Nutritional status, nutrient imbalances, food-related behaviors and dietary supplements use among patients with celiac disease on a gluten free diet in Lebanon: a national cross-sectional study.

Background: Celiac disease (CD) is an autoimmune disorder triggered by gluten, that occurs in susceptible individuals and is associated with dietary restriction and subsequent nutritional deficiencies. This study investigated the diet quality, nutrition imbalances and nutrition status among young children, adolescents and adults with CD who were referred to several hospitals in Lebanon. Methods: A cross-sectional study in 50 individuals (31.74 ± 15.64 years) with CD was conducted, using biochemical parameters, anthropometric measurements, dietary and physical activity assessments. Results: Of the 50 participants, 38% and 16% were presenting low serum levels of iron and vitamin B12, respectively. The majority of participants were physically inactive and around 40% of them had low muscle mass. A weight loss of 10% to 30% indicating mild to moderate malnutrition was shown in 14% of individuals. The assessment of food-related behaviors shows that 80% of participants were reading nutrition labels and 96% of them were following gluten-free diets (GFD). Some barriers including family ignorance (6%), language of the nutrition labels (20%) and expensive GF products (78%) were limiting the adherence to GFD. The inadequacy of the daily energy intake along with insufficient intakes of calcium and vitamin D were remarked among individuals with CD. However, protein and iron intake were exceeding the recommendations among all age groups, except in males aged 4-8 years and 19-30 years. Half the study participants were using dietary supplements where 38%, 10%, 46%, 18%, 16% and 4% used vitamin D, vitamin B12, iron, calcium, folate and probiotics, respectively. Conclusion: GFD is the key treatment for CD. However, it is not without inadequacies and may cause certain deficiencies such as calcium and vitamin D leading to reduced bone density. This underlines the critical role of dietitians in education and maintenance of healthy GFD among individuals with CD.

Narrative Review: Nutrient Deficiencies in Adults and Children with Treated and Untreated Celiac Disease.

Nutrient deficiencies are well recognized as secondary consequences of celiac disease (CD) and closely related to the clinical presentation of affected patients. Despite their clinical significance, consensus is lacking on the pattern and frequency of nutrient deficiencies in CD, the usefulness of their assessment at the time of diagnosis and during follow-up. This review aims to provide an overview of nutrient deficiencies among pediatric and adult CD patients at diagnosis and on a gluten-free diet (GFD), and their potential causes in CD. Secondly, we review their impact on CD management strategies including the potential of nutrient supplementation. A search of Medline, Pubmed and Embase until January 2019 was performed. Despite a high variability between the reported deficiencies, we noted that nutrient deficiencies occur frequently in children and adults with CD at diagnosis and during treatment with a GFD. Both inadequate dietary intake and/or diminished uptake due to intestinal dysfunction contribute to nutrient deficiencies. Most deficiencies can be restored with (long-term) treatment with a GFD and/or supplementation. However, some of them persist while others may become even more prominent during GFD. Our results indicate a lack of comprehensive evidence on the clinical efficacy of nutrient supplementation in CD management highlighting the need for further studies.

Safeness of Diets Based on Gluten-Free Buckwheat Bread Enriched with Seeds and Nuts-Effect on Oxidative and Biochemical Parameters in Rat Serum.

