Challenges in gluten-free diet in coeliac disease: Prague consensus (original) (raw)
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Challenging in Gluten-free diet in celiac disease: Prague consensus
European Journal of Clinical Investigation, 2017
Background New treatments in coeliac disease are being vigorously pursued to either replace or facilitate the difficult-tofollow gluten-free diet. Design The present review intends to summarise the challenges in gluten-free diet adherence during the transitional period, as reflected in the last Prague consensus, published in 2016. Results The honourable panel members recommended that dietary adherence and the consequences of nonadherence represent key components for discussion in the transitional period setting. Conclusions There are numerous difficulties in adhering to gluten withdrawal, but the transition period from adolescence to young adulthood is considered a fragile and high-risk period for intentional and unintentional gluten intake.
Challenges in Gluten-free diet in celiac disease: Prague consensus
New treatments in celiac disease are being vigorously pursued to either replace or facilitate the difficult-to-follow gluten-free diet. There are numerous difficulties in adhering to gluten withdrawal, but the adolescence and young adulthood is considered a fragile and high risk period for intentional and unintentional gluten intake. This is only one of the aspects that were reviewed and recommendations issued, in the Prague consensus report on the transition from childhood to adulthood in celiac disease patients. The present review intends to summarize the challenges in gluten-free diet adherence during the transitional period, as reflected in the last Prague concensus, published in 2016. The honorable panel members recommended that dietary adherence and the consequences of non-adherence represent key components for discussion in the transitional period setting.
2014
A dietary survey was performed during a large screening study in Sweden among 13-year-old adolescents. The aim was to study how the intake of food groups was affected by a screening-detected diagnosis of coeliac disease (CD) and its gluten-free (GF) treatment. Food intake was reported using a FFQ, and intake reported by the adolescents who were diagnosed with CD was compared with the intake of two same-aged referent groups: (i) adolescents diagnosed with CD prior to screening; and (ii) adolescents without CD. The food intake groups were measured at baseline before the screening-detected cases were aware of their CD, and 12-18 months later. The results showed that food intakes were affected by screen-detected CD and its dietary treatment. Many flour-based foods were reduced such as pizza, fish fingers and pastries. The results also indicated that bread intake was lower before the screened diagnosis compared with the other studied groups, but increased afterwards. Specially manufactured GF products (for example, pasta and bread) were frequently used in the screened CD group after changing to a GF diet. The present results suggest that changing to a GF diet reduces the intake of some popular foods, and the ingredients on the plate are altered, but this do not necessarily include a change of food groups. The availability of manufactured GF replacement products makes it possible for adolescents to keep many of their old food habits when diagnosed with CD in Sweden.
Grown-up coeliac children: the effects of only a few years on a gluten-free diet in childhood
Alimentary Pharmacology & Therapeutics, 2005
Aim: To evaluate clinical and psychological status of adults with childhood diagnosis of coeliac disease who were re-exposed to gluten after only a few years and now on a gluten-containing diet, compared with adults with recent diagnosis of coeliac disease, and adults who remained on gluten-free diet after childhood diagnosis. Methods: A total of 195 adults with a biopsy suggestive of coeliac disease in childhood, who either had adhered to a gluten-free diet for at least 1 year after diagnosis and now are either on gluten-free diet (n ¼ 110) or on gluten-containing diet (n ¼ 85), and adults with newly diagnosed coeliac disease (n ¼ 165) underwent a medical check-up. Results: Body mass index and main laboratory indices were statistically different among groups (lowest in never on gluten-free diet, highest in gluten-free diet). The lowest average levels of bone mineral density were found among never on gluten-free diet patients. Prevalence of autoimmune disorders was increased in never on gluten-free diet when compared with the transient gluten-free diet and gluten-free diet groups. Histology revealed villous subatrophy in all patients of never on gluten-free diet group, in 39 of 110 patients of gluten-free diet and in 84 of 85 of transient glutenfree diet groups. Herpetiform dermatitis was found in three patients of gluten-free diet, three of transient gluten-free diet and three of never on gluten-free diet. Dental enamel defects were found in 15 patients of transient gluten-free diet, 43 of never on gluten-free diet and in zero of the gluten-free diet group. Pregnancy outcome was not significantly different between the two groups, but neonatal weight was lower and breast feeding was shorter in the never on gluten-free diet group. Sexual habits, alcohol intake and cigarette smoking were significantly different in the never on gluten-free diet group when compared with the other two groups. Conclusion: Gluten withdrawal in childhood partly protects coeliac adults from clinical and behavioural effects of gluten sensitivity.
Compliance With Gluten-free Diet in Children With Coeliac Disease
Journal of Pediatric Gastroenterology & Nutrition, 2008
Objectives: Coeliac disease (CD) is a lifelong disorder with gluten-induced manifestations in different organs. Gluten-free diet (GFD) is required to achieve remission and prevent complications; however, study reports on GFD growth effect are not consistent. Methods: Compliance with GFD was estimated according to current body mass and height; presence of anaemia and other signs and symptoms; and attitude toward GFD. Results: Seventy-one patients with CD (mean age ¼ 12 years; mean age after CD diagnosis ¼ 9 years) were examined and their blood sampled for determination of endomysial antibodies (EMA), haemoglobin, and red blood cell count. Questionnaire analysis revealed 42 (59.1%; 4 EMA positive) patients to be on strict GFD, 19 (26.8%; 5 EMA positive) were taking small amounts of gluten, and 10 (14.1%; all EMA positive) were not on a diet at all. The patients on strict GFD had greatest body height, yet the difference was not significant. These patients also had a higher mean body mass (P ¼ 0.05) and significantly higher mean haemoglobin and mean cell haemoglobin levels (P ¼ 0.05 and P < 0.05, respectively). Apart from chronic fatigue in patients on partial diet (P ¼ 0.05), patient groups did not differ significantly in the frequency of symptoms. Anaemia and delayed puberty were recorded only in noncompliers (P < 0.01 and P < 0.05, respectively). Noncompliers often found the specific diet to pose a major life burden (P < 0.01) and did not visit a gastroenterologist on a regular basis (P < 0.01). Conclusions: Almost half of the coeliac patients were likely to abandon GFD without experiencing major symptoms, thus increasing the risk for developing complications later in life. An active attitude is required in the follow-up of patients with CD.
