Foetal gluten immunogenic peptides during pregnancy: a new determinant on the coeliac exposome.

BACKGROUND: The increasing incidence of coeliac disease is leading to a growing interest in active search for associated factors, even the intrauterine and early life. The exposome approach to disease encompasses a life course perspective from conception onwards has recently been highlighted. Knowledge of early exposure to gluten immunogenic peptides (GIP) in utero could challenge the chronology of early prenatal tolerance or inflammation, rather than after the infant's solid diet after birth. METHODS: We developed an accurate and specific immunoassay to detect GIP in amniotic fluid (AF) and studied their accumulates, excretion dynamics and foetal exposure resulting from AF swallowing. One hundred twenty-five pregnant women with different gluten diets and gestational ages were recruited. RESULTS: GIP were detectable in AF from at least the 16th gestational week in gluten-consuming women. Although no significant differences in GIP levels were observed during gestation, amniotic GIP late pregnancy was not altered by maternal fasting, suggesting closed-loop entailing foetal swallowing of GIP-containing AF and subsequent excretion via the foetal kidneys. CONCLUSIONS: The study shows evidence, for the first time, of the foetal exposure to gluten immunogenic peptides and establishes a positive correlation with maternal gluten intake. The results obtained point to a novel physiological concept as they describe a plausible closed-loop circuit entailing foetal swallowing of GIP contained in AF and its subsequent excretion through the foetal kidneys. The study adds important new information to understanding the coeliac exposome.

National survey on the experiences of people with celiac disease in Spain. The CELIAC-SPAIN project.

INTRODUCTION: coeliac disease (CD) is well known, but not so its impact on the patient's life. OBJECTIVE: to determine the impact of CD in the life of celiac patients on different aspects such as diagnosis, follow-up and treatment. MATERIAL AND METHODS: associates of FACE participated in an auto-administered, telematic survey conducted between May and July, 2019. Three participant profiles have been defined: adults diagnosed in adulthood, adults diagnosed in childhood and parents/guardians of celiac children. RESULTS: 540 surveys (343 adult celiacs, 58 celiacs from children and 139 parents/guardians) from all autonomous communities have been included. In the diagnostic process highlights the diagnostic delay (up to 2 years) and the limitations to screening of family members. After diagnosis, about 20 % of adults do not refer to follow any control. Having a CD generates different reactions, but concern and quality of life limitation are very common. As for the gluten-free diet, 90 % of patients referred good adherence to treatment, which is accompanied by improved symptoms and weight gain. Diet tracking limits patients' daily lives. Gluten-free manufactured products are considered expensive, with unclear and unappealing labeling. CONCLUSIONS: the results of the "CELIAC-SPAIN" project show that there are still many aspects to be improved in CD, both diagnosis and follow-up and in facilitating access to gluten-free products.

High-dose therapy and autologous stem cell transplantation in patients with POEMS syndrome: a retrospective study of the Plasma Cell Disorder sub-committee of the Chronic Malignancy Working Party of the European Society for Blood & Marrow Transplantation.

POEMS syndrome is a rare para-neoplastic syndrome secondary to a plasma cell dyscrasia. Effective treatment can control the disease-related symptom complex. We describe the clinical outcome of autologous stem cell transplantation for patients with POEMS syndrome, determining the impact of patient- and disease-specific factors on prognosis. One hundred and twenty-seven patients underwent an autologous stem cell transplantation between 1997-2010 with a median age of 50 years (range 26-69 years). Median time from diagnosis to autologous stem cell transplantation was 7.5 months with 32% of patients receiving an autologous stem cell transplantation more than 12 months from diagnosis. Engraftment was seen in 97% patients and engraftment syndrome was documented in 23% of autologous stem cell transplantation recipients. Hematologic response was characterized as complete response in 48.5%, partial response in 20.8%, less than partial repsonse in 30.7%. With a median follow up of 48 months (95%CI: 38.3, 58.6), 90% of patients are alive and 16.5% of patients have progressed. The 1-year non-relapse mortality was 3.3%. The 3-year probabilities of progression-free survival and overall survival are 84% and 94%, respectively, with 5-year probabilities of progression-free survival and overall survival of 74% and 89%. In a cohort of graft recipients, detailed organ-specific symptom response demonstrated clear symptom benefit after autologous stem cell transplantation especially in relation to neurological symptom control. The data analyzed in this study demonstrate the clinical utility of autologous stem cell transplantation for patients with POEMS syndrome.

