Gluten contamination in food services and industry: A systematic review.

Gluten-related disorders (GRD) affects approximately 10% of the general population. The only treatment for GRD is still so far is the lifelong complete exclusion of gluten from the daily diet. The correct information about the presence/absence of gluten in food is very important to this group. The present study aimed to evaluate the prevalence of gluten contamination in gluten-free industrial and non-industrial products. In this systematic review, 24 cross-sectional studies were analyzed. The authors developed specific search strategies for Science Direct, Scopus, Web of Science, Google Scholar and ProQuest Dissertations & Theses Global. The authors evaluated the methodological quality of the included studies using criteria from Meta-analysis of Statistics Assessment and Review Instrument (MASTARI). We performed the statistical meta-analysis by metafor package of R program. 95.83% (n = 23) of the studies presented positive results for contamination (over 20 ppm). In industrial food products, studies showed a contamination prevalence of 13.2% (95% CI: 10.8%-15.7%). In non-industrial food products, studies showed a contamination prevalence of 41.5% (95% CI: 16.6%-66.4%). Despite the non-industrial products presented higher contamination prevalence than the industrial products, the difference was not significant (p = 0.072). The findings indicate cross-contamination in industrialized and non-industrialized products. As expected, industrial products labeled as gluten-free showed a lower percentage of gluten-contamination than non-industrialized. Despite that, any contaminated sample found in this group present greater relevance than non-labeled foods. It indicates that foods labeled as "gluten-free" should not be considered safe for patients with GRD since information on the label regarding the presence/absence of gluten is unreliable. Therefore, any gluten-contamination in products labeled as gluten-free is a serious problem to whom present GRD. Further studies are needed to estimate gluten cross-contamination in food service meals and industry better.

Food Safety Knowledge, Attitudes, and Practices of Brazilian Food Truck Food Handlers.

This study aimed to (i) compare the food safety knowledge, attitudes, and self-reported practices (KAP) and observed food safety practices of food truck (FT) food handlers, (ii) evaluate the microbiological quality of food and water samples collected from these vehicles, and (iii) establish a score classification for the KAP instrument according to the food contamination probability assessment. This study was conducted in three stages with 40 food truck food handlers conveniently sampled in the Federal District, Brazil, through structured interviews, application of an observational checklist for the assessment of handlers' practices and the collection of food and water samples for determination of microbiological quality. FTs that are likely to exhibit food contamination and are at a high risk of foodborne diseases if at least one of the following situations occur: (1) if a food handler scores ≤6 in the knowledge section; (2) if a food handler scores ≤5 in the attitudes section; or (3) if a food handler scores ≤6 in the self-reported practices section. On the other hand, FTs in which handlers score higher than the cutoff points in all the sections are unlikely to exhibit food contamination and are at a low risk of foodborne diseases. The findings of this study are the first step to understand food handlers' point of view and the initial diagnosis to guide educational strategies in the FT sector.

Brazilian Food Truck Consumers' Profile, Choices, Preferences, and Food Safety Importance Perception.

This study aimed to investigate food truck consumers' profile, choices, preferences, and food safety importance perception. We conducted structured interviews with a convenient sample of 133 food truck consumers in the Federal District, Brazil. Most of the participating consumers were married (52%) and female (56%), who had completed at least tertiary school (81%). The interviews revealed that most food truck consumers eat from food trucks once or twice a week (96%), usually near home (74%), and have an average per capita expenditure of approximately US $5 to US $9.99 (70%). Hamburgers and sandwiches are the most popular food among consumers (72%). Consumers indicated that taste (30%) was the most important reason to choose a food truck and that poor vehicle hygiene (30%) was the main point assigned for not opting for a food truck. Food hygiene and vendors' personal hygiene were considered important by consumers when eating from food trucks (78% and 80%, respectively). Considering all food truck consumers interviewed and the questions about food safety importance perception, the minimum score was 1 and the maximum was 2.9, with a mean score of 1.68 (SD = 0.46), indicating a high level of perceived importance. The instrument of food safety importance perception presented a Cronbach's alpha coefficient of 0.73, indicating good internal consistency. No significant differences were observed in the food safety importance perception scores in gender (0.192), marital status (0.418), level of education (0.652) or food safety training (0.166). However, significant differences were found in the food safety importance perception scores for age (0.026) and the presence of children (0.001). The findings of this study indicate that there remains the need for consumers to comprehend their role in the food supply chain. Food safety and food handling practices are of public concern, and strategies are required to prevent foodborne diseases. Future public health interventions aiming to increase consumer knowledge and awareness of food safety should be emphasized.

