Gluten-free diet survey: are Americans with coeliac disease consuming recommended amounts of fibre,iron, calcium and grain foods?

OBJECTIVE: This survey was conducted to assess nutrient intakes and food consumption patterns of adults with coeliac disease who adhere to a strict gluten-free diet. DESIGN: Three-day estimated self-reported food records were used to assess daily intakes of calories, percent daily calories from carbohydrates, dietary fibre, iron, calcium and grain food servings. SUBJECTS: Volunteers for this survey were recruited through notices placed in coeliac disease support group newsletters, as well as a national magazine for persons with coeliac disease. Forty-seven volunteers met all criteria for participation and returned useable food records. RESULTS: Group mean daily intake of nutrients by gender: Males (n = 8): 2882 calories; 55% carbohydrate; 24.3 g dietary fibre; 14.7 mg iron; 1288.8 mg calcium; 6.6 grain food servings. Females (n = 39): 1900 calories; 52% carbohydrate; 20.2 g dietary fibre; 11.0 mg iron; 884.7 mg calcium; 4.6 grain food servings. Recommended amounts of fibre, iron and calcium were consumed by 46, 44 and 31% of women and 88, 100 and 63% of men, respectively. CONCLUSIONS: Nutrition therapy for coeliac disease has centred around food allowed/not allowed on a gluten-free diet. Emphasis also should be placed on the nutritional quality of the gluten-free diet, particularly as it concerns the iron, calcium and fibre consumption of women. The use of the estimated food record as the dietary survey method may have resulted in the under-reporting of energy intake. Due to the small sample size and possible bias of survey participants, the findings of this survey may not be representative of the larger coeliac community.     

Dietary fibre and fibre fractions in the diet of Finnish diabetic and non-diabetic adolescents

The intakes of total dietary fibre, water-soluble noncellulosic polysaccharides (WSNCP), water-insoluble noncellulosic polysaccharides (WISNCP), cellulose and lignins of 152 diabetic and 74 non-diabetic adolescents were studied. Food consumption data had been collected by means of two 48 h recall interviews. The diabetics obtained more total dietary fibre (33 g vs 18 g) and all fibre fractions than the controls. The fibre density of the diet was higher for the diabetics than for the controls for all meals and snacks. Positive correlations were found between total dietary fibre intake per 1000 kcal and energy-adjusted intakes of total carbohydrate, starch and most vitamins and minerals both in the diabetics and controls. A high concentration of dietary fibre in the diet thus indicated a higher general nutrient density.     

Diet quality of persons living with HIV/AIDS on highly active antiretroviral therapy

Background  This study sought to assess the diet quality of individuals living with HIV/AIDS who were receiving antiretroviral therapy in São Paulo, Brazil.
Methods  This cross-sectional study involved 56 HIV-infected adults. Demographic and anthropometric data were collected, and diet quality was measured using the Healthy Eating Index (HEI), modified for Brazilians, which included ten components: adequacy of intake of six different food groups, total fat, cholesterol, dietary fibre and dietary variety.
Results  Among the individuals assessed, 64.3% of the participants had a diet needing improvement, while 8.7% had a poor diet. The overall HEI score was 68.3 points (SD = 14.9). Mean scores were low for fruits, vegetables, dairy products and dietary fibre; and high for meats and eggs, total fat and cholesterol. The overall HEI score was higher among individuals who were not overweight ( P  = 0.003), who were also more likely to achieve dietary goals for dairy products ( P  = 0.039) and grains ( P  = 0.005).
Conclusion  Most of these adults living with HIV/AIDS had diets that required improvement, and being overweight was associated with poorer diet quality. Nutritional interventions aimed at maintaining healthy body weight and diet should be taken into account in caring for HIV-infected people.     