Can resistance prehabilitation training bring additional benefits in valvular cardiac surgery? protocol for a randomized controlled trial.

INTRODUCTION: Cardiovascular diseases (CVD) are a group of illnesses that include coronary heart disease, cerebrovascular disease, congenital heart disease and deep vein thrombosis. Major surgery is often chosen as the treatment of choice for CVD. The concept of fast-track rehabilitation after surgery appeared in the 1970s. Participation in these exercise-based prehabilitation programmes may decrease postoperative complications and length of hospital stay. The primary aim of the present study is to evaluate whether the implementation of an additional resistance training (RT) prehabilitation protocol within cardiac exercises based prehabilitation can reduce intensive care unit (ICU) length of stay, postoperative complications and hospital length of stay (LOS). METHODS: A protocol of a prospective, parallel, randomised clinical trial includes 96 adult patients diagnosed with valvular pathology and who have been scheduled for surgery. The participants will be randomly assigned to two groups of 48. Control group will be treated with ventilatory and strengthening of respiratory muscles, and aerobic exercise. Experimental group, in addition, will be treated with RT of peripheral muscles. Both hospital stay and ICU stay will be assessed as main variables. Other secondary variables such as exercise capacity, quality of life and respiratory values will also be assessed. Quantitative variables will be analysed with a T-Test or ANOVA, or Mann Witney if the distribution is non-parametric. RESULTS AND CONCLUSION: This will be the first controlled clinical study focused on adding strength exercise as an additional treatment during prehabilitation. The results of this study will focus on helping to improve rehabilitation and prehabilitation protocols, considering that it is essential to maintain pulmonary training, as well as the inclusion of peripheral exercises that help people with heart disease to be in a better physical condition in order to increase their participation and sense of quality of life.

Safety and efficacy of leriglitazone for preventing disease progression in men with adrenomyeloneuropathy (ADVANCE): a randomised, double-blind, multi-centre, placebo-controlled phase 2-3 trial.