Self-Reported Non-Celiac Gluten Sensitivity in Brazil: Translation, Cultural Adaptation, and Validation of Italian Questionnaire.

This study aimed to translate, culturally adapt, validate, and apply a questionnaire to the Brazilian non-celiac gluten sensitive (NCGS) population. We also aimed to estimate the prevalence of symptoms which affect Brazilian NCGS. The Brazilian Portuguese version of the NCGS questionnaire was developed according to revised international guidelines. Five-hundred-and-fourty-three participants responded the NCGS questionnaire. We evaluated the reproducibility and validity of the questionnaire which presents valid measures of reproducibility. This is the first specific self-reported validated questionnaire for NCGS patients in Brazilian Portuguese, and the first nationwide characterization of self-reported NCGS in Brazilian adults. Most respondents were female (92.3%), and the main intestinal symptoms reported were bloating and abdominal pain. The most frequent extraintestinal symptoms were lack of wellbeing, tiredness, and depression. We expect that the present study will provide a picture of Brazilian individuals with suspected NCGS, which could help health professionals and governmental institutions in developing effective strategies to improve the treatment and diagnosis of Brazilian NCGS.

Food Trucks: Assessment of an Evaluation Instrument Designed for the Prevention of Foodborne Diseases.

This study aimed to validate an evaluation instrument for food trucks (FTs) regarding its internal consistency and to establish a score classification according to the food contamination probability assessment. The instrument was applied in 44 food trucks (convenience sample), along with microbial analysis, in the Federal District, Brazil. After its application, sample collection and statistical analysis, the evaluation instrument was reduced to a 22-item final version. FTs were divided into three groups according to their ready-to-eat foods. Food trucks from Group A (hot and cold sandwiches) presented the highest percentage of contamination. The lowest percentage of contamination was observed in food trucks from Group C (regional and international cuisine). The application of the validated evaluation instrument to the 44 food trucks revealed that none achieved 100% adequacy. The reproducibility analysis exhibited an Intraclass Correlation Coefficient (ICC) value of 0.780 (CI 95%: 0.597; 0.880), indicating good reproducibility of the instrument. The reliability assessment presented a Kuder⁻Richardson Formula 20 (KR-20) value of 0.627 and a Cronbach's alpha coefficient of 0.634, indicating good internal consistency. The proposed classification score was obtained by assigning 1 point for each item with an inadequate response, and the final score may vary between 0 and 20 points. Food trucks with up to 11 points exhibit low probability of contamination and low risk of foodborne diseases, while food trucks scoring 12 or more points exhibit a high probability of contamination and high risk of foodborne diseases. The evaluation instrument will allow effective assessment of the hygienic⁻sanitary practices and conditions of food trucks and potentially ensure consumers' access to safe food.

Gluten-Free Diet: From Development to Assessment of a Check-List Designed for the Prevention of Gluten Cross-Contamination in Food Services.

Gluten cross-contamination in gluten-free food may jeopardize treatment of celiac patients. Considering the deficit of appropriate instruments to enable the implementation of safe production practices for gluten-free food, this study aimed to evaluate the application of a check-list elaborated for gluten cross-contamination prevention in food services. The instrument was applied in 60 Brazilian food services. Interobserver reproducibility and internal consistency of the check-list were tested. A score classification was created for establishments according to the food contamination risk assessment. Subsequent to the application and statistical analysis, the original instrument was reduced to a 30-item check-list. In the reproducibility analysis, none of the 30 items showed significant divergence among the evaluators (p > 0.05 in the Cochran Q test). The 30-item version of the check-list presented Kuder⁻Richardson Formula 20 (KR-20) = 0.771, indicating good internal consistency. The proposed classification score is obtained by adding 1 point for each item with an "adequate" response; therefore, the final score may vary between 0 and 30 points. Establishments with up to 15 points exhibit risk of gluten contamination, while establishments with a score above 16 points exhibit low risk of contamination. The check-list displayed good reproducibility and internal consistency, suggesting that it could be a useful gluten contamination control instrument in food services.