Fibre content of enteral feeds for the older child

Background:  There is currently a lack of clinical data on fibre requirements in UK children. Subsequently, the ideal fibre profile for enteral formulae designed to meet the requirements of older children is unknown. The present study aimed to investigate the effect of fibre supplementation on gastrointestinal function of children aged 7–12 years (or weight 21–45 kg) receiving an age-specific high-energy enteral feed.
Methods:  In this double-blind randomised crossover study, 25 home enterally tube-fed children with a range of medical conditions (including cystic fibrosis, neurological conditions, liver transplant and bone marrow transplant) were given a 1.5 kcal mL⁻¹ formula with or without added dietary fibre (1.13 g per 100 mL). Each formula was taken for 6 weeks, followed by 6 months on the second randomly assigned formula. Anthropometry, blood biochemistry, stool characteristics, tolerance and oral dietary intake were assessed.
Results:  Despite a higher median fibre intake on the fibre-containing formula (84% versus 26% of recommended intake; P  = 0.003), most children did not meet existing international recommendations for fibre as a result of small feed volumes (median 800 mL day⁻¹; 9 g fibre day⁻¹). There was some evidence of reduced constipation, laxative reliance and abdominal pain on the fibre-containing formula.
Conclusions:  Given the poor fibre intakes and absence of adverse effects, the use of fibre-containing formulae should become standard practice for the majority of children on enteral feeds. Larger trials in children are required to further evaluate the effect of amount and blend of fibre in enteral formulae for older children. However, it is likely that current formulae require higher levels of fibre.     

Coeliac disease. Following the diet and eating habits of participating individuals in the Federal District, Brazil

The western diet includes several food items based on wheat. Adherence and obedience to a gluten-free diet requires self-determination on the part of the person with Coeliac disease, as well as their family members. The objective of this research is to identify the main difficulties noted by people with Coeliac disease in their eating habits, the frequency of consumption and their satisfaction with gluten-free products. We employed an adapted already validated questionnaire, with open, closed, and multiple choice questions. Of the 105 participants with Coeliac disease, 90.38% of them followed, where possible, a gluten-free diet; 67.12% consumed food with gluten inadvertently or because of a lack of alternatives and/or information in food found in public places. Seventy percent affirmed that their diet provided all the energy and nutrients they need; 77.67% of the Coeliac participants prepared their meals by themselves or this task was assumed by their caregivers; 77.14% read the manufacturers labels on products, and, 74.49% expressed dissatisfaction regarding the price and availability of gluten-free products. The data show an association only between the energy and nutrients needed for good health and gluten-free dietary tracking (p = 0.0315). That is, people with Coeliac disease who avoided gluten consumed more calories and were more likely to have adequate nutrients in their diet.     

Sources of fibre in the diet of irritable bowel patients prescribed a high-fibre diet

Seventy-two patients (27 male and 45 female) with irritable bowel syndrome were prescribed a high-fibre diet. They were given a diet sheet and variable amounts of individual dietetic counselling. After 6 months they kept a 7-day weighed food inventory. Median (mean) intake of dietary fibre was 19.5 (21.6)g, 57% of which was provided by cereal sources, mainly breads and breakfast cereals. Patients also frequently ate low-fibre and energy-dense foods. Average fibre intakes were greater at the evening (main) meal of the day. However, the largest intakes by individuals were at breakfast and the lunch (snack) meal, which suggests that dietary advice should put emphasis on the consumption of high-fibre breakfast cereals and wholemeal bread at these two meals.     

Foods, nutrients and portions consumed by a sample of Australian children aged 16–24 months

