemented Gluten-Free Bread
by Urszula Krupa-Kozak, Natalia Bączek and Cristina M. Rosell
Nutrients 2013, 5(11), 4503-4520; https://doi.org/10.3390/nu5114503 - 14 Nov 2013
Cited by 49 | Viewed by 7959
Abstract
Effect of dairy proteins on gluten-free dough behavior, and nutritional and technological properties of gluten-free bread was evaluated. Experimental doughs, containing dairy powders, showed low consistency. Obtained gluten-free breads were rich in proteins, and, regarding the energy value delivered by proteins, they could [...] Read more.
Effect of dairy proteins on gluten-free dough behavior, and nutritional and technological properties of gluten-free bread was evaluated. Experimental doughs, containing dairy powders, showed low consistency. Obtained gluten-free breads were rich in proteins, and, regarding the energy value delivered by proteins, they could be considered as a source of proteins or high in proteins. Applied dairy proteins affected the technological properties of experimental breads causing a significant (p < 0.05) increase of the specific volume, crust darkening, and crumb lightness, depending on the dairy supplementation level, rather than the protein type. Dairy proteins incorporated at a 12% level, significantly (p < 0.05) decreased the hardness; nevertheless, the highest amount of proteins tested led to the opposite effect. These results indicate that milk proteins tested could be successfully added to gluten-free bread with beneficial effects on technological and nutritional properties. Full article
(This article belongs to the Special Issue Nutrition and Celiac Disease)
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351 KiB  
Article
Health-Related Quality of Life in Children with Celiac Disease: A Study Based on the Critical Incident Technique
by Chiara Biagetti, Giulia Naspi and Carlo Catassi
Nutrients 2013, 5(11), 4476-4485; https://doi.org/10.3390/nu5114476 - 12 Nov 2013
Cited by 27 | Viewed by 8225
Abstract
Celiac Disease (CD) is a chronic autoimmune disease triggered by dietary gluten. Gluten avoidance, which is the only available treatment for CD, could impact on quality of life of children with CD. We present the results of a qualitative study on the emotional [...] Read more.
Celiac Disease (CD) is a chronic autoimmune disease triggered by dietary gluten. Gluten avoidance, which is the only available treatment for CD, could impact on quality of life of children with CD. We present the results of a qualitative study on the emotional impact of gluten free diet (GFD) on the everyday life of children affected with CD. We investigated 76 celiac patients aged 2–18 years (average age: 9.5 years). By using the Critical Incident Technique (CIT), we defined emotions related to difficulties and awkward situations experienced by the patients. Written answers to open-ended questions from either children (older than 8 years) and parents (children younger than 8 years) were analyzed qualitatively. We found 80 dilemmas experienced in three different arenas (food situations at school, meals at home, meals outside) and characterized lived experiences of children with CD in everyday life (specific emotions, difficulties in relationships and in management of daily life). Children with CD experience strong emotions related to the GFD, permeating several aspects of everyday life. These dilemmas may be missed by a conventional, questionnaire-based approach to the psycho-social consequences of CD treatment. Full article
(This article belongs to the Special Issue Nutrition and Celiac Disease)
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264 KiB  
Article
Long-Term Consumption of Oats in Adult Celiac Disease Patients
by Katri Kaukinen, Pekka Collin, Heini Huhtala and Markku Mäki
Nutrients 2013, 5(11), 4380-4389; https://doi.org/10.3390/nu5114380 - 06 Nov 2013
Cited by 54 | Viewed by 11318
Abstract
Many celiac disease patients tolerate oats, but limited data are available on its long-term consumption. This was evaluated in the present study, focusing on small-bowel mucosal histology and gastrointestinal symptoms in celiac adults maintaining a strict gluten-free diet with or without oats. Altogether [...] Read more.
