Time to define food salt targets in Italy starting with cereal-based products: A safe and practical way to reduce the heavy burden of cardiovascular disease.

BACKGROUND AND AIMS: Excess salt intake is the leading dietary risk factor for cardiovascular disease in most countries, including Italy. While the cost-effectiveness of interventions aimed to reduce salt intake has been proved, the WHO recommendation to reduce salt intake by 30 % at the global level by 2025 is far from being reached. METHODS AND RESULTS: In Italy, two surveys of the general adult population have established that the average salt intake is still almost twice the WHO recommendation although it was reduced by 1.2 g/day between 2008-12 and 2018-19. Previous investigations had shown that non-discretionary salt added by the industry or by local craft producers represents at least 50 % of the total intake and indicated cereal-based products as the main source of non-discretionary salt. Two recent studies conducted by the Italian Society of Human Nutrition "Young Working Group" have provided updated information on the salt content of almost three thousand cereal-based products currently available on the Italian food market and shown that most of the items evaluated had a sodium content much higher than the sodium benchmarks recently proposed by WHO. CONCLUSIONS: Italy has built the foundations of an effective population strategy for salt intake reduction: it is time however to proceed with full commitment to food reformulation if any substantial further progress has to be made. Salt benchmarks for Italy need to be defined for the food categories most relevant to population salt intake and their implementation should ideally be mandatory after consultation with food producers.

Associations between grain intake and hospitalized nephrolithiasis in Chinese adults: a case-control study.

Introduction: nephrolithiasis is one of the most common urological disorders. Grains are essential staple foods worldwide. This study aimed to investigate the associations between whole grains and refined grains intake, and hospitalized nephrolithiasis in a Chinese population. Methods: the patients and healthy participants were enrolled in the Shenyang sub-cohort of Tianjin Chronic Low-Grade Systemic Inflammation and Health Cohort Study. After selecting and matching by age (±one year) and sex using a 1 : 2 ratio, a total of 666 participants (222 patients and 444 healthy controls) were included. Whole grains and refined grains intake was measured using a validated self-administered food frequency questionnaire. Multivariate conditional logistic regression analysis was used to evaluate the associations between whole grains and refined grains intake with hospitalized nephrolithiasis. Results: after multivariable adjustments, a higher intake of whole grains was inversely associated with hospitalized nephrolithiasis. Compared to participants with the lowest tertile of whole grains intake, the adjusted odds ratio (OR) and 95% confidence interval (CI) of hospitalized nephrolithiasis for participants in the highest tertile was 0.58 (0.26, 0.81) (P for trend = 0.020). In contrast, a higher intake of refined grains was positively associated with nephrolithiasis. Compared to participants with the lowest tertile of refined grains intake, the adjusted OR (95% CI) of hospitalized nephrolithiasis for participants in the highest tertile was 3.75 (1.48, 9.52) (P for trend = 0.006). The results were consistent in both genders. Conclusion: the consumption of whole grains was found to be negatively associated with hospitalized nephrolithiasis, while the consumption of refined grains was positively associated with hospitalized nephrolithiasis. Therefore, a substitution of whole grains for refined grains consumption may assist in hospitalized nephrolithiasis prevention.

Produção de biscoitos recheados com formação de organogel na base gordurosa / Production of sandwich cookies with the formation of organogel in the fatty base