Aim:  To describe the diet of a sample of Australian children aged 16–24 months with regard to the amounts of foods and nutrients consumed.
Methods:  Cross-sectional data collected from participants in a five-year randomised trial of the primary prevention of asthma. Pregnant women with a family history of atopy were recruited from six hospital antenatal clinics in western Sydney. At the 18-month assessment, carers of 429 of children completed three-day weighed food records. Three-day average intakes of foods and nutrients and average portions per eating occasion for commonly consumed foods. T -tests for comparing gender differences.
Results:  Diets were characterised by large amounts of milk and non-milk drinks with smaller amounts of cereals, fruits, vegetables and meats. Total energy intake was significantly higher for boys than girls and exceeded estimated energy requirements in both boys and girls. Food groups contributing most to energy included milk and milk products (35%), cereals (15%), cereal-based products (9%) and non-milk drinks (8%). Micronutrient intakes were below the Estimated Average Requirement in more than 5% of the children for vitamin A, calcium, vitamin C and iron. Sodium intakes exceeded the upper level of 1000 mg for 62% of children, while dietary fibre intake was only half the Adequate Intake of 14 g. Relatively few foods were widely consumed and median portion sizes were typically small in relation to commonly used reference portion sizes.
Conclusion:  These data may be useful as a preliminary basis for developing age-specific dietary surveillance tools and dietary guidance for children aged one to two years.     

An retrospective audit of patients with polycystic ovary syndrome: the effects of a reduced glycaemic load diet

Background  Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism and chronic anovulation. The aim of this retrospective audit was to determine the patient profile, including anthropometrics, biochemistry and symptoms, and to evaluate the influence of a dietary intervention in women with PCOS.
Methods  Data were collected retrospectively from dietetic and medical records from all PCOS patients ( n  = 88) who attended a dietetic consultation from July 2004 to July 2006. As standard clinic practice, a reduced glycaemic load diet had been prescribed, with energy reduction in overweight patients. Follow-up data were available for 59 patients.
Results  Fifty-eight patients had a body mass index (BMI) ≤ 24.9 kg m⁻² and 30 had a BMI ≥ 25 kg m⁻². Thirty-six patients, with a BMI ≤ 24.9 kg m⁻², self-reported central weight gain at their initial appointment. Over two-thirds of patients self-reported one or more of the following symptoms: carbohydrate cravings, hypoglycaemia, tiredness and hunger. At the follow-up appointment, BMI and waist circumference significantly decreased in overweight patients ( P  < 0.05). Seventy-one percent of women self-reported hypoglycaemia initially; this was reduced to 13% at follow-up ( P  < 0.01).
Conclusions  The audit indicated a low glycaemic load diet in combination with medication may contribute to an improvement in symptom relief in patients with PCOS.     

Child-care environment and dietary intake of 2- and 3-year-old children

Background:  Previous research has shown that children in child-care do not comply with dietary intake recommendations (i.e. either exceeding or not meeting recommendations), which may be attributable to specific features of the child-care environment. The present study explored the relationship between the social and physical child-care (day-care) environment and dietary intake of 2- and 3-year-olds in Dutch child-care centres.
Methods:  The dietary intake of 135 children, aged 2 and 3 years, who were in child-care was assessed by observing randomly selected children at three meals (morning snack, lunch and afternoon snack) to determine dietary intake (i.e. saturated fat, dietary fibre and energy intake). The environment was observed using the Environment and Policy Assessment and Observation checklist, a structured instrument assessing the physical and social environment.
Results:  Children consumed a mean of 486 kJ (116 kcal) during the morning snack, 2043 kJ (488 kcal) during lunch and 708 kJ (169 kcal) during the afternoon snack. There were some gender and age differences in dietary intake. Several environmental factors (e.g. serving style and staff's model dietary behaviour) were significantly associated with the children's dietary intake.
Conclusions:  Overall, energy intake was in the upper range of recommended intake for children in child-care. The associations of several environmental factors with dietary intake stress the importance of the child-care environment for children's dietary behaviour. Intervening in this setting could possibly contribute to the comprehensive prevention of childhood obesity.     

Celiac disease: understanding the gluten-free diet

Purpose

The only effective and safe treatment of celiac disease (CD) continues being strict exclusion of gluten for life, the so-called gluten-free diet (GFD). Although this treatment is highly successful, following strict GFD poses difficulties to patients in family, social and working contexts, deteriorating his/her quality of life. We aimed to review main characteristics of GFD with special emphasis on factors that may interfere with adherence to it.