BACKGROUND: Adult patients with adrenoleukodystrophy have a poor prognosis owing to development of adrenomyeloneuropathy. Additionally, a large proportion of patients with adrenomyeloneuropathy develop life-threatening progressive cerebral adrenoleukodystrophy. Leriglitazone is a novel selective peroxisome proliferator-activated receptor gamma agonist that regulates expression of key genes that contribute to neuroinflammatory and neurodegenerative processes implicated in adrenoleukodystrophy disease progression. We aimed to assess the effect of leriglitazone on clinical, imaging, and biochemical markers of disease progression in adults with adrenomyeloneuropathy. METHODS: ADVANCE was a 96-week, randomised, double-blind, placebo-controlled, phase 2-3 trial done at ten hospitals in France, Germany, Hungary, Italy, the Netherlands, Spain, the UK, and the USA. Ambulatory men aged 18-65 years with adrenomyeloneuropathy without gadolinium enhancing lesions suggestive of progressive cerebral adrenoleukodystrophy were randomly assigned (2:1 without stratification) to receive daily oral suspensions of leriglitazone (150 mg starting dose; between baseline and week 12, doses were increased or decreased to achieve plasma concentrations of 200 µg·h/mL [SD 20%]) or placebo by means of an interactive response system and a computer-generated sequence. Investigators and patients were masked to group assignment. The primary efficacy endpoint was change from baseline in the Six-Minute Walk Test distance at week 96, analysed in the full-analysis set by means of a mixed model for repeated measures with restricted maximum likelihood and baseline value as a covariate. Adverse events were also assessed in the full-analysis set. This study was registered with ClinicalTrials.gov, NCT03231878; the primary study is complete; patients had the option to continue treatment in an open-label extension, which is ongoing. FINDINGS: Between Dec 8, 2017, and Oct 16, 2018, of 136 patients screened, 116 were randomly assigned; 62 [81%] of 77 patients receiving leriglitazone and 34 [87%] of 39 receiving placebo completed treatment. There was no between-group difference in the primary endpoint (mean [SD] change from baseline leriglitazone: -27·7 [41·4] m; placebo: -30·3 [60·5] m; least-squares mean difference -1·2 m; 95% CI -22·6 to 20·2; p=0·91). The most common treatment emergent adverse events in both the leriglitazone and placebo groups were weight gain (54 [70%] of 77 vs nine [23%] of 39 patients, respectively) and peripheral oedema (49 [64%] of 77 vs seven [18%] of 39). There were no deaths. Serious treatment-emergent adverse events occurred in 14 (18%) of 77 patients receiving leriglitazone and ten (26%) of 39 patients receiving placebo. The most common serious treatment emergent adverse event, clinically progressive cerebral adrenoleukodystrophy, occurred in six [5%] of 116 patients, all of whom were in the placebo group. INTERPRETATION: The primary endpoint was not met, but leriglitazone was generally well tolerated and rates of adverse events were in line with the expected safety profile for this drug class. The finding that cerebral adrenoleukodystrophy, a life-threatening event for patients with adrenomyeloneuropathy, occurred only in patients in the placebo group supports further investigation of whether leriglitazone might slow the progression of cerebral adrenoleukodystrophy. FUNDING: Minoryx Therapeutics.

Characterization of hereditary transthyretin cardiac amyloidosis in Spain.

INTRODUCTION AND OBJECTIVES: Hereditary transthyretin amyloidosis (hATTR) is a disease caused by mutations in the transthyretin gene that frequently shows cardiac involvement due to amyloid deposition in the myocardium. Our objective was to identify cardiac involvement in a Spanish cohort. METHODS: Retrospective multicenter study of patients diagnosed with hATTR with cardiac involvement from Spanish centers. We collected demographic, clinical, and genetic data. RESULTS: A total of 181 patients from 26 centers were included (65.2% men, with a median age at diagnosis of 62 years). The most frequent mutations were Val50Met (67.7%) and Val142Ile (12.4%). The main reason for consultation was extracardiac symptoms (69%), mainly neurological. The mean N-terminal pro-B-type natriuretic peptide level was 2145±3586 pg/mL. The most characteristic electrocardiogram findings were a pseudoinfarct pattern (25.9%) and atrioventricular block (25.3%). Mean ventricular thickness was 15.4±4.1mm. Longitudinal strain was reduced in basal segments by 29.4%. Late diffuse subendocardial enhancement was observed in 58.8%. Perugini grade 2 or 3 uptake was observed in 75% of scintigraphy scans. During follow-up, 24.9% of the patients were admitted for heart failure, 34.3% required a pacemaker, and 31.6% required a liver transplant. One third (32.5%) died during follow-up, mainly due to heart failure (28.8%). The presence of non-Val50Met mutations was associated with a worse prognosis. CONCLUSIONS: HATTR cardiac amyloidosis in Spain shows heterogeneous genetic and clinical involvement. The prognosis is poor, mainly due to cardiac complications. Consequently early diagnosis and treatment are vital.

The «Museum and Inclusive Fashion¼ Project. A Design for All Experience at the Balearic School of Art and Design.