A fim de atender à demanda do público que atualmente busca por alimentos mais saudáveis, as indústrias têm procurado alternativas que possibilitem a aplicação de ingredientes que agreguem valor nutricional aos produtos. A redução de gorduras saturadas e trans em produtos alimentícios, bem como a inserção de cereais ou farinhas nutricionais, vem sendo aplicadas em produtos de panificação. Biscoitos recheados possuem como bases geralmente biscoitos à base de farinha de trigo. O objetivo foi desenvolver formulação de biscoitos recheados com substituição de gordura vegetal por organogel no recheio e de farinha de trigo por farinha de sorgo no biscoito, a fim de agregar valor nutricional ao produto. Foram desenvolvidos biscoitos recheados: 1) recheio controle e com substituição da gordura vegetal dos recheios por organogel elaborado com sistema emulsionado (colágeno + óleo vegetal + água), a fim de diminuir concentrações de gorduras saturadas e trans. 2) para a base elaborouse biscoitos controle (farinha de trigo) e com substituição parcial e total de farinha de trigo por farinha de sorgo em 50% (50FS) e 100% (100FS). Foram conduzidas nos recheios e das bases dos biscoitos análises físicas e físico-químicas (textura, atividade de água, cor, composição centesimal e reologia) para avaliação e para análise de estabilidade de 6 semanas. Os resultados apresentaram que o biscoito 50FS obteve melhor valor de textura (Controle: 16,09 ± 1,28 N; 50FS: 19,63 ± 5,68 N e 100FS: 10,09 ± 0,65 N) e menor teor de atividade de água (Semana 01: 0,327±0,01 e Semana 06: 0,389 ± 0,00) do que o biscoito controle, durante análise de estabilidade. O biscoito 100FS apresentou coloração mais avermelhada. Os biscoitos 50FS e 100FS apresentaram maior teor proteico do que o controle (Controle: 5,37 ± 0,23 %; 50FS: 5,64 ± 0,49 % e 100FS: 5,75 ± 0,49 %). O recheio com organogel apresentou maior dureza (N) durante análise de estabilidade do que o recheio controle (Semana 6 Organogel: 6,81±1,48; Controle: 4,29±0,38). Os parâmetros de adesividade, coesividade e gomosidade do recheio com organogel não apresentaram diferenças significativas (p > 0,05). Os valores de atividade de água da formulação com organogel foram mais altos do que o recheio controle (Semana 6 Organogel: 0,730±0,00; Controle: 0,555±0,01). O valor de L* foi maior para o recheio controle, apresentando coloração mais amarelada do que a formulação com organogel. O recheio com organogel apresentou redução de 65 % do teor lipídico e aumento do teor proteico. Os recheios controle, com organogel e de mercado apresentaram comportamento tixotrópico durante a avaliação reológica, sendo que o produto de mercado teve comportamento próximo à formulação controle, com recuperação quase total da estrutura. Foram desenvolvidos cinco produtos, sendo três inovadores com valor nutricional agregado, atendendo às legislações vigentes, vida útil mínima de 6 semanas e ao apelo do mercado atual, podendo ser comercializados como biscoito recheado

In order to satisfy the demand of the public that is currently looking for healthier foods industries have been looking for alternatives that allow the application of ingredients that add nutritional value to the products. The reduction of saturated and trans fats in food products, as well as the insertion of cereals or nutritional flours, has been applied in bakery products. Filled cookies are usually based on wheat flour. The objective was to develop a formulation of filled cookies with replacement of vegetable fat for organogel in the filling and wheat flour for sorghum flour in the biscuit, in order to add nutritional value to the product. In this study, cookies filled with vegetable fat and wheat flour were used as a control where: 1) filling was replaced by organogel elaborated with an emulsified system (collagen + vegetable oil + water); and 2) base was prepared with partial and total replacer of wheat flour for sorghum flour in 50% (50FS) and 100% (100FS). Physical and physicochemical analyzes (texture, water activity, color, proximate composition and rheology) were carried out on the fillings and bases of the biscuits for evaluation and for the stability analysis of 6 weeks. The results showed that the 50FS cookies had a better texture value (Control: 16,09±1,28 N; 50FS: 19,63±5,68N and 10,09±0,65 N) and lower content of water activity (Week 1: 0,327±0,01 and Week 6: 0,389±0,00) than the control cookie during stability analysis. The 100FS had a more reddish color. The 50FS and 100FS cookies had a higher protein content than the control (Control: 5,37±0,23 %; 50FS 5,64±0,49 %). The fillings with organogel showed a higher hardness (N) than the control during stability analysis (Week 6 Organogel: 6,81±1,48; Control: 4,29±0,38). The parameters of adhesiveness, cohesiveness and guminess of the filling with organogel showed no significant differences (p> 0.05). The water activity values of the organogel formulation were higher than the control filling (Week 6 Organogel: 0,730±0,00; Control: 0,555±0,01). The value of L * was higher for the control filling, showing a more yellowish color than the formulation with organogel. The filling with organogel showed a 65% reduction in lipid content and an increase in protein content. The control, organogel and market fillings showed a thixotropic behavior in the rheological evaluation, and the market product had a behavior close to the control formulation, with almost total recovery of the structure. Five products were developed, three of which were innovative with added nutritional value, in compliance with current legislation, a minimum shelf life of 6 weeks, which can be sold as a stuffed cookies.