Methods

We conducted a search of various databases, such as PubMed, Google Scholar, Embase, and Scielo, with focus on key words such as “gluten-free diet”, “celiac disease”, “gluten” and “gluten-free diet adherence”. Available literature has not reached definitive conclusions on the exact amount of gluten that is harmless to celiac patients, although international agreements establish cutoff points for gluten-free products and advise the use of clinical assessment to tailor the diet according to individual needs. Following GFD must include eliminating gluten as ingredient as well as hidden component and potential cross contamination in foods. There are numerous grains to substitute wheat but composition of most gluten-free products tends to include only a small number of them, especially rice. The diet must be not only free of gluten but also healthy to avoid nutrient, vitamins and minerals deficiencies or excess. Overweight/obesity frequency has increased among celiac patients so weight gain deserves attention during follow up. Nutritional education by a trained nutritionist is of great relevance to achieve long-term satisfactory health status and good compliance.

Conclusions

A balanced GFD should be based on a combination of naturally gluten-free foods and certified processed gluten-free products. How to measure and improve adherence to GFD is still controversial and deserves further study.

     

Economic burden of a gluten-free diet

BACKGROUND: Coeliac disease is a common, autoimmune disorder, for which the only treatment is lifelong adherence to a gluten-free diet. This study evaluates the economic burden of adhering to a gluten-free diet. METHODS: A market basket of products identified by name brand, weight or package size for both regular wheat-based products and gluten-free counterparts was developed. The differences in price between purchase venues, both type of store (general grocery store, an upscale grocery store and a health food store and four internet-based grocery sites) and region was also analysed. RESULTS: Availability of gluten-free products varied between the different venues, regular grocery stores carried 36%, while upscale markets carried 41%, and health food stores 94%, compared with 100% availability on the internet. Overall, every gluten-free product was more expensive than their wheat-based counterpart (P 相似文献   

The effect of diet on microfaunal population and function in the caecum of a subterranean naked mole-rat, Heterocephalus glaber.

The effect of dietary fibre and starch content on digestibility, microfaunal population and caecal function was investigated in a subterranean mole-rat, Heterocephalus glaber (Rodentia). Mole-rats were fed on a diet of either sweet potato (neutral-detergent fibre (NDF) 65 g/kg dry matter (DM), starch 638 g/kg DM) or carrot (NDF 157 g/kg DM, starch 258.7 g/kg DM) for 4 weeks. Daily intake and faecal output were monitored. Thereafter caecal microfaunal population, density and function were assessed using light and scanning electron microscopy and by measuring both gas and short chain fatty acid (SCFA) production. A 2.4-fold increase in fibre and 2.5-fold decrease in starch content resulted in a decrease in caecal DM content (390 g/kg). A concomitant dramatic decline (by 93%) in ciliate protozoa with a corresponding 2-fold increase in bacteria also accompanied this change in diet. Fermentative efficiency as indicated by gas production was 2.6 times greater on a carrot diet than on sweet potato. Microbial fermentation resulted in higher SCFA concentrations on the carrot diet, with a 42% reduction in SCFA concentration on the sweet potato diet. Here, SCFA contributed 5.1% of daily energy expenditure and this increased 5.0-fold on the carrot diet. Caecal micro-organism function, therefore, played an important role in the nutritional physiology of these naked mole-rats, and enabled maximum utilization of the food substrate.     