Alimentary Pharmacology & Therapeutics, 2007
Background Increasing numbers of individuals are now being diagnosed with coeliac disease. The only accepted treatment for coeliac disease is lifelong adherence to a strict gluten-free diet (GFD). Individuals' ability to adhere to the GFD varies, but systematic studies guiding the assessment of adherence are currently lacking. Aim We sought to compare the predictive value of self-report and four serologic tests compared to expert nutritionist evaluation. Methods In all, 154 individual adults with biopsy-proven coeliac disease rated their adherence to the GFD on a Likert scale. Serum antibody titres of IgA anti-tissue transglutaminase, and IgA and IgG anti-deamidated gliadin peptides were determined. Using ANOVA and ROC analyses, results were compared to a standardized evaluation by an expert nutritionist blinded to the participants' self-rated adherence and serology results. Results All serologic measures as well as participant reported adherence were significantly associated with GFD adherence as assessed by expert nutritionist evaluation. However, on ROC analysis no measure performed satisfactorily. The performance of serologic testing, but not self-report, improved with increased time on the GFD. Conclusion Although current serologic tests have very high sensitivities and specificities for the diagnosis of coeliac disease, they cannot replace trained nutritionist evaluation in the assessment of GFD adherence.
Living with coeliac disease and a gluten-free diet: a Canadian perspective
Journal of Human Nutrition and Dietetics, 2012
Objective: Strict adherence to a gluten-free diet is the only treatment for coeliac disease. The gluten-free diet is complex, costly and impacts on all activities involving food, making it difficult to maintain for a lifetime. The purpose of this cross-sectional study was to evaluate the difficulties experienced, the strategies used and the emotional impact of following a glutenfree diet among Canadians with coeliac disease. Methods: A questionnaire was mailed to all members (n = 10 693) of both the Canadian Celiac Association and the Fondation québécoise de la maladie coeliaque in 2008. Results: The overall response rate was 72%. Results are presented for the 5912 respondents (18 years) reporting biopsy-confirmed coeliac disease and/or dermatitis herpetiformis. Two-thirds never intentionally consumed gluten. Women reported significantly greater emotional responses to a gluten-free diet but, with time, were more accepting of it than men. Difficulties and negative emotions were experienced less frequently by those on the diet for >5 years, although food labelling and eating away from home remained very problematic. Frustration and isolation because of the diet were the most common negative emotions experienced. Conclusions: The present study quantifies the difficulties experienced, the strategies used and the emotional impact of following a gluten-free diet. It highlights the need to improve the training and education of dietitians, other health providers and the food service industry workers about coeliac disease and a gluten-free diet, with the aim of better helping individuals improve their adherence to a gluten-free diet and their quality of life.
sswahs.nsw.gov.au
The treatment for coeliac disease is a gluten free diet. Whether it is safe for coeliacs to ingest the minute amounts of gluten often found in gluten free diets is still controversial. The WHO/FAO Codex Alimentarius allows 0.3% protein from gluten containing grains in foods labelled as gluten free. This is thought to be the standard upon which gluten free diets are based in research studies and which is adopted as practice in many countries including Australia in the past. In March 1995 the Australian standard for gluten free food labelling changed from this WHO guideline. Currently a food cannot be labelled gluten free if it contains any detectable gluten. This study set out to examine the dietary patterns in a large population of subjects with coeliac disease and to relate any symptoms being experienced to the different levels of gluten restriction. This may help to determine if the dietary advice given to all coeliacs should now fall in line with the new Australian food standard for gluten free food labelling. Of the 1672 questionnaires sent to members of the Coeliac Society of NSW, 965 (58%) were returned. This questionnaire asked for a graded description of the severity and frequency of gastrointestinal symptoms commonly experienced by coeliacs, and other less commonly related symptoms. Food brand selection questions were asked so classification into one of three diet categories could be made. The categories were: overt gluten ingestion; trace gluten ingestion in accordance with the old Australian food standard and no detectable gluten ingestion as in the new Australian guidelines. Of the 71.9% of the respondents with trace gluten ingestion, 73% stated that they were not aware of ingesting gluten. After diagnosis and commencement of gluten restriction, a large proportion were still experiencing symptoms but generally found them to be less frequent and less severe. The frequency and severity of symptoms was greater at gluten intakes above that allowed in the old Australian gluten free diet. A comparison of symptom expression between the trace gluten and no detectable gluten diets revealed that only 2 of the 13 symptom categories were significantly different (p<0.01). Constipation was more severe(p=0.0051) in the trace gluten group, while diarrhoea occurred more frequently in those consuming no detectable gluten. The lack of differences in symptoms seen between the trace gluten and no detectable gluten diet categories would suggest that the less restrictive trace gluten diet may be appropriate for some coeliacs.