Might gluten traces in wheat substitutes pose a risk in patients with celiac disease? A population-based probabilistic approach to risk estimation
ABSTRACT BACKGROUND: In patients with treated celiac disease (CD), the ingestion of gluten traces contained in gluten-free (GF) wheat substitutes (eg, GF bread, flour, and pasta) could cause persisting intestinal mucosal damage. OBJECTIVE: The objective was to evaluate the proportion of CD patients at risk of mucosal damage due to the consumption of GF products in 4 European countries (Italy, Spain, Germany, and Norway). DESIGN: A probabilistic modeling approach was used to assess the risk of gluten intake at the population level. The input variables were 1) consumption of GF products, 2) concentration of gluten traces in GF products determined by the sandwich R5 ELISA method, and 3) the gluten threshold for mucosal damage of 10 to 50 mg/d. Different population and product availability scenarios were examined for risk assessment. RESULTS: The gluten content of 205 commercially available GF products ranged between <5 and 27.8 mg/kg. Overall, 99.5% of the analyzed samples had a gluten concentration <20 mg/kg. Most (94%) had a gluten concentration below the limit of quantification (5 mg/kg). The mean percentage of the CD European population at risk of mucosal damage resulting from consumption of GF products ranged between 0.01 (Germany) and 0.15 (Italy) and remained very low, even in the worst-case scenario (<1%). CONCLUSIONS: The adoption of a single gluten threshold (20 mg/kg) for gluten contamination is suggested. GF products in Europe constitute a very safe option for patients with CD. The dietary follow-up of CD patients should focus on other potential sources of gluten contamination.
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ABSTRACT: Many gluten-free (GF) food choices are now available in supermarkets. However, the unintentional presence of gluten in these foods poses a serious health risk to wheat-allergic and celiac patients. Different GF labelled foods (275) and non-GF labelled foods, without wheat/rye/barley on the ingredient label (186), were analysed for gluten content by two different enzyme linked immunosorbent assay (ELISA) kits. Considering the gluten threshold of 20 ppm, GF labelled foods had 98.9% GF labelling compliance with 1.1% (3 out of 275) of foods being mislabelled/misbranded. Among the non-GF labelled foods, 19.4% (36 out of 186) of foods had >20 ppm of gluten, as measured by at least one ELISA kit, of which 19 foods had >100 ppm of gluten. The presence of oats in non-GF labelled foods was strongly correlated with a positive ELISA result. Gluten was also found in a significant number of foods with gluten/wheat-related advisory warnings.Food Chemistry 02/2015; 169:120–126. DOI:10.1016/j.foodchem.2014.07.134 · 3.26 Impact Factor
Article: Enfermedad celíaca[Show abstract] [Hide abstract]
ABSTRACT: La enfermedad celíaca es una alteración sistémica de carácter autoinmune desencadenada por el consumo de gluten y prolaminas relacionadas en individuos con predisposición genética (principalmente HLA), caracterizada por una combinación variable de: manifestaciones clínicas gluten-dependientes, anticuerpos específicos de enfermedad celíaca, haplotipo HLA-DQ2 y/o DQ8 y enteropatía. Los anticuerpos específicos comprenden autoanticuerpos anti-TG2, incluyendo antiendomisio y antipéptidos deamidados de gliadina. En la infancia y adolescencia, la biopsia intestinal podría omitirse en sujetos sintomáticos con títulos de anticuerpos anti-TG2-IgA > 10 veces el punto de corte, verificados por anticuerpos antiendomisio y HLA-DQ2 y/o DQ8 positivos, y solo en este supuesto se podría realizar el diagnóstico e iniciar la dieta sin gluten. En todos los demás casos, la primera biopsia intestinal, antes de retirar el gluten de la dieta, es obligatoria para evitar diagnósticos incorrectos.Revista del Laboratorio Clínico 11/2014; DOI:10.1016/j.labcli.2014.10.003
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ABSTRACT: The gluten-free (GF) products market represents one of the most prosperous markets in the field of food and beverages in the immediate future. Historically, counselling for celiac disease has focused on the absence of gluten in foods, however the nutritional quality of GF foodstuffs is an important aspect to consider. The aim of the present work was to compare the nutritional composition of the 206 GF rendered products most consumed in Spain, against the composition of 289 equivalent foods with gluten, and to make a comparison between the diet including GF products and the same diet with equivalent products with gluten in a 58 adult celiac population. The results of the present collaborative study pointed out differences in calorie, macronutrient, fiber, sodium, salt and cholesterol content between GF rendered and gluten-containing foodstuffs. Thus, calorie and nutrient intake in a GF diet is different when compared to its equivalent diet with gluten. Following a diet based on GF products could suppose a nutritional imbalance for celiac patients as well as for non-celiacs who follow a diet that includes many GF rendered foodstuffs.Plant Foods for Human Nutrition 03/2014; 69(2). DOI:10.1007/s11130-014-0410-4 · 2.42 Impact Factor