Many celiac disease patients tolerate oats, but limited data are available on its long-term consumption. This was evaluated in the present study, focusing on small-bowel mucosal histology and gastrointestinal symptoms in celiac adults maintaining a strict gluten-free diet with or without oats. Altogether 106 long-term treated celiac adults were enrolled for this cross-sectional follow-up study. Daily consumption of oats and fiber was assessed, and small-bowel mucosal morphology and densities of CD3+, αβ+ and γσ+ intraepithelial lymphocytes determined. Gastrointestinal symptoms were assessed by a validated Gastrointestinal Symptom Rating Scale questionnaire. Seventy (66%) out of the 106 treated celiac disease patients had consumed a median of 20 g of oats (range 1–100 g) per day for up to eight years; all consumed oat products bought from general stores. Daily intake and long-term consumption of oats did not result in small-bowel mucosal villous damage, inflammation, or gastrointestinal symptoms. Oat-consumers had a significantly higher daily intake of fiber than those who did not use oats. Two thirds of celiac disease patients preferred to use oats in their daily diet. Even long-term ingestion of oats had no harmful effects. Full article
(This article belongs to the Special Issue Nutrition and Celiac Disease)
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232 KiB  
Article
Vitamin and Mineral Deficiencies Are Highly Prevalent in Newly Diagnosed Celiac Disease Patients
by Nicolette J. Wierdsma, Marian A. E. Van Bokhorst-de van der Schueren, Marijke Berkenpas, Chris J. J. Mulder and Ad A. Van Bodegraven
Nutrients 2013, 5(10), 3975-3992; https://doi.org/10.3390/nu5103975 - 30 Sep 2013
Cited by 185 | Viewed by 23716
Abstract
Malabsorption, weight loss and vitamin/mineral-deficiencies characterize classical celiac disease (CD). This study aimed to assess the nutritional and vitamin/mineral status of current “early diagnosed” untreated adult CD-patients in the Netherlands. Newly diagnosed adult CD-patients were included (n = 80, 42.8 ± 15.1 [...] Read more.
Malabsorption, weight loss and vitamin/mineral-deficiencies characterize classical celiac disease (CD). This study aimed to assess the nutritional and vitamin/mineral status of current “early diagnosed” untreated adult CD-patients in the Netherlands. Newly diagnosed adult CD-patients were included (n = 80, 42.8 ± 15.1 years) and a comparable sample of 24 healthy Dutch subjects was added to compare vitamin concentrations. Nutritional status and serum concentrations of folic acid, vitamin A, B6, B12, and (25-hydroxy) D, zinc, haemoglobin (Hb) and ferritin were determined (before prescribing gluten free diet). Almost all CD-patients (87%) had at least one value below the lower limit of reference. Specifically, for vitamin A, 7.5% of patients showed deficient levels, for vitamin B6 14.5%, folic acid 20%, and vitamin B12 19%. Likewise, zinc deficiency was observed in 67% of the CD-patients, 46% had decreased iron storage, and 32% had anaemia. Overall, 17% were malnourished (>10% undesired weight loss), 22% of the women were underweight (Body Mass Index (BMI) < 18.5), and 29% of the patients were overweight (BMI > 25). Vitamin deficiencies were barely seen in healthy controls, with the exception of vitamin B12. Vitamin/mineral deficiencies were counter-intuitively not associated with a (higher) grade of histological intestinal damage or (impaired) nutritional status. In conclusion, vitamin/mineral deficiencies are still common in newly “early diagnosed” CD-patients, even though the prevalence of obesity at initial diagnosis is rising. Extensive nutritional assessments seem warranted to guide nutritional advices and follow-up in CD treatment. Full article
(This article belongs to the Special Issue Nutrition and Celiac Disease)
322 KiB  
Article
Is Dietitian Use Associated with Celiac Disease Outcomes?
by SriHari Mahadev, Suzanne Simpson, Benjamin Lebwohl, Suzanne K. Lewis, Christina A. Tennyson and Peter H. R. Green
Nutrients 2013, 5(5), 1585-1594; https://doi.org/10.3390/nu5051585 - 15 May 2013
Cited by 33 | Viewed by 9093
Abstract
A gluten-free diet (GFD) is the treatment for celiac disease (CD), but due to its complexity, dietitian referral is uniformly recommended. We surveyed patients with CD to determine if dietitian use is associated with quality of life, symptom severity, or GFD adherence. The [...] Read more.