International regulations about Accessibility and Design for All are clear. They provide two guidelines to ensure equality, autonomy, and non-discrimination, such as Reasonable Accommodation and Universal Design (or Design for All). Reasonable Accommodation leads to Adapted Fashion, which adjusts clothing to the body (average clothes for the average consumer). Universal Design leads to Inclusive Fashion, which creates clothes for everybody even if you have a body issue. Design for All (or Universal Design) implies projecting from the beginning to the end of the design process based on inclusion. In this context, the Museum-Foundation Juan March in Palma was the starting point to conceive, develop and communicate a collaborative and transdisciplinary design project; it was designed under the principle of Universal Design. This transdisciplinary co-design project took place during the first semester of the 2019-2020 academic year with a third-year BA in Fashion Design students. They designed an inclusive ready-to-wear fashion micro-collection, which focused on sensitizing BA in Fashion Design students, promoting a change of attitude, and fostering a better understanding of the challenges clothing design process. Students were invited to complete two online questionnaires to collect data on the project. The first survey was used to assess alumni's perception of acquisition, development, and/or consolidation of key competences in participating students and control groups. The second survey was used to assess alumni's activity on the project among participating students. This project was aimed at sensitizing BA in Fashion Design students, promoting a change of attitude, and a better understanding of the challenges clothing design process. After visiting the museum, getting inspired by their artists and their works of art, creating a mood board, and drawing the first sketches, two groups were created to develop an inclusive, ready-to-wear fashion micro-collection. Each collection focused on a different users' profile: one group worked with a model with achondroplasia (woman), and the other group worked with two wheelchair models (man, woman). Despite the mixed results, the main objectives of the project were reached. As members of a school community, students must learn about other realities that differ from their everyday environment. As members of a school of design, students must be aware of an important prospective market niche and expand their fields of action that must include Design for All. In any case, human diversity is the key concept to approach user-centred design in the twenty-first century. The «Museum and Inclusive Fashion¼ project was part of an ongoing academic research project funded by the Balearic Government (2017-2020). This article reflects the views only of the authors, and the Balearic Government cannot be held responsible for any use which may be made of the information contained therein.

Effects of neuromuscular training compared to classic strength-resistance training in patients with acute coronary syndrome: A study protocol for a randomized controlled trial.

The aim of the present clinical trial is to evaluate the effectiveness of neuromuscular versus classical strength-resistance training as part of a cardiac rehabilitation programme in patients following acute coronary syndrome. The study is designed as a double-blinded, randomised, and controlled clinical trial. Thirty participants suffering from acute coronary syndrome who meet our inclusion criteria will be recruited by a private tertiary hospital. The intervention group will follow 20 sessions of a cardiac rehabilitation programme divided into two parts: aerobic training and neuromuscular strength-resistance training. The control group will complete the same aerobic training as well as a classical strength-resistance training workout programme. The primary outcome of the study will be the mean difference in change from baseline in the Incremental Shuttle Walking Test. The secondary outcomes will be the cardiorespiratory fitness of the patients (assessed by means of the Chester Step Test), lower-limb performance (assessed with the 30-Second Chair Stand Test and Single-Leg Squat Test), lower-limb strength (hip flexor handheld dynamometry), sexual dysfunction assessment (Sex Health Inventory for Men) and quality of life (EQ-5D-5L). This work will provide evidence for the effectiveness of a neuromuscular versus a classic strength-training programme in terms of cardiorespiratory fitness, lower-limb performance capacities and quality of life, in cardiac patients. The data obtained could lead to more effective and functional workouts which, in turn, may enhance the speed at which these patients can return to their everyday activities of life and improve the efficiency of their movement patterns and heart responses. Furthermore, patients may find neuromuscular workout routines more motivating and engaging, thus encouraging them to adopt healthier lifestyle patterns.

