The Gluten-Free Diet for Celiac Disease and Beyond.

The gluten-free diet (GFD) has gained popularity beyond its main medical indication as the treatment for gluten-induced immune-mediated disorders such as celiac disease (CD), dermatitis herpetiformis, gluten ataxia, wheat allergy, and non-celiac gluten sensitivity. However, the diet carries some disadvantages such as elevated costs, nutritional deficiencies, and social and psychological barriers. The present work aims to review indications, proven benefits, and adverse events of a gluten-free diet. Close follow-up with patients following the diet is recommended. More data is needed to assess the effectiveness of the diet in managing mental and cognitive disorders and to establish a connection between the brain and gluten.

Assessment of price and nutritional quality of gluten-free products versus their analogues with gluten through the algorithm of the nutri-score front-of-package labeling system.

Evidence has shown that the nutritional quality of gluten-free products (GFPs) is lower than that of non-GFPs. Our main objective was to compare the nutritional quality through nutritional profiles of foods underlying the Nutri-Score front-of-pack and the price of GFPs with respect to non-GFPs, and to evaluate whether there is a correlation between both parameters. Nutritional information of all products was obtained from the CELIACBASE database and the price through Spanish supermarkets websites. Global quality using the Nutri-Score algorithm and the price were compared between both types of products. GFPs do not always have poorer quality than their counterparts. A better quality of gluten-free pasta was correlated with the higher price but also a worse quality of gluten-free muesli was correlated with the higher price. The price of GFPs compared to non-GFPs was higher up to 391.5%. However, for ham and cheese pizza, ham pizza, Marie biscuits, and baby biscuits, the difference was not statistically significant. Generally, the price of GFPs did not correlate with better nutritional quality. Nutri-Score would ease the nutritional quality identification, empowering consumers and could also influence manufacturers to improve the nutritional quality of GFPs. Nowadays, given that many GFPs have poor nutritional quality, they should be included only occasionally in a balanced gluten-free diet.

Factores que limitan la adherencia a la dieta y la calidad de vida en enfermos celiacos chilenos durante COVID-19 / Factors that limit adherence to diet and quality of life in Chilean celiac patients during COVID-19

La enfermedad por coronavirus (COVID-19) es altamente contagiosa y las medidas de confinamiento dinámico han demostrado que reducen significativamente el número de contagios, sin embargo, pueden alterar la disponibilidad de alimentos afectando la adherencia a la dieta libre de gluten (DLG) y la calidad de vida (CV) en la enfermedad celiaca (EC). El objetivo de este estudio fue evaluar los factores que limitan, la adherencia a la dieta libre de gluten y la calidad de vida en personas con enfermedad celiaca en periodo de pandemia por COVID-19. Métodos Se aplicaron encuestas on-line respecto a adherencia a la DLG, CV y acerca de los factores que han generado dificultad para llevar una DLG en este escenario. Resultados Se analizaron 216 encuestas de enfermos celiacos, mayores de 15 años, de los cuales un 91% eran mujeres con un promedio de edad de 36 + 10,7 años y con 5,8 + 6,0 años de enfermedad. El 56,48% tenía una excelente adherencia a la DLG y un 43,52% una buena CV. El costo elevado de los alimentos sin gluten fue la pregunta con mayor porcentaje de respuesta, asociándose con regular y mala adherencia a la DLG (valor p=0,001) y con pobre CV (valor p=0,023). Conclusión En periodo de pandemia por COVID-19, el costo de los alimentos se asocia con adherencia regular y mala a la DLG y con pobre CV(AU)

Coronavirus disease (COVID-19) is highly contagious and dynamic confinement measures have shown to significantly reduce the number of infections, however, they can alter the availability of food, affecting adherence to a gluten-free diet (GFD) and quality of life (QoL) in celiac disease (CD). The objective of this study was to evaluate the limiting factors, adherence to a gluten-free diet and quality of life in people with celiac disease in a COVID-19 pandemic period. Methods. On-line surveys were applied regarding adherence to the GFD, CV, and factors that have generated difficulty in carrying out a GFD in this setting. Results. 216 surveys of celiac patients over 15 years of age were analyzed, of which 91% were women with an average age of 36 + 10.7 years and with 5.8 + 6.0 years of the disease. 56.48% had excellent adherence to the GFD and 43.52% had a good QoL. The high cost of gluten-free foods was the question with the highest response percentage, associated with regular and poor adherence to the GFD (p-value = 0.001) and with poor QoL (p-value = 0.023). Conclusion. In a COVID-19 pandemic period, the cost of food is associated with regular and poor adherence to the GFD and with poor QoL(AU)

Gluten-Free Diet and Migraine.