Buckwheat breads enriched with seeds (e.g., poppy, carum, amaranth, sunflower, and pumpkin) and nuts can be excellent sources of selected macro- and microelements and bioactive components, such as phenolics, essential oils, unsaturated fatty acids, fiber, and vitamins; however, no studies described their impacts on body biochemical parameters and antioxidant status. The aim of this study was to a determine the safety (the analyses of blood morphological and biochemical parameters) of short-term diets based on buckwheat breads supplemented with the commonly used functional ingredients. Additionally, we confirmed the usefulness of these fortified breads in a reduction of blood cholesterol and triacylglycerols, as well as an improvement of in vivo antioxidant status of Wistar rats. Enriched breads presented an increased phenolic content; however, it has not been translated into an elevation of antioxidant capacities. During short-term in vivo experiments, the studied breads increased the body mass of the rats, except the control buckwheat bread. Compared to the control, the poppy-milk bread markedly lowered (-23%) and egg yolk-carum bread significantly increased (+17%) the total cholesterol concentration in serum. All the fortified breads decreased triacylglycerols' levels by about 50%. Bread enriched with the poppy-milk, milk-seed, egg yolk-carum, and a mix of additives decreased superoxide dismutase activity by 68%, 66%, 73%, and 71%, respectively. Catalase activity was significantly decreased in the rats fed with carum bread (-62%) and markedly increased in the groups fed with egg yolk-carum bread (+89%), hazel nuts-amaranth bread (+72%), and milk-seeds bread (+65%). The results confirmed the usefulness and safety of functional additives in buckwheat breads.

Micronutrients Dietary Supplementation Advices for Celiac Patients on Long-Term Gluten-Free Diet with Good Compliance: A Review.

Background and objective: Often micronutrient deficiencies cannot be detected when patient is already following a long-term gluten-free diet with good compliance (LTGFDWGC). The aim of this narrative review is to evaluate the most recent literature that considers blood micronutrient deficiencies in LTGFDWGC subjects, in order to prepare dietary supplementation advice (DSA). Materials and methods: A research strategy was planned on PubMed by defining the following keywords: celiac disease, vitamin B12, iron, folic acid, and vitamin D. Results: This review included 73 studies. The few studies on micronutrient circulating levels in long-term gluten-free diet (LTGFD) patients over 2 years with good compliance demonstrated that deficiency was detected in up to: 30% of subjects for vitamin B12 (DSA: 1000 mcg/day until level is normal, then 500 mcg), 40% for iron (325 mg/day), 20% for folic acid (1 mg/day for 3 months, followed by 400-800 mcg/day), 25% for vitamin D (1000 UI/day or more-based serum level or 50,000 UI/week if level is <20 ng/mL), 40% for zinc (25-40 mg/day), 3.6% of children for calcium (1000-1500 mg/day), 20% for magnesium (200-300 mg/day); no data is available in adults for magnesium. Conclusions: If integration with diet is not enough, starting with supplements may be the correct way, after evaluating the initial blood level to determine the right dosage of supplementation.

Comprehensive Nutritional and Dietary Intervention for Autism Spectrum Disorder-A Randomized, Controlled 12-Month Trial.

This study involved a randomized, controlled, single-blind 12-month treatment study of a comprehensive nutritional and dietary intervention. Participants were 67 children and adults with autism spectrum disorder (ASD) ages 3-58 years from Arizona and 50 non-sibling neurotypical controls of similar age and gender. Treatment began with a special vitamin/mineral supplement, and additional treatments were added sequentially, including essential fatty acids, Epsom salt baths, carnitine, digestive enzymes, and a healthy gluten-free, casein-free, soy-free (HGCSF) diet. There was a significant improvement in nonverbal intellectual ability in the treatment group compared to the non-treatment group (+6.7 ± 11 IQ points vs. -0.6 ± 11 IQ points, p = 0.009) based on a blinded clinical assessment. Based on semi-blinded assessment, the treatment group, compared to the non-treatment group, had significantly greater improvement in autism symptoms and developmental age. The treatment group had significantly greater increases in EPA, DHA, carnitine, and vitamins A, B2, B5, B6, B12, folic acid, and Coenzyme Q10. The positive results of this study suggest that a comprehensive nutritional and dietary intervention is effective at improving nutritional status, non-verbal IQ, autism symptoms, and other symptoms in most individuals with ASD. Parents reported that the vitamin/mineral supplements, essential fatty acids, and HGCSF diet were the most beneficial.

Gluten-free bread with an addition of freeze-dried red and purple potatoes as a source of phenolic compounds in gluten-free diet.