A gluten-free diet (GFD) is the treatment for celiac disease (CD), but due to its complexity, dietitian referral is uniformly recommended. We surveyed patients with CD to determine if dietitian use is associated with quality of life, symptom severity, or GFD adherence. The survey utilized three validated CD-specific instruments: the CD quality of life (CD-QOL), CD symptom index (CSI) and CD adherence test (CDAT). Four hundred and thirteen patients with biopsy-proven CD were eligible for inclusion. The majority (77%) were female and mean BMI was 24.1. Over three-quarters of patients (326, 79%) had seen a dietitian, however, 161 (39%) had seen a dietitian only once. Age, sex, and education level were not associated with dietitian use; nor was BMI (24.6 vs. 24.0, p = 0.45). On multivariate analysis, adjusting for age gender, education, duration of disease, and body mass index, dietitian use was not associated with CD-QOL, CSI, or CDAT scores. Our survey did not show an association between dietitian use and symptom severity, adherence, or quality of life. Delay in diagnosis was associated with poorer outcomes. This is a preliminary study with several limitations, and further prospective analysis is needed to evaluate the benefits and cost-effectiveness of dietitian-referral in the care of celiac disease patients. Full article
(This article belongs to the Special Issue Nutrition and Celiac Disease)

Review

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192 KiB  
Review
The Overlap between Irritable Bowel Syndrome and Non-Celiac Gluten Sensitivity: A Clinical Dilemma
by Archita Makharia, Carlo Catassi and Govind K. Makharia
Nutrients 2015, 7(12), 10417-10426; https://doi.org/10.3390/nu7125541 - 10 Dec 2015
Cited by 82 | Viewed by 19098
Abstract
The spectrum of gluten-related disorders has widened in recent times and includes celiac disease, non-celiac gluten sensitivity, and wheat allergy. The complex of symptoms associated with these diseases, such as diarrhea, constipation or abdominal pain may overlap for the gluten related diseases, and [...] Read more.
The spectrum of gluten-related disorders has widened in recent times and includes celiac disease, non-celiac gluten sensitivity, and wheat allergy. The complex of symptoms associated with these diseases, such as diarrhea, constipation or abdominal pain may overlap for the gluten related diseases, and furthermore they can be similar to those caused by various other intestinal diseases, such as irritable bowel syndrome (IBS). The mechanisms underlying symptom generation are diverse for all these diseases. Some patients with celiac disease may remain asymptomatic or have only mild gastrointestinal symptoms and thus may qualify for the diagnosis of IBS in the general clinical practice. Similarly, the overlap of symptoms between IBS and non-celiac gluten sensitivity (NCGS) often creates a dilemma for clinicians. While the treatment of NCGS is exclusion of gluten from the diet, some, but not all, of the patients with IBS also improve on a gluten-free diet. Both IBS and NCGS are common in the general population and both can coexist with each other independently without necessarily sharing a common pathophysiological basis. Although the pathogenesis of NCGS is not well understood, it is likely to be heterogeneous with possible contributing factors such as low-grade intestinal inflammation, increased intestinal barrier function and changes in the intestinal microbiota. Innate immunity may also play a pivotal role. One possible inducer of innate immune response has recently been reported to be amylase-trypsin inhibitor, a protein present in wheat endosperm and the source of flour, along with the gluten proteins. Full article
(This article belongs to the Special Issue Nutrition and Celiac Disease)
200 KiB  
Review
Celiac Disease and Overweight in Children: An Update
by Antonella Diamanti, Teresa Capriati, Maria Sole Basso, Fabio Panetta, Vincenzo Maria Di Ciommo Laurora, Francesca Bellucci, Fernanda Cristofori and Ruggiero Francavilla
Nutrients 2014, 6(1), 207-220; https://doi.org/10.3390/nu6010207 - 02 Jan 2014
Cited by 69 | Viewed by 12129
Abstract
The clinical presentation of celiac disease in children is very variable and differs with age. The prevalence of atypical presentations of celiac disease has increased over the past 2 decades. Several studies in adults and children with celiac disease indicate that obesity/overweight at [...] Read more.