Distribución espacio-temporal de cianobacterias planctónicas y factores ambientales asociados a sus proliferaciones en el embalse Cerrón Grande, El Salvador / Spatio-temporal distribution of planktonic cyanobacteria and environmental factors associated with their proliferation in the Cerrón Grande reservoir, El Salvador

Resumen Introducción: El embalse Cerrón Grande de 135 km2 es el humedal más grande de El Salvador, reconocido como "Humedal de Importancia Internacional" por la Convención Ramsar. Además, es uno de los ecosistemas más contaminados a nivel nacional, enfrentando serios problemas, entre ellos, las proliferaciones de cianobacterias. Objetivo: Evaluar las relaciones entre los factores ambientales y la distribución espacial y temporal de las cianobacterias en el embalse a lo largo de un año hidrológico. Métodos: Extrajimos agua con cianobacterias de seis sitios fijos, desde octubre 2018 hasta septiembre 2019. Resultados: Identificamos 16 géneros, el más abundante Microcystis sp. Además, Dolichospermum sp.; Microcistis sp. alcanzaron 1.5 x 106 células/ml en junio 2019, principalmente en el sector noroeste, que es poco profundo y cercano a las zonas de confluencia de afluentes altamente contaminados que llegan al embalse. El sector sureste más profundo tenía bajas concentraciones de estos organismos. Los factores ambientales mayormente relacionados con dicho comportamiento fueron: fósforo, la conductividad eléctrica y el valor de Secchi, como se esperaba de un cuerpo eutrófico. Conclusiones: La variación en la concentración celular de cianobacterias en este embalse está altamente influenciada por la lluvia, la mezcla de agua y el contenido de nutrientes.

Abstract Introduction: The 135 km2 Cerrón Grande reservoir is the largest wetland in El Salvador, recognized as "Wetland of International Importance" by the Ramsar Convention. It is also one of the most polluted ecosystems nationwide, facing serious problems, among them, a proliferation of cyanobacteria. Objective: To assess the relationships among environmental factors and the spatial and temporary distribution of cyanobacteria in the reservoir throughout a hydrological year. Methods: We extracted water with cyanobacteria from six fixed sites, from October 2018 through September 2019. Results: We identified 16 genera, the most abundant Microcystis sp. And Dolichospermum sp.; Microcystis sp. reached 1.5 x 106 cells/ml in June 2019, mainly in the north-west sector, which is shallow and close to the confluence zones where highly polluted tributaries reach the reservoir. The deeper south-east sector had low concentrations of these organisms. The environmental factors mostly related to this behavior were: phosphorus, electrical conductivity and Secchi value, as expected from a eutrophic body. Conclusions: Variation in the cellular concentration of cyanobacteria in this reservoir is highly influenced by rain, water mixing and nutrient content.

Moderate red-wine consumption partially prevents body weight gain in rats fed a hyperlipidic diet.

Red wine is a beverage that can exert a broad spectrum of health-promoting actions both in humans and laboratory animal models if consumed moderately. However, information about its effect on body weight is scarce. We have evaluated the effect of moderate red wine consumption on body weight and energy intake in male Zucker lean rats fed a hypercaloric diet for 8 weeks. For this purpose, we used three 5-animal groups: a high-fat diet group (HFD), a high-fat-diet red-wine-drinking group (HFRWD), and a standard diet group (SD). After 8 weeks, the HFRWD group had a lower body weight gain (175.66 +/- 2.78% vs 188.22 +/- 4.83%; P<.05) and lower energy intake (269.45 +/- 4.02 KJ/animal.day vs day vs 300.81 +/- 4.52 KJ/animal.day; P<.05) and had less fat mass at epididymal location respect to the whole body weight (0.014 +/- 0.001 vs 0.017 +/- 0.001; P<.05) than the HFD group. However, the red wine didn't modified the fed efficiency 0.012 +/- 0.001 g/KJ for HFRWD group versus 0.013 +/- 0.001 g/KJ for the HFD one (P=.080). These findings, though preliminary, show that moderate red wine intake can prevent the increase of body weight by modulating energy intake in a rat diet-induced model of obesity.