Adoption and maintenance of a Mediterranean diet in patients with coronary heart disease from a Northern European population: a pilot randomised trial of different methods of delivering Mediterranean diet advice

Background:  A Mediterranean diet has been shown to protect against coronary heart disease (CHD). Adherence to a Mediterranean diet can be assessed using a Mediterranean diet score. The primary aim of this pilot study was to examine whether CHD patients in a Northern European population would adopt and maintain a Mediterranean diet, with a secondary aim of comparing the effectiveness of different methodologies aimed at improving compliance.
Methods:  Sixty-one patients with a diagnosis of CHD were randomised to one of three groups: either to receive conventional dietetic advice for CHD or advice to implement a Mediterranean-style diet using either behavioural counselling or nutritional counselling. Patients received a follow-up assessment at 6 months (adoption) and a subset of patients was followed up at 12 months (maintenance). The primary outcome measure was the between-group difference in the mean change in Mediterranean diet score (MDS).
Results:  The change in MDS was not significantly different between groups. However, all three groups reported a significant within-group increase in MDS ( P  < 0.01) at 6 and 12 months follow-up.
Conclusions:  All three groups made dietary changes towards a Mediterranean diet, but behavioural counselling did not have significant additional benefit over nutritional counselling in initiating and maintaining dietary change, and neither method offering specific Mediterranean diet advice had any significant benefit in terms of improvement in MDS over conventional dietetic practice.     

Food Safety and Cross-Contamination of Gluten-Free Products: A Narrative Review

A gluten-free diet (GFD) is currently the only effective treatment for celiac disease (CD); an individual’s daily intake of gluten should not exceed 10 mg. However, it is difficult to maintain a strict oral diet for life and at least one-third of patients with CD are exposed to gluten, despite their best efforts at dietary modifications. It has been demonstrated that both natural and certified gluten-free foods can be heavily contaminated with gluten well above the commonly accepted threshold of 20 mg/kg. Moreover, meals from food services such as restaurants, workplaces, and schools remain a significant risk for inadvertent gluten exposure. Other possible sources of gluten are non-certified oat products, numerous composite foods, medications, and cosmetics that unexpectedly contain “hidden” vital gluten, a proteinaceous by-product of wheat starch production. A number of immunochemical assays are commercially available worldwide to detect gluten. Each method has specific features, such as format, sample extraction buffers, extraction time and temperature, characteristics of the antibodies, recognition epitope, and the reference material used for calibration. Due to these differences and a lack of official reference material, the results of gluten quantitation may deviate systematically. In conclusion, incorrect gluten quantitation, improper product labeling, and poor consumer awareness, which results in the inadvertent intake of relatively high amounts of gluten, can be factors that compromise the health of patients with CD.     

The effect of starch-protein interaction in wheat on the glycemic response and rate of in vitro digestion

To determine the effect on blood glucose of removal of protein from wheat products, healthy volunteers took test meals of white bread made from either regular or gluten-free flour. After bread made from gluten-free flour, the blood-glucose rise was significantly greater. This corresponded with a significantly more rapid rate of digestion in vitro and reduced starch malabsorption in vivo as judged by breath-H2 measurements. Addition of gluten to the gluten-free bread mix did not reverse these effects. Factors associated with unprocessed wheat flour, such as the natural starch-protein interaction, may therefore be important in wheat products in reducing both their rate of absorption and glycemic response. They may have implications in the dietary management both of diabetes and of diseases where small intestinal absorptive capacity is impaired.     

Beneficial effects of oats in the gluten-free diet of adults with special reference to nutrient status,symptoms and subjective experiences

In several studies oats have been reported to be tolerated by coeliac patients. The aim of the present study was to investigate the nutritional and symptomatic effects of including oats in the gluten-free diet, as well as the patients' subjective experiences. Twenty adult coeliac patients included large amounts of oats in their diet. Food intake, gastrointestinal symptoms, blood samples and body weight were examined and compared with examination at baseline. Diet compliance was checked monthly. The results are based on fifteen patients eating oats for 2 years plus three with only 6-months consumption. The median daily intake of oats was 93 (range 27-137) g/d, and the compliance was good. The mean intakes of Fe and dietary fibre increased (P<0.001) with the oat diet, as well as the intakes of thiamin and Zn (P<0.02). The bioavailability of Fe tended to decrease; this seems not to have influenced the Fe status. Temporary increased flatulence was experienced the first few weeks, as well as improved bowel function with oats in the diet. All patients who carried out the whole study period wanted to continue eating oats after the study, as they found that addition of oats in the gluten-free diet gave more variation, better taste and satiety. Oats improved the nutritional value of the gluten-free diet, had no negative effects on nutritional status and were appreciated by the subjects. Including oats can help coeliac patients following a strict gluten-free diet.     