The clinical presentation of celiac disease in children is very variable and differs with age. The prevalence of atypical presentations of celiac disease has increased over the past 2 decades. Several studies in adults and children with celiac disease indicate that obesity/overweight at disease onset is not unusual. In addition, there is a trend towards the development of overweight/obesity in celiac patients who strictly comply with a gluten-free diet. However, the pathogenesis and clinical implications of the coexistence of classic malabsorption (e.g., celiac disease) and overweight/obesity remain unclear. This review investigated the causes and main clinical factors associated with overweight/obesity at the diagnosis of celiac disease and clarified whether gluten withdrawal affects the current trends of the nutritional status of celiac disease patients. Full article
(This article belongs to the Special Issue Nutrition and Celiac Disease)
191 KiB  
Review
Problems and Challenges to Adaptation of Gluten Free Diet by Indian Patients with Celiac Disease
by Preeti Rajpoot and Govind K. Makharia
Nutrients 2013, 5(12), 4869-4879; https://doi.org/10.3390/nu5124869 - 27 Nov 2013
Cited by 29 | Viewed by 8897
Abstract
Celiac disease is emerging in India and has become a public health problem. Almost 6–8 million Indians are estimated to have celiac disease. While there is a large pool of patients with celiac disease in India, until now, only a fraction of them [...] Read more.
Celiac disease is emerging in India and has become a public health problem. Almost 6–8 million Indians are estimated to have celiac disease. While there is a large pool of patients with celiac disease in India, until now, only a fraction of them have been diagnosed. With increasing awareness about celiac disease amongst health care providers and the general population, a massive increase in the number of patients with celiac disease is expected now and in the subsequent decade in India. While the number of patients with celiac disease is increasing, the country’s preparedness towards the emerging epidemic of this disease is minimal. There are a number of issues, which requires urgent attention. Some of the key issues include increased awareness amongst health care professionals and the general public about the disease and its management, team-based management of patients with celiac disease, proper counseling and supervision of patients, training of dietitians in the management of patients with celiac disease, industrial production of reliable and affordable gluten-free food, and food labeling for gluten contents. Full article
(This article belongs to the Special Issue Nutrition and Celiac Disease)
273 KiB  
Review
Bone Mass and Mineral Metabolism Alterations in Adult Celiac Disease: Pathophysiology and Clinical Approach
by Michele Di Stefano, Caterina Mengoli, Manuela Bergonzi and Gino Roberto Corazza
Nutrients 2013, 5(11), 4786-4799; https://doi.org/10.3390/nu5114786 - 22 Nov 2013
Cited by 46 | Viewed by 9242
Abstract
Osteoporosis affects many patients with celiac disease (CD), representing the consequence of calcium malabsorption and persistent activation of mucosal inflammation. A slight increase of fracture risk is evident in this condition, particularly in those with overt malabsorption and in postmenopausal state. The adoption [...] Read more.
Osteoporosis affects many patients with celiac disease (CD), representing the consequence of calcium malabsorption and persistent activation of mucosal inflammation. A slight increase of fracture risk is evident in this condition, particularly in those with overt malabsorption and in postmenopausal state. The adoption of a correct gluten-free diet (GFD) improves bone derangement, but is not able to normalize bone mass in all the patients. Biomarkers effective in the prediction of bone response to gluten-free diet are not yet available and the indications of guidelines are still imperfect and debated. In this review, the pathophysiology of bone loss is correlated to clinical aspects, defining an alternative proposal of management for this condition. Full article
(This article belongs to the Special Issue Nutrition and Celiac Disease)
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296 KiB  
Review
The Clinical Response to Gluten Challenge: A Review of the Literature
by Maaike J. Bruins
Nutrients 2013, 5(11), 4614-4641; https://doi.org/10.3390/nu5114614 - 19 Nov 2013
Cited by 44 | Viewed by 9953
Abstract
The aim of this review was to identify, evaluate and summarize all relevant studies reporting on the clinical response to gluten challenge by adult or pediatric patients with suspected or diagnosed coeliac disease (CD) on a gluten-free diet. We evaluated the effect of [...] Read more.