Migraine is common in celiac disease (CD) and usually improves on a gluten-free diet (GFD). The benefit for people impacted by migraine without CD is poorly evidenced. A GFD may have adverse health consequences and is expensive.

Difficulties and factors influencing purchase decision. The perspective of families with children with autism spectrum disorders on a gluten-free and casein-free diet. Preliminary study.

Background: Gluten-free and casein-free diet is frequently used in the support of therapy of children with autism spectrum disorders. In addition, many parents restrict the consumption of simple sugars for their children. Objective: The aim of this paper was to understand factors influencing purchase decision in case of family with children with autism spectrum disorders on gluten-free and/or casein-free and/or sugar-free diet and the difficulties associated with this type of nutrition. Material and methods: The study covered a group of 40 families with children with autism spectrum disorders (32 boys and 8 girls) aged 3 to 10 years. Data were collected with questionnaire included questions concerning overall characteristics of caregivers, availability of foods used in the special diet, factors affecting decision on the purchase of products, difficulties in maintaining the child nutrition method. Results: The factors having strongest impact on parents' decisions on the purchase of products were product composition, presence of a certificate confirming the absence of gluten and/or milk and taste values. Exclusion diet constituted a considerable obstruction for traveling, social gatherings and resulted in conflicts with family and the environment. The limited range of healthy gluten-free, casein-free and sugar-free foods, low taste quality and unsatisfactory quality impeded purchase and preparation of varied meals. Conclusions: The surveyed parents were aware consumers, paying attention primarily to product composition and safety. The respondents were looking for healthy, organic and nutritionally valuable products with low sugar content. Further development of the gluten/casein/ sugar free products market may considerably improve certain aspects of family's life with children with autism spectrum disorders.

A comparison of the nutritional profile and price of gluten-free products and their gluten-containing counterparts available in the Spanish market.

INTRODUCTION: Background: to date, gluten-free (GF) diet is the only treatment available for individuals with celiac disease. Both individual and collective food intake assessments are a challenge because a food composition database of GF products (GFPs) is lacking. Objectives: to describe the process of developing a food composition database of GFPs, and to compare the nutritional profile and price of some GFPs and non-GFPs. Methods: initially, a total of 216 brands of GFPs marketed in Spain were recorded. Nutritional information was collected from nutritional labels and product fact sheets that had been provided by food companies or collected first-hand by researchers. Then, the nutritional profile and price of the cereal and cereal byproducts foodstuff groups, including 19 types of products, were compared. Statistical analyses were performed using the SPSS statistical program (22.0 edition; SPSS, Chicago, IL, USA). Results: a total of 2,247 GFPs from 126 different foodstuff brands were included in the food composition database of GFPs (CELIAC-BASE). We classified these products into 14 foodstuff groups. The protein content of the GFPs studied was significantly lower, and the price was higher, than that of their non-GFP counterparts. Some, but not all, GFPs had a higher content of fat and sugar, and a lower content of dietary fiber as compared to their non-GFP counterparts. Some GFPs were up to 6 times more expensive than the corresponding non-GFPs. Conclusions: CELIAC-BASE is a pioneering tool for dietitians. Many GFPs have poor nutritional profiles and should be consumed only occasionally in a balanced GF diet.

INTRODUCCIÓN: Introducción: hasta la fecha, una dieta sin gluten (SG) es el único tratamiento para las personas con enfermedad celíaca. Tanto las evaluaciones de ingesta de alimentos individuales como las colectivas son un desafío debido a la falta de una base de datos de composición de productos SG (PSG). Objetivos: describir el proceso de desarrollo de una base de datos de composición de PSG y comparar el perfil nutricional y el precio de algunos PSG y productos con gluten. Métodos: inicialmente, se registraron un total de 216 marcas de PSG comercializadas en España. La información nutricional se recopiló de las etiquetas nutricionales y hojas informativas de los productos, que habían sido proporcionadas por las compañías de alimentos o recopiladas de primera mano por los investigadores. Luego, se compararon el perfil nutricional y el precio de los grupos de cereales y subproductos alimenticios, incluidos 19 tipos de productos. Los análisis estadísticos se realizaron utilizando el programa estadístico SPSS (edición 22.0; SPSS, Chicago, IL, EUA). Resultados: se incluyeron un total de 2247 PSG de 126 marcas de alimentos diferentes en la base de datos de composición de PSG (CELIAC-BASE). Clasificamos estos productos en 14 grupos de alimentos. El contenido de proteínas de los PSG estudiados fue significativamente menor, y el precio de los mismos fue más alto, que el de sus homólogos con gluten. Algunos PSG, pero no todos, presentaron un mayor contenido de grasa y azúcar, y un menor contenido de fibra dietética, que sus contrapartes con gluten. Algunos PSG eran hasta 6 veces más caros que sus homólogos con gluten. Conclusiones: CELIAC-BASE es una herramienta pionera para dietistas-nutricionistas. Muchos PSG tienen perfiles nutricionales no saludables y deben consumirse solo ocasionalmente en una dieta equilibrada libre de gluten.