Contenido actual de los cereales para lactantes y posibles alternativas: no todo vale en nutrición infantil / Current content of infant cereals and possible alternatives: Not everything counts in childhood nutrition

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Short-term amino acid, clinicopathologic, and echocardiographic findings in healthy dogs fed a commercial plant-based diet.

Consumer demand for commercially prepared plant-based (PB) dog food is increasing, but studies evaluating the short- or long-term effects of PB diets on canine health are lacking. The objective of this study was to assess the short-term amino acid (AA), clinicopathologic, and echocardiographic findings in 34 client-owned dogs fed a commercial extruded plant-based diet (PBD) in which pea protein was the primary protein source and 4 control dogs fed a commercial extruded traditional diet (TD). Plasma AA and whole blood taurine concentrations were measured in dogs at baseline and after 4 weeks on the PBD or the TD. Hematologic, serum biochemical, and echocardiographic testing were performed at baseline and after 12 weeks on the PBD or the TD. Four dogs in the PBD group did not complete the study. All essential AAs, except methionine, were higher in dogs after 4 weeks on the PBD compared to baseline. Taurine (plasma and whole blood) was also higher after 4 weeks on the PBD compared to baseline. A meaningful difference was detected in whole blood taurine between the PBD group and the control group at 4 weeks (P = .026) with the PBD group being higher. Median hematologic and biochemical results for the PBD group were within normal limits at baseline and at 12 weeks. In the PBD group, left ventricular internal diastolic dimension (LVIDd, P = < .001) and normalized LVIDd (P = .031) were higher 12 weeks post-PBD compared to baseline. There were no meaningful differences in left ventricular internal systolic dimension (LVIDs), normalized LVIDs, or fractional shortening 12 weeks post-PBD. There was no statistical evidence of difference between the 2 groups of dogs for any of the echocardiographic parameters at baseline or at 12 weeks. Essential AA or taurine deficiency was not observed in this cohort of dogs fed a commercial extruded PBD. Additionally, clinically relevant hematologic, serum biochemical and echocardiographic alterations were not detected. Further research is required to determine if long-term static feeding of PB diets can meet and maintain AA and other nutrient targets in dogs.

Celiac Disease: Fallacies and Facts.

Our understanding of the pathophysiology of celiac disease has progressed greatly over the past 25 years; however, some fallacies about the clinical characteristics and management persist. Worldwide epidemiologic data are now available showing that celiac disease is ubiquitous. An elevated body mass index is common at the time of the diagnosis. The gluten-free diet (GFD) is an imperfect treatment for celiac disease; not all individuals show a response. This diet is widely used by people without celiac disease, and symptomatic improvement on a GFD is not sufficient for diagnosis. Finally, the GFD is burdensome, difficult to achieve, and thus has an incomplete efficacy, opening exciting opportunities for novel, nondietary treatments.

Food antigen-specific IgE in dogs with suspected food hypersensitivity.