The aim of this review was to identify, evaluate and summarize all relevant studies reporting on the clinical response to gluten challenge by adult or pediatric patients with suspected or diagnosed coeliac disease (CD) on a gluten-free diet. We evaluated the effect of gluten challenge on changes in symptoms, intestinal mucosa histology, and serum antibodies. A systematic electronic search was performed for studies published as of 1966 using PubMed and Scopus databases. In the reviewed studies, doses ranged from 0.2 to 30 g/day of wheat gluten or comprised a gluten-containing diet. The onset of symptoms upon gluten intake varied largely from days to months and did not parallel serum antibody or histological changes. Within 3 months of gluten challenge, 70%–100% of pediatric CD patients became positive for AGA-IgA and EMA-IgA antibodies and 50%–70% for AGA-IgG. A limited number of trials suggest that no more than half of adult patients developed positive AGA-IgA, EMA-IgA, tTG-IgA or DGP-IgA/IgG titers. Approximately 50%–100% of pediatric and adult patients experienced mucosal relapse of gluten provocation within 3 months, which was preceded by increased mucosal intra-epithelial lymphocytes within several days of challenge. A 3-month high-dose gluten challenge should be suitable to diagnose the majority of CD patients. In some cases prolonged challenge may be needed to verify diagnosis. Combination testing for antibodies and mucosal histology may fasten the diagnosis. Full article
(This article belongs to the Special Issue Nutrition and Celiac Disease)
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236 KiB  
Review
Gluten-Free Diet in Children: An Approach to a Nutritionally Adequate and Balanced Diet
by Francesca Penagini, Dario Dilillo, Fabio Meneghin, Chiara Mameli, Valentina Fabiano and Gian Vincenzo Zuccotti
Nutrients 2013, 5(11), 4553-4565; https://doi.org/10.3390/nu5114553 - 18 Nov 2013
Cited by 113 | Viewed by 29354
Abstract
Gluten-free diet (GFD) is the cornerstone treatment for celiac disease (CD). GFD implies a strict and lifelong elimination from the diet of gluten, the storage protein found in wheat, barley, rye and hybrids of these grains, such as kamut and triticale. The absence [...] Read more.
Gluten-free diet (GFD) is the cornerstone treatment for celiac disease (CD). GFD implies a strict and lifelong elimination from the diet of gluten, the storage protein found in wheat, barley, rye and hybrids of these grains, such as kamut and triticale. The absence of gluten in natural and processed foods, despite being the key aspect of GFD, may lead to nutritional consequences, such as deficits and imbalances. The nutritional adequacy of GFD is particularly important in children, this the age being of maximal energy and nutrient requirements for growth, development and activity. In recent years, attention has focused on the nutritional quality of gluten-free products (GFPs) available in the market. It is well recognized that GFPs are considered of lower quality and poorer nutritional value compared to the gluten-containing counterparts. The present review focuses on the nutritional adequacy of GFD at the pediatric age, with the aim being to increase awareness of the potential complications associated with this diet, to identify strategies in order to avoid them and to promote a healthier diet and lifestyle in children with CD. Full article
(This article belongs to the Special Issue Nutrition and Celiac Disease)
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718 KiB  
Review
The Gluten-Free Diet: Testing Alternative Cereals Tolerated by Celiac Patients
by Isabel Comino, María De Lourdes Moreno, Ana Real, Alfonso Rodríguez-Herrera, Francisco Barro and Carolina Sousa
Nutrients 2013, 5(10), 4250-4268; https://doi.org/10.3390/nu5104250 - 23 Oct 2013
Cited by 76 | Viewed by 18358
Abstract
A strict gluten-free diet (GFD) is the only currently available therapeutic treatment for patients with celiac disease, an autoimmune disorder of the small intestine associated with a permanent intolerance to gluten proteins. The complete elimination of gluten proteins contained in cereals from the [...] Read more.
A strict gluten-free diet (GFD) is the only currently available therapeutic treatment for patients with celiac disease, an autoimmune disorder of the small intestine associated with a permanent intolerance to gluten proteins. The complete elimination of gluten proteins contained in cereals from the diet is the key to celiac disease management. However, this generates numerous social and economic repercussions due to the ubiquity of gluten in foods. The research presented in this review focuses on the current status of alternative cereals and pseudocereals and their derivatives obtained by natural selection, breeding programs and transgenic or enzymatic technology, potential tolerated by celiac people. Finally, we describe several strategies for detoxification of dietary gluten. These included enzymatic cleavage of gliadin fragment by Prolyl endopeptidases (PEPs) from different organisms, degradation of toxic peptides by germinating cereal enzymes and transamidation of cereal flours. This information can be used to search for and develop cereals with the baking and nutritional qualities of toxic cereals, but which do not exacerbate this condition. Full article
(This article belongs to the Special Issue Nutrition and Celiac Disease)
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191 KiB  
Review
Maize Prolamins Could Induce a Gluten-Like Cellular Immune Response in Some Celiac Disease Patients
by Juan P. Ortiz-Sánchez, Francisco Cabrera-Chávez and Ana M. Calderón De la Barca
Nutrients 2013, 5(10), 4174-4183; https://doi.org/10.3390/nu5104174 - 21 Oct 2013
Cited by 28 | Viewed by 12630
Abstract
Celiac disease (CD) is an autoimmune-mediated enteropathy triggered by dietary gluten in genetically prone individuals. The current treatment for CD is a strict lifelong gluten-free diet. However, in some CD patients following a strict gluten-free diet, the symptoms do not remit. These cases [...] Read more.