Vivir sin gluten: percepción sobre alimentación, calidad de vida y socialización en adultos celiacos / GLUTEN-FREE LIFE: FOOD PERCEPTION- QUALITY OF LIFE AND SOCIALIZATION IN CELIAC ADULTS

La enfermedad celiaca es la intolerancia alimentaria más común del mundo, alcanzando a un 1% de la población y su único tratamiento es una dieta libre de gluten. El objetivo del estudio, de tipo exploratorio y diseño descriptivo, es conocer la percepción que los adultos celiacos tienen sobre su alimentación, calidad de vida y socialización después de empezar el tratamiento. Se entrevistó a 8 celiacos entre 24 y 37 años. Los entrevistados describen una respuesta emocional ante su nueva alimentación, que abarca frustración, cansancio, alivio, tranquilidad, no siendo excluyentes entre sí. El tratamiento nutricional hace ganar habilidades como la cocina, lo que genera mayor consciencia sobre lo que se come. Extrañar la comida con gluten es transversal; hay quienes pueden manejarlo, otros quienes rompen el tratamiento. La calidad de vida se ve afectada por el mayor costo económico de alimentacion sin gluten, las enfermedades asociadas y los factores que facilitan la adherencia a la dieta. La socialización con el entorno es facilitada cuando al celiaco se le apoya en su tratamiento; el ocio se vuelve más escaso y difícil, llevando a la restricción social

Celiac disease is the most common food intolerance in the world, reaching a prealenve of 1% of the population and its only treatment is a gluten-free diet. The aim of the study, exploratory and descriptive design, is to know the perception that celiac adults have about their diet, quality of life and socialization after starting treatment. Eight celiacs between the ages of 24 and 37 were interviewed. The interviewees describe an emotional response to their new diet, encompassing frustration, tiredness, relief and calm. Nutritional treatment makes them gain skills like cooking, which raises awareness about what you eat. Missing gluten-food is cross-cutting, some can handle it, others break treatment. Quality of life is affected by the higher economic cost of gluten-free nutrition, associated diseases and factors that facilitate diet adherence. Socialization with the environment is facilitated when celiac people is supported in its treatment; leisure becomes scarcer and more difficult, leading to social restrictions

Concepts and Instruments for Patient-Reported Outcome Assessment in Celiac Disease: Literature Review and Experts' Perspectives.

BACKGROUND: In diseases where there is a large subjective component, such as celiac disease (CD), patient reported-outcomes (PRO) endpoints are highly relevant. However, there is a gap in knowledge about which PRO endpoints and instruments should be used for clinical trials for treatment of celiac disease. OBJECTIVES: To identify patient-centered symptom, impact, and health-related quality of life (HRQoL) concepts in CD and relevant PRO instruments, and to gather expert input on concepts and instruments to inform selection of PRO endpoints for use in clinical trials of new CD treatments. METHODS: A targeted literature review was conducted to identify symptom, impact, and HRQoL concepts, including those captured in PROs further reviewed against U.S. Food and Drug Administration standards for development and validation as endpoints. US and European clinicians, payers, and a patient advocate (n = 21) were interviewed to assess the identified concepts' relative importance in measuring treatment benefit and to gauge the value of potential PROs as endpoints for market access/reimbursement. RESULTS: Thirty-four published studies were identified: 27 elucidated patient-centered concepts and 7 detailed the development or validation of PRO instruments. The Celiac Disease Symptom Diary and Celiac Disease Patient Reported Outcome instrument were deemed most appropriate for use as endpoints; however, each had limitations related to conceptual coverage, evidence for measurement properties, and feasibility for use in clinical trials. Experts reported gastrointestinal symptoms as most important to treat, with extra-intestinal symptoms burdensome from the patient perspective as well. Payers emphasized measuring both frequency and severity of symptoms and targeting patients nonresponsive to the gluten-free diet for treatment. CONCLUSIONS: With emerging treatment options for CD, further work is needed to operationalize PRO symptom endpoints that are meaningful to patients, valued by payers, and acceptable to regulators in demonstrating efficacy.