OBJECTIVE: Knowledge of cross-reactions in food-sensitive dogs will influence the choice of elimination diets and the long-term management of those patients. The objective of this study was to evaluate food allergen-specific IgE tests of suspected allergic dogs for concurrent positive reactions as possible evidence for cross reactions between allergens. MATERIAL AND METHODS: Results of serum IgE tests from 760 suspected allergic dogs submitted to 2 laboratories were evaluated statistically. After the tested allergens were grouped by their phylogenetic relationship, odds ratios as well as a sensitivity analysis of the odds ratios were performed to evaluate if concurrent positive IgE results to 2 allergens occurred more often than expected. RESULTS: Within related allergen pairs 27% (laboratory 1) and 72% (laboratory 2) of the pairs could be considered as associated. For the unrelated allergen pairs only 6.8% and 10.6% of the analyzed pairs were considered associated respectively. Strong correlations were shown in the group of ruminant allergens, especially beef and lamb, and grain allergens. High rates of concurrent reactions were also detected in the poultry group, especially between chicken and duck, as well as between pork and ruminant allergens, and soy and grain allergens. CONCLUSION: As our results showed not only correlations within related but also between non-related allergens, the possible relevance of carbohydrate moieties as well as panallergens for canine hypersensitivities warrants further study. Further investigations are necessary to distinguish co-sensitization from cross-reactions and determine the clinical relevance of food-specific IgE reactivity. CLINICAL RELEVANCE: Due to possible cross reactivity related allergens, especially beef and lamb as well as grain allergens, should not be used for an elimination diet to avoid false results.

Circulating miRNAs as molecular markers of occupational grain dust exposure.

Dust from grain and feed production may cause adverse health effects in exposed workers. In this study we explored circulating miRNAs as potential biomarkers of occupational grain dust exposure. Twenty-two serum miRNAs were analyzed in 44 grain dust exposed workers and 22 controls. Exposed workers had significantly upregulated miR-18a-5p, miR-124-3p and miR-574-3p, and downregulated miR-19b-3p and miR-146a-5p, compared to controls. Putative target genes for the differentially expressed miRNAs were involved in a range of Kyoto Encyclopedia of Genes and Genomes signaling pathways, and 'Pathways in cancer' and 'Wnt signaling pathway' were common for all the five miRNAs. MiRNA-diseases association analysis showed a link between the five identified miRNAs and several lung diseases terms. A positive correlation between miR-124-3p, miR-18a-5p, and miR-574-3p and IL-6 protein level was shown, while miR-19b-3p was inversely correlated with CC-16 and sCD40L protein levels. Receiver-operating characteristic analysis of the five miRNA showed that three miRNAs (miR-574-3p, miR-124-3p and miR-18a-5p) could distinguish the grain dust exposed group from the control group, with miR-574-3p as the strongest predictor of grain dust exposure. In conclusion, this study identified five signature miRNAs as potential novel biomarkers of grain dust exposure that may have potential as early disease markers.

New insights into food protein-induced enterocolitis in children.

Food protein-induced enterocolitis syndrome (FPIES) represents a non-IgE-mediated food allergic disorder with delayed gastrointestinal symptoms that may evolve in a medical emergency. Clinically, FPIES can be distinguished into acute and chronic phenotypes. FPIES is mainly diagnosed in infancy however the onset at older ages is being progressively described. The pathogenetic mechanism underlying FPIES remains mainly unexplained, but an alteration of food-specific T-cell response has been proposed. The diagnosis of FPIES is primarily clinical, since there are not available specific biomarkers. Oral food challenge (OFC) is the gold standard for diagnosing FPIES or excluding the onset of tolerance to the triggering food. Management of FPIES includes an acute phase treatment and a maintenance therapy with the strict food avoidance until challenge, in order to prevent new attacks and avoid nutritional alterations. Acute management requires hydration that can be performed orally or intravenously according to clinical status. Long-term management of FPIES is based on the avoidance of the culprit food(s) and supervised introduction of other high-risk foods if never taken before among infants before 12 months of age. There is a compelling need of future achievements in FPIES research for the definition of underlying disease pathogenesis and potential therapeutic point of care.

Differential Effects of Dietary Patterns on Advanced Glycation end Products: A Randomized Crossover Study.