Celiac disease (CD) is an autoimmune-mediated enteropathy triggered by dietary gluten in genetically prone individuals. The current treatment for CD is a strict lifelong gluten-free diet. However, in some CD patients following a strict gluten-free diet, the symptoms do not remit. These cases may be refractory CD or due to gluten contamination; however, the lack of response could be related to other dietary ingredients, such as maize, which is one of the most common alternatives to wheat used in the gluten-free diet. In some CD patients, as a rare event, peptides from maize prolamins could induce a celiac-like immune response by similar or alternative pathogenic mechanisms to those used by wheat gluten peptides. This is supported by several shared features between wheat and maize prolamins and by some experimental results. Given that gluten peptides induce an immune response of the intestinal mucosa both in vivo and in vitro, peptides from maize prolamins could also be tested to determine whether they also induce a cellular immune response. Hypothetically, maize prolamins could be harmful for a very limited subgroup of CD patients, especially those that are non-responsive, and if it is confirmed, they should follow, in addition to a gluten-free, a maize-free diet. Full article
(This article belongs to the Special Issue Nutrition and Celiac Disease)
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Review
Non-Celiac Gluten Sensitivity: The New Frontier of Gluten Related Disorders
by Carlo Catassi, Julio C. Bai, Bruno Bonaz, Gerd Bouma, Antonio Calabrò, Antonio Carroccio, Gemma Castillejo, Carolina Ciacci, Fernanda Cristofori, Jernej Dolinsek, Ruggiero Francavilla, Luca Elli, Peter Green, Wolfgang Holtmeier, Peter Koehler, Sibylle Koletzko, Christof Meinhold, David Sanders, Michael Schumann, Detlef Schuppan, Reiner Ullrich, Andreas Vécsei, Umberto Volta, Victor Zevallos, Anna Sapone and Alessio Fasanoadd Show full author list remove Hide full author list
Nutrients 2013, 5(10), 3839-3853; https://doi.org/10.3390/nu5103839 - 26 Sep 2013
Cited by 404 | Viewed by 84631
Abstract
Non Celiac Gluten sensitivity (NCGS) was originally described in the 1980s and recently a “re-discovered” disorder characterized by intestinal and extra-intestinal symptoms related to the ingestion of gluten-containing food, in subjects that are not affected with either celiac disease (CD) or wheat allergy [...] Read more.
Non Celiac Gluten sensitivity (NCGS) was originally described in the 1980s and recently a “re-discovered” disorder characterized by intestinal and extra-intestinal symptoms related to the ingestion of gluten-containing food, in subjects that are not affected with either celiac disease (CD) or wheat allergy (WA). Although NCGS frequency is still unclear, epidemiological data have been generated that can help establishing the magnitude of the problem. Clinical studies further defined the identity of NCGS and its implications in human disease. An overlap between the irritable bowel syndrome (IBS) and NCGS has been detected, requiring even more stringent diagnostic criteria. Several studies suggested a relationship between NCGS and neuropsychiatric disorders, particularly autism and schizophrenia. The first case reports of NCGS in children have been described. Lack of biomarkers is still a major limitation of clinical studies, making it difficult to differentiate NCGS from other gluten related disorders. Recent studies raised the possibility that, beside gluten, wheat amylase-trypsin inhibitors and low-fermentable, poorly-absorbed, short-chain carbohydrates can contribute to symptoms (at least those related to IBS) experienced by NCGS patients. In this paper we report the major advances and current trends on NCGS. Full article
(This article belongs to the Special Issue Nutrition and Celiac Disease)
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Review
2013 Update on Celiac Disease and Eosinophilic Esophagitis
by Rinaldo Pellicano, Claudio De Angelis, Davide Giuseppe Ribaldone, Sharmila Fagoonee and Marco Astegiano
Nutrients 2013, 5(9), 3329-3336; https://doi.org/10.3390/nu5093329 - 22 Aug 2013
Cited by 32 | Viewed by 9161
Abstract
Celiac disease is a chronic, immune-mediated disorder, characterized by small intestinal inflammation and villous atrophy after the ingestion of gluten by genetically susceptible individuals. Several extraintestinal manifestations have been associated to celiac disease. Eosinophilic esophagitis is a primary disorder of the esophagus characterized [...] Read more.