The basis for gluten-free diet is often gluten-free bread, which is usually characterized by a low-nutritional value, and lacks any pro-health properties. Only after an introduction of gluten-free raw materials, containing high level of bioactive compounds it would be possible to obtain the product with a pro-health potential. The aim of the study was to analyze the content of bioactive compounds (total phenolic content, phenolic acids, flavonoids, flavonols, anthocyanins and carotenoids) in gluten-free bread prepared with 5% addition of freeze-dried red and purple potatoes as well as to assess their antioxidant potential. Summarizing, among the analyzed gluten-free breads with an addition of freeze-dried red and purple potatoes, the best results could be obtained by using variety Magenta Love (red potato), which provided the highest levels of phenolic compounds and carotenoids and also antioxidant and antiradical activity.

Secondary acrodermatitis enteropathica-like lesions in a child with newly diagnosed coeliac disease.

Zinc deficiency in patients with coeliac disease (CD) may result either from cumulative loss of insoluble zinc complexes or impaired zinc absorption because of damaged intestinal epithelial cell membrane. Zinc deficiency in CD is mild to moderate, though severe deficiency can occur in refractory or chronic CD cases with poor response to gluten-free diet (GFD). A boy aged 19 months presented with persistent diarrhoea, was diagnosed with CD, and developed severe zinc deficiency with acrodermatitis enteropathica-like disease while on GFD and zinc supplementation.

Nutritional Impact of a Gluten-Free Casein-Free Diet in Children with Autism Spectrum Disorder.

We compared anthropometric values, nutrient intake, the Healthy Eating Index and food variety in children with autism spectrum disorder (ASD), 20 on a gluten-free casein-free (GFCF) diet and 85 on a regular diet in Valencia (Spain) using 3-days food diaries. Those on the GFCF diet had a lower weight, body mass index, and total energy, pantothenic acid, calcium, phosphorus and sodium intake, but a higher intake of fiber, legumes, and vegetables. Further, the GFCF diet group had a better quality of fat intake, but needed supplementation with vitamin D. Randomized controlled trials are required to explore long-term effects of this diet on anthropometric and nutritional status (the focus of our study), but also behavioral symptoms, in children with ASD.

Assessment of Nutritional Adequacy of Packaged Gluten-free Food Products.

PURPOSE: There is concern about the nutritional quality of processed gluten-free (GF) products. The aim was to investigate the nutrient composition and cost of processed GF products compared with similar regular products. METHODS: Product size, price, caloric value, and macro- and micronutrient composition were compared between foods labeled "Gluten-free" and comparable regular products in 5 grocery stores in 3 Canadian cities. Data were calculated per 100 g of product. RESULTS: A total of 131 products were studied (71 GF, 60 regular). Overall, calories were comparable between GF and regular foods. However, fat content of GF breads was higher (mean 7.7 vs. 3.6 g, P = 0.003), whereas protein was lower (mean 5.0 vs. 8.0 g, P = 0.001). Mean carbohydrate content of GF pasta was higher (78 vs. 74 g, P = 0.001), whereas protein (7.5 vs. 13.3 g, P < 0.001), fibre (3.3 vs. 5.8 g, P = 0.048), iron (9% vs. 25%DV, P < 0.001), and folate content (5% vs. 95%DV, P < 0.001) were lower. Mean price of GF products was $1.99 versus $1.23 for regular products (P < 0.001). CONCLUSIONS: Some commonly consumed packaged GF foods are higher in fat and carbohydrates and lower in protein, iron, and folate compared with regular products. GF products are more expensive. Dietitians should counsel patients on the GF diet regarding its nutritional and financial impact.

Cereal foods are the major source of betaine in the Western diet--analysis of betaine and free choline in cereal foods and updated assessments of betaine intake.

Betaine and its precursor choline are important components of one-carbon metabolism, remethylating homocysteine into methionine and providing methyl groups for DNA methylation. Cereals are the main source of betaine in the diet, though there is little literature available on the content of betaine in cereal products, nor on betaine intake from cereals. Betaine and free-choline concentrations were measured by liquid-chromatography with tandem mass spectrometry in a wide range of commercially available cereal foods and cereal fractions. Whole grain wheat and related fractions were the best overall common source of betaine, while the pseudocereal quinoa had the highest amount of betaine measured (3900 µg/g). Based on estimates of dietary intake data cereal foods provide approximately 60-67% of betaine in Western diets, and 20-40% of betaine in South-East Asian diets. Average intake of betaine was 131 mg/d, well below those used in intervention studies using betaine to lower blood homocysteine.