Dietary advanced glycation end products (AGEs) are believed to contribute to pathogenesis of diabetes and cardiovascular disease. The objective of this study was to determine if a diet high in red and processed meat and refined grains (HMD) would elevate plasma concentrations of protein-bound AGEs compared with an energy-matched diet high in whole grain, dairy, nuts and legumes (HWD). We conducted a randomized crossover trial with two 4-week weight-stable dietary interventions in 51 participants without type 2 diabetes (15 men and 36 women aged 35.1 ± 15.6 y; body mass index (BMI), 27.7 ± 6.9 kg/m2). Plasma concentrations of protein-bound Nε-(carboxymethyl) lysine (CML), Nε-(1-carboxyethyl) lysine (CEL) and Nδ-(5-hydro-5-methyl-4-imidazolon-2-yl)-ornithine (MG-H1) were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The HMD significantly increased plasma concentrations (nmol/mL) of CEL (1.367, 0.78 vs. 1.096, 0.65; p < 0.01; n = 48) compared with the HWD. No differences in CML and MG-H1 between HMD and HWD were observed. HMD increased plasma CEL concentrations compared with HWD in individuals without type 2 diabetes.

Review of canine dilated cardiomyopathy in the wake of diet-associated concerns.

Dilated cardiomyopathy (DCM) has been in the literature and news because of the recent opinion-based journal articles and public releases by regulatory agencies. DCM is commonly associated with a genetic predisposition in certain dog breeds and can also occur secondary to other diseases and nutritional deficiencies. Recent communications in veterinary journals have discussed a potential relationship between grain-free and/or novel protein diets to DCM, citing a subjective increase in DCM in dog breeds that are not known to have a genetic predisposition for the disease. This literature review describes clinical presentations of DCM, common sequelae, treatment and preventative measures, histopathologic features, and a discussion of the varied etiological origins of the disease. In addition, current literature limitations are addressed, in order to ascertain multiple variables leading to the development of DCM. Future studies are needed to evaluate one variable at a time and to minimize confounding variables and speculation. Furthermore, to prevent sampling bias with the current FDA reports, the veterinary community should be asked to provide information for all cases of DCM in dogs. This should include cases during the same time period, regardless of the practitioner's proposed etiology, due to no definitive association between diets with specific characteristics, such as, but not limited to, grain-free diets and those containing legumes, novel protein diets, and those produced by small manufacturers to DCM in dogs. In summary, in order to determine if certain ingredients, categories of diets, or manufacturing processes are related to an increased risk of DCM, further studies investigating these variables are necessary.

Síndrome d'enterocolitis induïda per proteïnes alimentàries. Forma aguda en tres lactants / Síndrome de enterocolitis inducido por proteínas alimentarias. Forma aguda en tres lactantes / Food protein-induced enterocolitis syndrome: acute form in three infants

INTRODUCCIÓ: La SEIPA (síndrome d'enterocolitis induïda per proteïnes alimentàries) és un tipus d'al·lèrgia alimentària poc coneguda I potencialment greu que pot arribar al xoc. Tot I la potencial gravetat que presenta, el coneixement d'aquesta patologia és baix, I en molts casos és infradiagnosticada. El fet de conèixer l'entitat en facilita el diagnòstic I el tractament correctes a urgències. OBSERVACIÓ CLÍNICA: Es presenten tres casos clínics de tres lactants de mesos, que acudeixen a urgències amb clínica de vòmits persistents, deposicions diarreiques, pal·lidesa, letargia I hipotonia. No van presentar cap altre símptoma d'anafilaxi. Aquesta clínica va aparèixer unes hores després de la ingesta de cereals, en els dos primers casos, I d'ou, en el tercer, I només en el segon dels casos era una primera exposició a l'al·lergen. Tots tres van millorar amb tractament simptomàtic a urgències (fluïdoteràpia, I ondansetró en un dels casos) al cap de 2 o 3 hores. En tots tres casos es van obtenir proves d'al·lèrgia mediada per IgE negatives, I a l'evitar l'aliment implicat no han aparegut nous símptomes. En un dels casos es va fer la prova de provocació per corroborar el diagnòstic. COMENTARIS: La SEIPA és una al·lèrgia no mediada per IgE a diversos aliments. Els més freqüents són la llet de vaca, la de soja I l'arròs. La forma aguda es diagnostica sovint al voltant dels 4-8 mesos. Un cop descartada l'al·lèrgia mediada per IgE típica, el diagnòstic es basa en el compliment d'un seguit de criteris clínics. El tractament durant l'episodi agut són mesures de suport, I el definitiu és evitar l'aliment implicat. El coneixement de les característiques de l'entitat fa més senzill el diagnòstic