Diarrea crónica de fácil solución, a propósito de 3 casos / Chronic diarrhea with easy solution, about 3 cases

No disponible

Dietary supplement use and health-related behaviors in a Mediterranean population.

OBJECTIVE: To determine predictors and health-related motivation for supplement use. DESIGN: Population-based, cross-sectional survey. Food intake was determined by a validated food frequency questionnaire that included questions on dietary supplement consumption. Physical activity, smoking status, educational level, self-perceived mental and physical health, and medical information and drug treatment of diabetes, hypertension, and hypercholesterolemia were recorded. Weight and height were measured. SETTING: Girona, Spain. PARTICIPANTS: Six thousand three hundred fifty-two men and women aged 35-80 years. ANALYSIS: Multiple logistic regression analysis to evaluate the association between dietary supplement use and the other variables. RESULTS: Dietary supplements were consumed by 9.3% of the participants. Positive predictors of supplement use were female sex (odds ratio = 2.44, 95% confidence interval 1.96-3.04), higher educational level (P < .001), and a high adherence to the Mediterranean diet pattern (P < .001) and to the nutrient adequacy score (P = .004). A higher body mass index (P < .001) and the awareness of hypertension (odds ratio = 0.69, 95% confidence interval 0.56-0.87) were negatively associated with supplement use. CONCLUSIONS AND IMPLICATIONS: The relatively small number of dietary supplement users did not show a clustering of healthy lifestyle habits. Self-perception of mental and physical health and awareness of a cardiometabolic disorder were not motivators for supplement use.

Hipoglucemia post cirugía bariátrica. Presentación de un caso con buena respuesta a octreótide / HYPOGLYCEMIA COMPLICATING BARIATRIC SURGERY. CASE REPORT WITH SUCCESSFUL RESPONSE TO OCTROTIDE

El Bypass Gástrico (BPG) representa la herramienta terapéutica más efectiva para el manejo de la obesidad. Sin embargo, la hipoglucemia con neuroglucopenia post BPG es una complicación que se describe cada vez con mayor frecuencia. Se presenta el caso de una paciente con hipoglucemia hiperinsulinémica (HH) post BPG y los distintos esquemas terapéuticos utilizados, pudiendo controlar finalmente los valores de glucemia con octreótide y evitando así, la realización de una pancreatectomía para el tratamiento de las hipoglucemias

Gastric Bypass (GBP) is the most effective treatment for patients with severe obesity. Hyperinsulinemic hypoglycemia with neuroglycopenia is an increasingly late complication of GBP. A case of a post GBP hyperinsulinemic hypoglycemia is reported, and the different drugs used for its treatment, being able to control the glycemia with octreotide and avoiding a pancreatectomy surgery as hypoglycemia treatment

Recomendaciones para el manejo de las pacientes con diabetes gestacional / Recommendations for the management of patients with pregestational diabetes

La diabetes mellitus pregestacional afecta el desarrollo de la gestación y se asocia a complicaciones maternas y feto-neonatales. Si bien hace algunos años la mayoría de las pacientes con diabetes pregestacional era diabética tipo 1, la prevalencia de mujeres con diabetes tipo 2 en edad reproductiva aumentó asociada al incremento de la obesidad. La paciente con diabetes pregestacional con mal control presenta mayor riesgo de complicaciones desde el inicio y hasta el final de embarazo. El control metabólico adecuado, el correcto estado nutricional y el tratamiento de las complicaciones maternas previenen las complicaciones o reducen su severidad. Por ello es fundamental la programación del embarazo para prevenir el daño en las primeras semanas de gestación. Además es necesario el riguroso seguimiento clínico durante todo el embarazo. En este contexto, en el marco del Comité de Diabetes y Embarazo, y a través del estudio de evidencias científicas y estudios vinculados, surgen estas recomendaciones para mujeres con diabetes pregestacional