Celiac disease is a chronic, immune-mediated disorder, characterized by small intestinal inflammation and villous atrophy after the ingestion of gluten by genetically susceptible individuals. Several extraintestinal manifestations have been associated to celiac disease. Eosinophilic esophagitis is a primary disorder of the esophagus characterized by upper gastrointestinal symptoms, absence of gastroesophageal reflux disease and more than 15 eosinophils per high-power field in biopsy specimens. Both celiac disease and eosinophilic esophagitis are caused by aberrant, but distinct, immune responses to ingested antigens and can be responsive to restricted food intake. The aim of this review is to assess whether there is an association between these two pathologies. In the majority of the studies examined, including the studies in pediatric population, the prevalence of eosinophilic esophagitis in subjects with celiac disease was about 10-times that of the general population. We suggest searching for eosinophilic esophagitis in all children undergoing endoscopy for suspicious celiac disease. Full article
(This article belongs to the Special Issue Nutrition and Celiac Disease)
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186 KiB  
Letter
Letter to the Editor Re: Comino, I., et al. Nutrients 2013, 5, 4250–4268
by Kamil K. Hozyasz
Nutrients 2013, 5(12), 4964-4965; https://doi.org/10.3390/nu5124964 - 05 Dec 2013
Cited by 1 | Viewed by 5426
Abstract
I read with interest the recently published review article titled “The gluten-free diet: testing alternative cereals tolerated by celiac patients” by Comino et al. [1] in Nutrients. However, there is very sparse data on so-called minor cereals and no data on candidate wild [...] Read more.
I read with interest the recently published review article titled “The gluten-free diet: testing alternative cereals tolerated by celiac patients” by Comino et al. [1] in Nutrients. However, there is very sparse data on so-called minor cereals and no data on candidate wild graminoids, which have been gathered in the past. Full article
(This article belongs to the Special Issue Nutrition and Celiac Disease)
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Concept Paper
Life Events and the Onset of Celiac Disease from a Patient’s Perspective
by Carolina Ciacci, Monica Siniscalchi, Cristina Bucci, Fabiana Zingone, Ivonne Morra and Paola Iovino
Nutrients 2013, 5(9), 3388-3398; https://doi.org/10.3390/nu5093388 - 28 Aug 2013
Cited by 11 | Viewed by 9534
Abstract
Stressful events have been investigated in various immune-mediated diseases but not in celiac disease. Our aim was to examine the relationship of stressful events assessed by the standardized interview of Paykel with the diagnosis of celiac disease in comparison to patients, with a [...] Read more.
Stressful events have been investigated in various immune-mediated diseases but not in celiac disease. Our aim was to examine the relationship of stressful events assessed by the standardized interview of Paykel with the diagnosis of celiac disease in comparison to patients, with a diagnosis of gastroesophageal reflux disease used as the control group. Adults with celiac disease (n = 186) reported more frequent and more severe life events in the years prior to the diagnosis than control patients (n = 96) (67.2% vs. 37.5%, p < 0.001, mean Paykel score 11.5 vs. 13.4, p = 0.001, respectively). Findings were not significantly different between celiac disease and control patients for the time lapse between the event and the diagnosis (mean 5.5 vs. 5.7 months). Pregnancy was defined as a negative event by 20.3% of celiac women, but never by control women. Findings were confirmed when analyses were repeated in the subgroup of patients of both groups with diagnosis made within one year of onset of symptoms. Data indicate that, before diagnosis, the number of stressful events in celiac disease was more frequent although less severe than in the control group suggesting that life events may favor the clinical appearance of celiac disease or accelerate its diagnosis. Full article
(This article belongs to the Special Issue Nutrition and Celiac Disease)
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