INTRODUCCIÓN: El SEIPA (síndrome de enterocolitis inducido por proteínas del alimento) es un tipo de alergia alimentaria poco conocida y potencialmente grave que puede llegar al choque. A pesar de su potencial gravedad, el conocimiento de esta patología es escaso, y en muchas ocasiones está infradiagnosticada. El conocimiento de esta enfermedad facilita su correcto diagnóstico y tratamiento en urgencias. OBSERVACIÓN CLÍNICA: Se presentan tres casos clínicos de lactantes que acuden a urgencias con clínica de vómitos persistentes, deposiciones diarreicas, palidez cutánea, letargia e hipotonía. No presentaron ningún otro signo de anafilaxia. Esta clínica apareció unas horas después de la ingesta de cereales, en los dos primeros casos, y de huevo, en el tercero, y sólo en el segundo de los casos se trataba de una primera exposición al alérgeno. Los tres mejoraron con tratamiento sintomático en urgencias (fluidoterapia, y ondansetrón en uno de los casos) en 2-3 horas. En los tres casos se obtuvieron pruebas de alergia mediada por IgE negativas, y al evitar el alimento implicado no reaparecieron los síntomas. En uno de los casos se realizó prueba de provocación para corroborar el diagnóstico. COMENTARIOS: La SEIPA es una alergia no mediada por IgE a diversos alimentos. Los más frecuentes son leche de vaca, leche de soja y arroz. La forma aguda se diagnostica frecuentemente alrededor de los 4-8 meses. Una vez descartada la alergia mediada por IgE típica, el diagnóstico se basa en el cumplimiento de una serie de criterios clínicos. El manejo durante el episodio agudo se basa en medidas de soporte, y el tratamiento definitivo consiste en evitar el alimento implicado

INTRODUCTION: Food protein-induced enterocolitis syndrome (FPIES) is a relatively unknown and potentially serious type of food allergy that can lead to shock. Despite its potential severity, it is often underdiagnosed. Therefore, clinical suspicion of this entity is very important. The awareness of this disease makes its correct diagnosis and treatment possible in the emergency department. CASE REPORTS: We present three cases of infants who presented to the emergency department with symptoms of persistent vomiting, diarrhea, pale skin, lethargy and hypotonia. They did not present any other signs of anaphylaxis. These symptoms appeared a few hours after the ingestion of cereals in the first two cases, and eggs in the third. All three improved in 2-3 hours with symptomatic treatment in the emergency department (intravenous fluid therapy, ondansetron in one of the cases). In all three cases, Results of IgE-mediated allergy tests were negative and withdrawal of the suspected trigger avoided new episodes. In one of the cases, a provocation test was performed to corroborate the diagnosis. COMMENTS: FPIES is a non-IgE-mediated allergy, triggered by various foods. The most frequent are cow's milk, soybean and rice. It is most frequently diagnosed around 4-8 months of age. Once the typical IgE-mediated allergy is ruled out, the diagnosis is based on a series of clinical criteria. Treatment during the acute episode includes support measures. The definitive treatment is based on avoiding the food involved

Clinical and in vitro cross-reactivity of cereal grains in children with IgE-mediated wheat allergy.

INTRODUCTION AND OBJECTIVES: Wheat and cereal grains have a broad range of cross-reactivity, but the clinical relevance of this cross-reactivity is uncertain. This study aimed to evaluate clinical and in vitro cross-reactivity with barley, oat, and Job's tears among wheat-allergic patients. MATERIALS AND METHODS: Patients aged 5 to 15 years with IgE-mediated wheat allergy were enrolled. Skin prick test (SPT) and specific IgE (sIgE) to wheat, barley, and oat, and SPT to Job's tears were performed. Oral food challenge (OFC) was conducted if the SPT was ≤5 mm in size and there was no history of anaphylaxis to each grain. Profiles of sIgE bound allergens of wheat, barley, and oat, and inhibition ELISA of IgE binding to barley and oat with wheat were performed. RESULTS: Ten patients with a median age of 8 years were enrolled. Nine of those patients had a history of wheat anaphylaxis. The median SPT size and sIgE level to wheat was 7.3 mm and 146.5 kUA/l, respectively. The cross-reactivity rate for barley, oat, and Job's tears was 60.0%, 33.3%, and 20.0%, respectively. Significantly larger SPT size and higher sIgE level were observed in patients with positive cross-reactivity to barley and oat when compared to patients without cross-reactivity. Barley and oat extracts inhibited 59% and 16% of sIgE bound to wheat gliadins and glutenins, respectively. CONCLUSION: The cross-reactivity rate was quite low for oat and Job's tears compared to that of barley; therefore, avoidance of all cereal grains may be unnecessary in patients with severe wheat allergy.