Una vida sin gluten: enfermedad celíaca / No disponible

No disponible

Encuesta nacional sobre las vivencias de las personas con enfermedad celíaca en España. Proyecto CELIAC-SPAIN / No disponible

INTRODUCCIÓN: la enfermedad celíaca (EC) es muy bien conocida, pero no así las percepciones y necesidades de los pacientes. OBJETIVO: determinar en nuestro entorno la repercusión de la EC en la vida del paciente celíaco tanto en las vertientes del diagnóstico, seguimiento y tratamiento de la EC. MATERIAL Y MÉTODOS: encuesta telemática autoadministrada, realizada entre mayo y julio del 2019, y dirigida a socios de FACE. Se han definido tres perfiles de PARTICIPANTES: adultos diagnosticados en la edad adulta, adultos diagnosticados en la infancia y padres/tutores de niños celíacos. RESULTADOS: se han incluido 540 encuestas (343 celíacos adultos, 58 celíacos desde niños y 139 padres/tutores) procedentes de todas las comunidades autónomas. En el proceso diagnóstico destaca la demora diagnóstica (de hasta 2 años) y las limitaciones para hacer el cribado de los familiares. Tras el diagnóstico cerca del 20 % de adultos no refieren seguir ningún control. Padecer una EC genera distintas reacciones, pero es muy común la preocupación y la limitación de la calidad de vida. En cuanto a la dieta sin gluten, el 90 % de pacientes se consideran buenos cumplidores, que se acompaña de una mejora de los síntomas y ganancia ponderal. El seguimiento de la dieta limita la vida diaria de los pacientes. Los productos manufacturados sin gluten se consideran caros, con etiquetado poco claro y poco apetecibles. CONCLUSIONES: los resultados del proyecto "CELIAC-SPAIN" demuestran que aún quedan muchos aspectos por mejorar en la EC, tanto el diagnóstico como en el seguimiento y en facilitar el acceso a los productos sin gluten

No disponible

Metástasis hipofisarias de tumores sólidos: 2 casos de diferente presentación / Pituitary metastasis of solid tumors: 2 cases of different presentation

No disponible

Abriendo puertas: conociendo a un celiaco / Opening the Doors: Getting to know a celiac

Justificación: La enfermedad celiaca o celiaquía es una intolerancia al gluten, afecta a cualquier grupo étnico o región, afectando a todas la dimensiones de la vida de los que la padecen. El tratamiento se centra, únicamente, en tomar una dieta sin gluten de por vida. Teniendo en cuenta que el trigo es el cereal de consumo mayoritario en países occidentales, adherirse a esta dieta puede ser realmente dificultoso.Objetivos: Conocer cómo afecta el seguimiento de la dieta sin gluten en la vida cotidiana del celiaco para mejorar su calidad de vida.Diseño: Estudio de caso.Metodología: Entrevistas abiertas semiestructuradas al paciente celiaco y a su entorno más cercano (madre y amigos), así como al enfermero y al trabajador social de su Centro de Salud.Resultados-conclusiones: El seguimiento de la dieta sin gluten afecta tanto a la dimensión personal, familiar y social y económica de la persona celiaca (AU)

Background: Celiac disease is an intolerance to gluten, that can affect any ethnicgroup in any region, as well as all aspects of the lives of those who suffer from it. The treatment for this pathology focuses solely on a gluten-free diet for life. Bearing in mind that wheat is the most widely consumed cerealin Western countries, maintaining such a diet can be difficult.Objectives: To learn how a life-long, gluten-free diet daily affects those who suffer from celiac disease in order to be able to improve their quality of life.Design: A case study.Methodology: Conducting open, semi-structured interviews with a patient suffering from celiac disease and those closest to him (mother and friends), as well as with the male nurse and the social worker from his Health Centre.Results and conclusions: A gluten-free diet affects the personal, family and social and economic aspects of the life of an individual suffering from celiac disease (AU)