Gluten-Free Products: From Dietary Necessity to Premium Price Extraction Tool.

Every year, the Italian National Health Service (NHS) provides about 200,000 celiac people (based on 2017 data) living in Italy with financial support of about 250 million euro to cover the cost of their specific dietary constrains. The existence of gluten-free products of high quality and affordable price is very important for the quality of life of celiac people and the sustainability of public support. Over the last decade, the market for gluten-free products has experienced a dramatic surge, with an increasing shelf space dedicated to these products in supermarkets, and a large variety of products both in terms of kind of agricultural inputs and processing and packaging methods. This study aimed at assessing the offer of gluten-free (GF) pasta in Italian supermarkets, with respect to its ability to meet the needs of celiac people in terms of variety, prices and safety. A hedonic price analysis was performed. Results indicated that GF pasta is sold only in 44% of the 212 stores of the sample, with a price equal to more than twice that of conventional pasta. A premium price was found for the following attributes: small packages, brands specialized in GF products, content in fiber and the presence of quinoa as ingredient.

Persistent Economic Burden of the Gluten Free Diet.

Gluten free (GF) products have been reported to be more expensive and less available than their gluten containing counterparts. We examined the current U.S. cost and availability of GF products and made comparisons to the marketplace over a decade ago. Cost, determined by price per ounce and availability of a "market basket" of regular and GF products across four venues and five geographic regions was compared using a student's t test. GF products were more expensive (overall 183%), and in all regions and venues (p < 0.001). GF products from mass-market producers were 139% more expensive than the wheat-based version of the same product. Availability of GF products was greatest (66%) in the health food and upscale venues. In contrast to the results of the 2006 study, the cost of GF products has declined from 240% to 183% (adjusted for inflation). The introduction of mass-market production of GF products may have influenced the increase in availability and overall reduction of cost since 2006. The extent to which the cost of GF products impacts dietary adherence and quality of life for those on a GFD warrants exploration.

Quality of Life in People with Coeliac Disease: Psychological and Socio- Economic Aspects.

BACKGROUND AND OBJECTIVE: Coeliac disease (CD) is a chronic autoimmune intestinal disorder characterized by intolerance to gluten, a protein contained in certain cereals. The main physiopathological basis of CD is the progressive destruction of intestinal villi caused by gluten ingestion by genetically-susceptible individuals. Patients who receive a diagnosis of CD must make significant changes to their daily habits and this can affect their quality of life. The objective of this review is to summarize the evidence regarding the economic, physical and social limitations which can affect the quality of life in patients with CD. RESULTS: Different factors such as physical changes, psychological effects, interpersonal relationships, emotions and economic difficulties can affect the quality of life of these patients. Observations suggest that, in general, women with CD experience a greater deterioration in their quality of life than men. Lastly, complications in daily life are also associated with the reduced availability of gluten-free products which also usually cost more than standard products. CONCLUSIONS: Continuous health education and care regarding socio-economic issues should be continuously developed and provided to people with CD.

Gluten-free sorghum pasta: starch digestibility and antioxidant capacity compared with commercial products.

BACKGROUND: The development of new products with a focus on nutrition, rather than other technical aspects, is essential to improve the quality of celiac diets. Nutritional attributes of white and brown sorghum gluten-free pasta developed in a previous work were analyzed. The extent and kinetics of starch in vitro digestion, estimated glycemic index (eGI), potentially bioaccessible and dialyzable polyphenols, and antioxidant activity were evaluated and compared with commercial products. RESULTS: Sorghum flour samples were used to obtain pasta with high protein (≈170 g kg-1 ), dietary fiber (≈80 g kg-1 ), polyphenols (2.6 g GA kg-1 pasta), and antioxidant activity. This sorghum pasta showed slower starch in vitro digestion than the other gluten-free pasta, with a high level of protein hydrolysis (76%). The highest eGI was observed in a rice sample (69.8) followed by a corn-based pasta (66.4). White and brown sorghum gluten-free pasta showed 2.9 and 2.4 times, respectively, higher potentially bioaccessible polyphenol content compared to that in cooked pasta. No significant variation in antioxidant activity was found in sorghum pasta after digestion and around 48% and 36% of activity was detected in dialysate. CONCLUSION: Both types of sorghum gluten-free pasta have demonstrated their nutritional value and represent a good potential alternative to current commercial pasta. © 2018 Society of Chemical Industry.