The Pros and Cons of Using Oat in a Gluten-Free Diet for Celiac Patients.

A therapeutic gluten-free diet often has nutritional limitations. Nutritional qualities such as high protein content, the presence of biologically active and beneficial substances (fiber, beta-glucans, polyunsaturated fatty acids, essential amino acids, antioxidants, vitamins, and minerals), and tolerance by the majority of celiac patients make oat popular for use in gluten-free diet. The health risk of long-time consumption of oat by celiac patients is a matter of debate. The introduction of oat into the diet is only recommended for celiac patients in remission. Furthermore, not every variety of oat is also appropriate for a gluten-free diet. The risk of sensitization and an adverse immunologically mediated reaction is a real threat in some celiac patients. Several unsolved issues still exist which include the following: (1) determination of the susceptibility markers for the subgroup of celiac patients who are at risk because they do not tolerate dietary oat, (2) identification of suitable varieties of oat and estimating the safe dose of oat for the diet, and (3) optimization of methods for detecting the gliadin contamination in raw oat used in a gluten-free diet.

Prevention of Food Allergy: The Significance of Early Introduction.

Over the last two decades, the prevalence of food allergies has registered a significant increase in Westernized societies, potentially due to changes in environmental exposure and lifestyle. The pathogenesis of food allergies is complex and includes genetic, epigenetic and environmental factors. New evidence has highlighted the role of the intestinal microbiome in the maintenance of the immune tolerance to foods and the potential pathogenic role of early percutaneous exposure to allergens. The recent increase in food allergy rates has led to a reconsideration of prevention strategies for atopic diseases, mainly targeting the timing of the introduction of solid foods into infants' diet. Early recommendation for high atopy risk infants to delay the introduction of potential food allergens, such as cow's milk, egg, and peanut, until after the first year of life, has been rescinded, as emerging evidence has shown that these approaches are not effective in preventing food allergies. More recently, high-quality clinical trials have suggested an opposite approach, which promotes early introduction of potential food allergens into infants' diet as a means to prevent food allergies. This evidence has led to the production of new guidelines recommending early introduction of peanut as a preventive strategy for peanut allergy. However, clinical trials investigating whether this preventive dietary approach could also apply to other types of food allergens have reported ambiguous results. This review focuses on the latest high-quality evidence from randomized controlled clinical trials examining the timing of solid food introduction as a strategy to prevent food allergies and also discusses the possible implications of early complementary feeding on both the benefits and the total duration of breastfeeding.

Irregular Dietary Habits with a High Intake of Cereals and Sweets Are Associated with More Severe Gastrointestinal Symptoms in IBS Patients.

