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Gastrointestinal Disease
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Justine Turner, Sally Schwartz
The gluten-free diet is not without nutrition and non-nutrition risks (Table 16.16). It should be recommended only when necessary for gluten-related disorders and should be supervised by a dietitian. A number of nutrients, notably vitamin D and folate, are at risk for deficiency on a GFD, with lack of nutrient fortification being a contributing factor. In comparison to gluten-containing equivalents, the sugar and fat added into processed gluten-free foods to increases palatability, increases energy content and glycemic load, reduces diet quality, and contributes to the risk of becoming overweight or obese. Processed gluten-free foods have an acceptably low gluten content (<20 ppm) that nevertheless cumulatively, with excess daily intake, can lead to persistent enteropathy. Children may be uniquely at risk given processed foods remain a significant component of their diet. An all-natural GFD is healthiest and may strictly be required, at least in the short term, for patients with refractory celiac disease reporting dietary compliance.
Nutrition for Special Needs—In Pediatric Gastrointestinal Diseases
Published in Fima Lifshitz, Childhood Nutrition, 2020
Particularly for celiac disease, a gluten-free diet (avoidance of all wheat, rye and barley) is important. Extra fat-soluble vitamins are necessary, and iron-and/or Mate-deficient patients need appropriate supplements.
Celiac disease
Published in Phillip D. Smith, Richard S. Blumberg, Thomas T. MacDonald, Principles of Mucosal Immunology, 2020
The diagnosis of celiac disease in a person on a gluten-free diet is problematic, because in the absence of gluten ingestion, the clinical signs, serology, and morphology return to normal. Thus, several months of gluten ingestion are required for a proper diagnosis. Many patients are reluctant to engage in a prolonged gluten challenge, but such a challenge may not be necessary in the future. After oral gluten consumption for 3 days, most celiac disease patients have T cells specific to deamidated gluten peptides in their peripheral blood. Such T cells can be detected by ELISPOT (enzyme-linked immunospot assay) or by staining with HLA-DQ2–gliadin peptide tetramers. Anti-TG2 antibodies can be detected in patients with extraintestinal diseases, such as dermatitis herpetiformis, but biopsy is required when the levels of anti-TG2 antibodies are low.
Gluten-free diet attenuates the impact of exogenous vitamin D on thyroid autoimmunity in young women with autoimmune thyroiditis: a pilot study
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2022
Robert Krysiak, Karolina Kowalcze, Bogusław Okopień
The study population consisted of two groups of patients. Group A included 31 women who, because of non-celiac gluten sensitivity, were on a gluten-free diet for at least 12 months preceding the study. Non-celiac gluten sensitivity was defined as self-reported gluten intolerance, a rapid resolution of symptoms on a gluten-free diet and exclusion of celiac disease and IgE-mediated wheat allergy. Celiac disease was considered adequately excluded if tissue transglutaminase antibodies and endomysial antibodies were negative (based upon IgA testing or IgG testing in individuals with IgA deficiency), and there was no villous atrophy on biopsy. IgE-mediated wheat allergy was ruled out based on the lack of an immediate reaction after wheat ingestion combined with a negative skin prick test and levels of specific IgE below the threshold value. The gluten-free diet was defined as the consumption of gluten-free natural and processed products containing no more than 20 mg of gluten per 1 kg of product. In turn, group B included 31 women without gluten-related disorders. They were unaffected sisters of women with non-celiac gluten sensitivity and did not follow dietary interventions. To limit the impact of seasonal variations in the outcome variables and seasonal confounds, participants were recruited between December and January, and between July and August. The flow of patients through the study is shown in Figure 1.
High disease burden in treated celiac patients – a web-based survey
Published in Scandinavian Journal of Gastroenterology, 2021
Frida van Megen, Gry I. Skodje, Marianne Stendahl, Marit B. Veierød, Knut E. A. Lundin, Christine Henriksen
A standardized dietetic assessment is considered the most objective and non-invasive method for monitoring adherence to a gluten-free diet [43,44]. CDAT is found to be highly correlated with expert dietitian evaluation and performs better than serology anti‐tissue transglutaminase antibodies [35]. However, biopsy histology is considered the gold standard to measure CeD activity [44], but due to the nature of the design in this study, we were not able to compare self-reported adherence with nutritional, serological or histological assessment. Therefore, gluten intake cannot be excluded as the cause of ongoing symptoms in our study. Another limitation of this study is the lack of assessment of dietary intake, for example, known triggers of IBS symptoms like FODMAPs. Others have shown that a gluten-free diet is lower in fiber and several micronutrients, and higher in saturated fat and as compared to a gluten-containing diet [45–47]. However, it is unknown whether this less healthy profile of the gluten-free diet is related to ongoing GI symptoms in patients with celiac disease.
Well-being and dietary adherence in patients with coeliac disease depending on follow-up
Published in Scandinavian Journal of Gastroenterology, 2021
Jesper Lexner, Henrik Hjortswang, Rickard Ekesbo, Klas Sjöberg
It is known that initiation of a gluten-free diet generally improves quality-of-life, though not necessarily to the same levels as the healthy general population [7]. The self-reported mental and physical health in the SF-36 questionnaire in both of our cohorts were slightly below the median scores of the general Swedish population (PCS 53.3 and MCS 53.4) [25], though the study was not primarily designed to compare the two cohorts with the background population. No differences were found between the two studied groups, except that the patients in the GP group felt more limited due to their physical health (p = .02). However, there was no difference in the other physical health subdimensions, and we therefore believe that this could be related to mass significance in the statistical analyses.