Systematic Literature Review of the Economic Burden of Celiac Disease.

BACKGROUND: The prevalence of celiac disease (CD) has rapidly increased over recent decades, but costs related to CD remain poorly quantified. OBJECTIVE: This systematic review assessed the economic burden of CD in North America and Europe. METHODS: MEDLINE, EMBASE, EconLit, and the Cochrane Library databases were systematically searched to identify English-language literature from 2007 to 2018 that assessed costs, cost effectiveness, and health resource utilization for CD. RESULTS: Forty-nine studies met the inclusion criteria, of which 28 (57.1%) addressed costs of testing and diagnosis; 33 (67.3%) were from Europe. The cost per positive CD diagnosis of testing patients already undergoing esophagogastroduodenoscopy for other indications ranged from 1300 Canadian dollars ($Can) in Canada (2016 value) to €44,712 in the Netherlands (2013 value). Adding the CD test was cost effective when it combined diagnostic modalities (e.g., serology and biopsy). Direct annual excess costs to a US payer per diagnosed CD patient totaled $US6000 (2013 value) more than for a person without CD, chiefly due to outpatient care. Hospitalizations, emergency visits, and medication use were more common with CD. After initiating a gluten-free diet (GFD), patients visited primary care providers less often, used more medications, and missed fewer days from school and work. CONCLUSIONS: Most of the few available economic studies of CD assess testing and diagnosis costs, especially in Europe. Methods of testing generally are considered cost effective when they combine diagnostic modalities in symptomatic patients. Most costs to a payer of managing CD derive from outpatient care. Following GFD initiation, patients lose fewer days from work and school than pretreatment.

The Availability and Nutritional Adequacy of Gluten-Free Bread and Pasta.

Management of coeliac disease (CD) requires the removal of gluten from the diet. Evidence of the availability, cost, and nutritional adequacy of gluten-free (GF) bread and pasta products is limited. GF flours are exempt from UK legislation that requires micronutrient fortification of white wheat flour. This study surveyed the number and cost of bread and pasta products available and evaluated the back-of-pack nutritional information, the ingredient content, and the presence of fortification nutrients of GF bread and pasta, compared to standard gluten-containing equivalent products. Product information was collected from four supermarket websites. Standard products were significantly cheaper, with more products available than GF (p < 0.05). GF bread products were significantly higher in fat and fiber (p < 0.05). All GF products were lower in protein than standard products (p < 0.01). Only 5% of GF breads were fortified with all four mandatory fortification nutrients (calcium, iron, niacin, and thiamin), 28% of GF breads were fortified with calcium and iron only. This lack of fortification may increase the risk of micronutrient deficiency in coeliac sufferers. It is recommended that fortification legislation is extended to include all GF products, in addition to increased regulation of the nutritional content of GF foods.

Breaking bread: examining the impact of policy changes in access to state-funded provisions of gluten-free foods in England.

BACKGROUND: Coeliac disease affects approximately 1% of the population and is increasingly diagnosed in the United Kingdom. A nationwide consultation in England has recommend that state-funded provisions for gluten-free (GF) food should be restricted to bread and mixes but not banned, yet financial strain has prompted regions of England to begin partially or fully ceasing access to these provisions. The impact of these policy changes on different stakeholders remains unclear. METHODS: Prescription data were collected for general practice services across England (n = 7176) to explore changes in National Health Service (NHS) expenditure on GF foods over time (2012-2017). The effects of sex, age, deprivation and rurality on GF product expenditure were estimated using a multi-level gamma regression model. Spending rate within NHS regions that had introduced a 'complete ban' or a 'complete ban with age-related exceptions' was compared to spending in the same time periods amongst NHS regions which continued to fund prescriptions for GF products. RESULTS: Annual expenditure on GF products in 2012 (before bans were introduced in any area) was £25.1 million. Higher levels of GF product expenditure were found in general practices in areas with lower levels of deprivation, higher levels of rurality and higher proportions of patients aged under 18 and over 75. Expenditure on GF food within localities that introduced a 'complete ban' or a 'complete ban with age-related exceptions' were reduced by approximately 80% within the 3 months following policy changes. If all regions had introduced a 'complete ban' policy in 2014, the NHS in England would have made an annual cost-saving of £21.1 million (equivalent to 0.24% of the total primary care medicines expenditure), assuming no negative sequelae. CONCLUSIONS: The introduction of more restrictive GF prescribing policies has been associated with 'quick wins' for NHS regions under extreme financial pressure. However, these initial savings will be largely negated if GF product policies revert to recently published national recommendations. Better evidence of the long-term impact of restricting GF prescribing on patient health, expenses and use of NHS services is needed to inform policy.