Dietary advice constitutes one of the first choices of treatment for irritable bowel syndrome (IBS). We have recognized an increased prevalence of sucrase-isomaltase (SI) gene variants in IBS patients, possibly rendering starch- and sucrose-intolerance. The aims were to examine participants' dietary habits at baseline, to correlate habits with gastrointestinal (GI) symptoms and blood levels of minerals and vitamins, and to examine the effect of a starch- and sucrose-reduced diet (SSRD) on GI symptoms. In the study 105 IBS patients (82 women, 46.06 ± 13.11 years), irritable bowel syndrome-symptom severity scale (IBS-SSS)>175, were randomized to SSRD for 2 weeks or continued ordinary eating habits. Blood samples, visual analog scale for irritable bowel syndrome (VAS-IBS), IBS-SSS, and 4-day food diaries were collected at baseline and after 2 weeks. Patients with irregular dietary habits exhibited higher IBS-SSS than patients with regular habits (p = 0.029). Women already on a diet had lower ferritin levels than others (p = 0.029). The intervention led to 66.3% of patients being responders, with differences in the change of IBS-SSS (p < 0.001), abdominal pain (p = 0.001), diarrhea (p = 0.002), bloating and flatulence (p = 0.005), psychological well-being (p = 0.048), and intestinal symptoms' influence on daily life (p < 0.001), compared to controls. Decreased intake of cereals and sweets/soft drinks correlated with decreased scores.

Perspective: Refined Grains and Health: Genuine Risk, or Guilt by Association?

Refined grain intake is widely assumed to be associated with adverse health outcomes, including increased risk for cardiovascular disease (CVD), type 2 diabetes (T2D), and obesity. The 2015 Dietary Guidelines Advisory Committee recommended that to improve dietary quality, the US population should replace most refined grains with whole grains. This recommendation was based largely on results from studies that examined dietary patterns, not separate food groups. A Western dietary pattern typically includes red and processed meat, sugar-sweetened foods and beverages, French fries, and high-fat dairy products, as well as refined grains, and has been linked to increased risk of many chronic diseases. However, when evaluated as a distinct food category, 11 meta-analyses of prospective cohort studies, which included a total of 32 publications with data from 24 distinct cohorts, demonstrated that refined grain intake was not associated with all-cause mortality, T2D, CVD, coronary heart disease (CHD), stroke, hypertension, or cancer. By contrast, consumption of red and processed meat was consistently associated with increased risk of these same health outcomes. Refined grain consumption up to 6-7 servings/d (1 serving = 30 g) was not associated with higher risk of CHD, T2D, hypertension, or all-cause mortality. Moreover, total grain intake was not associated with risk of CVD, CHD, stroke, or cancer, but was associated with lower risk of all-cause mortality. Consequently, the recommendation to reduce refined grain intake based on results from studies linking a Western dietary pattern to numerous adverse health outcomes is contrary to a substantial body of published scientific evidence. Future research needs to better define refined grain intake to distinguish between staple grain foods and indulgent grain foods, and to better design randomized controlled trials to resolve discrepancies between results from observational studies and such trials with regard to determining the benefits of whole grains compared with refined grains.

Echocardiographic phenotype of canine dilated cardiomyopathy differs based on diet type.

INTRODUCTION: Canine dilated cardiomyopathy (DCM) can result from numerous etiologies including genetic mutations, infections, toxins, and nutritional imbalances. This study sought to characterize differences in echocardiographic findings between dogs with DCM fed grain-free (GF) diets and grain-based (GB) diets. ANIMALS: Forty-eight dogs with DCM and known diet history. METHODS: This was a retrospective analysis of dogs with DCM from January 1, 2015 to May 1, 2018 with a known diet history. Dogs were grouped by diet (GF and GB), and the GF group was further divided into dogs eating the most common grain-free diet (GF-1) and other grain-free diets (GF-o). Demographics, diet history, echocardiographic parameters, taurine concentrations, and vertebral heart scale were compared between GB, all GF, GF-1, and GF-o groups at diagnosis and recheck. RESULTS: Dogs eating GF-1 weighed less than GB and GF-o dogs, but age and sex were not different between groups. Left ventricular size in diastole and systole was greater, and sphericity index was less for GF-1 compared with GB dogs. Diastolic left ventricular size was greater for all GF compared with that of GB dogs. Fractional shortening, left atrial size, and vertebral heart scale were not different between groups. Taurine deficiency was not identified in GF dogs, and presence of congestive heart failure was not different between groups. Seven dogs that were reevaluated after diet change (6 received taurine supplementation) had clinical and echocardiographic improvement. CONCLUSIONS: Dietary-associated DCM occurs with some GF diets and can improve with nutritional management, including diet change. The role of taurine supplementation, even without deficiency, is uncertain.