Gluten contamination of naturally gluten-free flours and starches used by Canadians with celiac disease.

A large national investigation into the extent of gluten cross-contamination of naturally gluten-free ingredients (flours and starches) sold in Canada was performed. Samples (n = 640) were purchased from eight Canadian cities and via the internet during the period 2010-2012 and analysed for gluten contamination. The results showed that 61 of the 640 (9.5%) samples were contaminated above the Codex-recommended maximum level for gluten-free products (20 mg kg⁻¹) with a range of 5-7995 mg kg⁻¹. For the ingredients that were labelled gluten-free the contamination range (5-141 mg kg⁻¹) and number of samples were lower (3 of 268). This picture was consistent over time, with approximately the same percentage of samples above 20 mg kg⁻¹ in both the initial set and the subsequent lot. Looking at the total mean (composite) contamination for specific ingredients the largest and most consistent contaminations come from higher fibre ingredients such as soy (902 mg kg⁻¹), millet (272 mg kg⁻¹) and buckwheat (153 mg kg⁻¹). Of the naturally gluten-free flours and starches tested that do not contain a gluten-free label, the higher fibre ingredients would constitute the greatest probability of being contaminated with gluten above 20 mg kg⁻¹.

Complementary, holistic, and integrative medicine: autism spectrum disorder and gluten- and casein-free diet.

On the basis of review of the published literature,limitations in current data do not support the use ofa gluten-free and casein-free diet (gfcf-d) asa primary autism spectrum disorder (ASD) treatment.(13)(25)(26)(36) On the basis of clinical opinion, given the popularity of parents seeking a gfcf-d for their children with ASD, clinicians should acknowledge family's concerns and provide appropriate information about a gfcf-d toguide them and prevent possible harm.

Nutritional deficiencies in children on restricted diets.

Pediatric nutritional deficiencies are associated not only with poverty and developing countries, but also in children in the developed world who adhere to restricted diets. At times, these diets are medically necessary, such as the gluten-free diet for management of celiac disease or exclusion diets in children with food allergies. At other times, the diets are self-selected by children with behavioral disorders, or parent-selected because of nutrition misinformation, cultural preferences, alternative nutrition therapies, or misconceptions regarding food tolerance. Health care providers must be vigilant in monitoring both growth and feeding patterns to identify inappropriate dietary changes that may result in nutritional deficiencies.

Zinc and micronutrient combinations to combat gastrointestinal inflammation.

PURPOSE OF REVIEW: To examine current evidence for dietary supplementation with zinc and other micronutrients for primary prevention of multiple micronutrient deficiencies that are known to result from therapies used in the treatment of gastrointestinal inflammatory disorders. RECENT FINDINGS: Epidemiological observations and clinical findings have strengthened the concept that both nutritional deficiencies and nutritional excesses impair the gastrointestinal response(s) and alter susceptibility to inflammation and other diseases. The interaction of micronutrient intake, biochemical indicators of nutritional status, and four specific gastrointestinal inflammation states are reviewed. These conditions include celiac disease and concomitant micronutrient deficiencies resulting from the sustained adherence to a gluten-free diet; micronutrient nutrition as an important determinant of immunity for two major types of inflammatory bowel disease: ulcerative colitis and Crohn's disease; and HIV/AIDS-related diarrhea and concomitant micronutrient deficiencies which may be exacerbated by the initiation of highly active antiretroviral therapy. SUMMARY: For each inflammation 'state', enhancement of micronutrient status can improve immunocompetance and minimize therapeutic side-effects. The impact of single-micronutrient deficiencies on immune responses, and the possible impact of uncorrected micronutrient status are discussed.