The Nutritional Quality of Gluten-Free Products for Children.

OBJECTIVES: To examine the nutritional quality of gluten-free (GF) products specifically marketed for children. METHODS: All child-targeted food products were purchased from 2 major supermarket chains in Calgary, Alberta, Canada. Using the Pan American Health Organization Nutrient Profile Model, the nutritional quality of products with a GF claim was compared with those without such a claim. A secondary analysis further compared the nutrient profile of child-targeted GF products to their product "equivalents." RESULTS: Overall, child-targeted GF products had lower levels of sodium, total fat, and saturated fat but also had less protein and a similar percentage of calories from sugar compared with child-targeted products without a GF claim. According to the Pan American Health Organization criteria, both GF products and "regular" products designed for children can be classified as having poor nutritional quality (88% vs 97%; P < .001). When analyzed in light of their product equivalents without a GF claim, both had similarly high levels of sugar (79% vs 81%; P < .001). CONCLUSIONS: GF supermarket foods that are targeted at children are not nutritionally superior to regular child-targeted foods and may be of greater potential concern because of their sugar content. The health halo often attributed to the GF label is not warranted, and parents who substitute GF products for their product equivalents (assuming GF products to be healthier) are mistaken. Parents of children with gluten intolerance and/or sensitivity, along with parents who purchase GF products for other health reasons, need to carefully assess product labels when making purchases.

There is no such thing as a (gluten-)free lunch: Higher food prices and the cost for coeliac consumers.

A lifelong gluten-free diet is the only available treatment for coeliac disease at present. However, the high price of gluten-free substitute foods is likely to generate a welfare loss for consumers who drop gluten from their diet. Using original data on retail prices in four major UK supermarkets and consumption data from the UK Living Cost and Food Survey, we simulate the welfare change associated to a switch to the gluten-free diet. Within the "Bread and Cereals" category, retail price data show that the average price of gluten-free products is £1.12/100g relative to £ 0.59/100g of gluten-containing products. Our estimates indicate that on average in the UK coeliac consumers have to pay an extra £ 10 per week to maintain their utility levels prior to the dietary switch. This correspond to 29% of the weekly food budget. Results by income quartile are suggestive of regressive effects and the welfare loss for low-income consumers is estimated at 36% of their food budget compared to 24% of high-income consumers.

An investigation into the nutritional composition and cost of gluten-free versus regular food products in the UK.

BACKGROUND: The gluten-free (GF) food market has expanded considerably, although there is limited comparative evidence for the nutritional quality and cost of GF food products. The present study aims to compare the nutrient composition and cost of GF and gluten-containing (regular) foods across 10 food categories in the UK. METHODS: Nutritional information and the cost of GF foods available in the UK (n = 679) and comparable regular foods (n = 1045) were systematically collected from manufacturer and supermarket websites. Foods were classified using UK front-of-pack labelling for content of fat, saturated fat, sugar and salt and nutrient content, and cost per 100 g were identified and compared between GF and regular foods. RESULTS: Overall, more GF foods were classified as containing high and medium fat, saturated fat, sugar and salt than regular foods, although this was not universally consistent. More GF bread and flour products contained high fat and sugar, whereas fewer GF crackers contained high fat and sugar compared to regular foods. High salt content was found more frequently in GF than regular products. On average, GF products were 159% more expensive than regular (£0.44/100 g versus £1.14/100 g). GF items were also more likely to be lower in fibre and protein content than regular foods. CONCLUSIONS: Differences exist in the nutritional composition of GF and regular food. GF food is unlikely to offer healthier alternatives to regular foods, except for those who require a GF diet for medically diagnosed conditions, and it is associated with higher costs.