Compliance and Attitudes towards the Gluten-Free Diet in Celiac Patients in Italy: What Has Changed after a Decade?

This study aims were (i) to describe Italian celiac patients who agreed to participate in the latest web survey and their attitudes toward the GF diet (compliance, perceived limitations, and worries) and (ii) to compare the answers given by the 2011 and 2022 responders. The self-administered questionnaire was distributed through the Italian Coeliac Association channels (link on social media, websites, and newsletters) to all of the celiac patients willing to participate in 2011 and 2022 (2427 and 3529 responders who answered the same questions, respectively). Descriptive analyses and the Pearson's chi-squared test were performed. The responders were 1 to 84 years old and mainly female. The prevalence of adherent patients in 2022 was 91%, with the highest value (94%) in children (≤10 years old) and adolescents (15-17 years old). Overall, young adults were the most worried group. About a decade after the first survey, we observed a decreasing prevalence of transgression events (-5%) and (at least) occasional temptation (-17%), a decreasing prevalence of health-related and general worries, but an increasing prevalence of social life withdrawal. In conclusion, it is important to periodically monitor celiac patients' compliance and attitudes towards the gluten-free diet. As also highlighted in international guidelines, a reorganization of the diagnosis/follow-up visits, including an expert dietary consultation, is needed.

Protein transition: focus on protein quality in sustainable alternative sources.

The current consumption trends, combined with the expected demographic growth in the coming years, call for a protein transition, i.e., the partial substitution of animal protein-rich foods with foods rich in proteins produced in a more sustainable way. Here, we have discussed some of the most common and promising protein sources alternative to animal proteins, namely: legumes, insects, and microorganisms (including microalgae and fungi). The primary objective was to assess their nutritional quality through the collection of digestible indispensable amino acid score (DIAAS) values available in the scientific literature. Protein digestibility corrected amino acid score (PDCAAS) values have been used where DIAAS values were not available. The ecological impact of each protein source, its nutritional quality and the potential applications in traditional foods or novel food concepts like meat analogues are also discussed. The data collected show that DIAAS values for animal proteins are higher than all the other protein sources. Soybean proteins, mycoproteins and proteins of some insects present relatively high DIAAS (or PDCAAS) values and must be considered proteins of good quality. This review also highlights the lack of DIAAS values for many potentially promising protein sources and the variability induced by the way the proteins are processed.

Role of particle size in modulating starch digestibility and textural properties in a rye bread model system.

In cereal products, the use of flour containing clusters of intact cells has been indicated as a potential strategy to decrease starch digestion. Rye possesses more uniform and thicker cell walls than wheat but its protective effect against starch digestion has not been elucidated. In this study, rye flours with three different particle sizes, large (LF) (∼1700 µm), medium (MF) (∼1200 µm), and small (SF) (∼350 µm), were used to produce model bread. The textural properties of these breads were analysed using Textural Profile Analysis (TPA). The starch digestibility of both the flour and the bread was measured using Englyst's method, while the presence of intact cell clusters was examined using Confocal Laser Scanning Microscopy (CLSM). Additionally, the disintegration of bread digesta during simulated digestion was assessed through image analysis. CLSM micrographs revealed that bread made with MF and LF retained clusters of intact cells after processing, whereas bread made with SF showed damaged cell walls. Starch digestibility in LF and MF was lower (p ≤ 0.05) than that in SF. Bread produced with MF and LF exhibited the least (p ≤ 0.05) cohesive and resilient texture, disintegrated more during digestion, and exhibited higher starch digestibility (p ≤ 0.05) than bread made with SF. These results highlight the central role of bread texture on in vitro starch digestibility.

Assessment of Protein Quality and Digestibility in Plant-Based Meat Analogues.

In this first work, commercial steak-like (n = 3) and cured meat (n = 3) analogues with different legume and cereal formulations were studied and compared to their animal-based (n = 3) counterparts. Plant-based products showed lower protein content than meat controls but a good amino acidic profile even though the sum of essential amino acids of plant-cured meats does not fulfill the requirements set by the Food and Agriculture Organization for children. A comparable release of soluble proteins and peptides in the digestates after in vitro digestion was observed in meat analogues as meat products, whereas the digestibility of proteins was lower in plant-based steaks and higher in plant-based cured meats than their counterparts. The overall protein quality and digestibility of products are related to both the use of good blending of protein sources and processes applied to produce them. An adequate substitution of meat with its analogues depends mostly on the quality of raw materials used, which should be communicated to consumers.

Levels of lipid-derived gut microbial metabolites differ among plant matrices in an in vitro model of colon fermentation.

This study explored differences in microbial lipid metabolites among sunflower seeds, soybeans, and walnuts. The matrices were subjected to in vitro digestion and colonic fermentation. Defatted digested materials and fiber/phenolics extracted therefrom were added to sunflower oil (SO) and also fermented. Targeted and untargeted lipidomics were employed to monitor and tentatively identify linoleic acid (LA) metabolites. Walnut fermentation produced the highest free fatty acids (FFAs), LA, and conjugated LAs (CLAs). Defatted digested walnuts added to SO boosted FFAs and CLAs production; the addition of fibre boosted CLAs, whereas the addition of phenolics only increased 9e,11z-CLA and 10e,12z-CLA. Several di-/tri-hydroxy-C18-FAs, reported as microbial LA metabolites for the first time, were annotated. Permutational multivariate analysis of variance indicated significant impacts of food matrix presence and type on lipidomics and C18-FAs. Our findings highlight how the food matrices affect CLA production from dietary lipids, emphasizing the role of food context in microbial lipid metabolism.

Effect of shape, gluten, and mastication effort on in vitro starch digestion and the predicted glycemic index of pasta.

Gluten-containing (GC) and gluten-free (GF) pasta consumption has been growing in recent years. The market offers a wide variety of pasta types, with differences in shape and formulation that influence the mastication process and, consequently, their nutritional behaviors (i.e. starch digestibility and glycemic response). This study investigated the effect of shape, gluten, and structural breakdown on in vitro starch digestibility and predicted the glycemic index (pGI) of GC and GF penne, spaghetti, and risoni. Pasta was cooked and minced to mimic short, intermediate, and long mastication efforts. Short mastication led to a higher number of big particles than intermediate and long mastications for all pasta samples, which was reflected in the different starch digestibility and pGI patterns. Multivariate analysis of variance showed that the three studied factors differently affected the in vitro starch digestion of pasta. Mastication effort, shape, and their interaction mainly affected the starch digestion rate and pGI. Gluten was the major factor in affecting the amount of digested starch. The results suggested that small shapes (i.e. risoni), the presence of gluten, and short mastication effort led to a lower pGI. The findings will be useful for the development of pasta products tailored to fulfill the needs of specific consumers following a rational food design approach.