Dietary Approaches to Stop Hypertension (DASH) diet: applicability and acceptability to a UK population

Background:  The Dietary Approaches to Stop Hypertension (DASH) diet is widely promoted in the USA for the prevention and treatment of high blood pressure. It is high in fruit and vegetables, low-fat dairy and wholegrain foods and low in saturated fat and refined sugar. To our knowledge, the use of this dietary pattern has not been assessed in a free-living UK population.
Methods:  The DASH diet was adapted to fit UK food preferences and portion sizes. Fourteen healthy subjects followed the adapted DASH diet for 30 days in which they self-selected all food and beverages. Dietary intake was assessed by 5-day food diaries completed before and towards the end of the study. Blood pressure was measured at the beginning and end of the study to assess compliance to the DASH style diet.
Results:  The DASH diet was easily adapted to fit with UK food preferences. Furthermore, it was well tolerated and accepted by subjects. When on the DASH style diet, subjects reported consuming significantly ( P  <   0.01) more carbohydrate and protein and less total fat (5%, 6% and 9% total energy, respectively). Sodium intakes decreased by 860 mg day⁻¹ ( P  <   0.001). Systolic and diastolic blood pressure decreased significantly ( P  <   0.05) by 4.6 and 3.9 mmHg, respectively when on the DASH style diet.
Conclusions:  The DASH style diet was well accepted and was associated with a decrease in blood pressure in normotensive individuals and should be considered when giving dietary advice to people with elevated blood pressure in the UK.     

Amino acid composition of the diet in a region of Southern Tunisia.

As part of a study of the effects of lysine supplementation of wheat products in Southern Tunisia one qualitative and four quantitative surveys of food consumption were carried out. The average diet provided 7.1 MJ (1,670 kcal), 42 g of protein and 1,280 mg of lysine per person per day. The overall dietary protein thus supplied only 31 mg of lysine/g of protein, or about 56% of the level recommended by the FAO/WHO Expert Committee on Protein Requirements. Addition of lysine to all wheat products to a final effective concentration of 0.2% would raise the dietary lysine level to 45 mg/g protein, or 82% of the FAO/WHO recommended level, at which time threonine would become limiting. Irrespective of whether the FAO/WHO pattern of 1973, breast milk, cow's milk, whole egg or a modification of the FAO pattern of 1957 was used to assess the quality of the protein in the diet, lysine was the first, and threonine the second limiting amino acid (except in comparison with breast milk, which showed tryptophan as the second limiting amino acid). In no case did there appear to be any problem with the sulfur-containing amino acids.     

Formulated meal replacements: A comparison of the nutritional adequacy of available products

Objective:  To assess the nutritional compliance of formulated meal replacements available in Australian pharmacies with the Food Standards Australia and New Zealand guidelines; and to assess the nutritional adequacy of formulated meal replacements recommended diets based on meal replacement or total diet replacement (very low energy diets).
Design:  Products available at major pharmacies as of November 2007 were identified and nutritional information and instructions for use were obtained from the product packaging and/or the manufacturing company.
Main Outcome Measures:  Individual serves, prepared as directed, were compared to Standards Australia and New Zealand standard 2.9.3 of the food standards code. Nutritional adequacy was assessed by comparing the nutritional composition to the Nutrient Reference Values for average obese adult males and females, using Foodworks 2007.
Results:  Results demonstrated that while most products were compliant with the Standards Australia and New Zealand standard for formulated meal replacements composition the majority of the products and/or programs were deficient in one or more nutrients. Of the 17 products from 11 brands, no very low energy diets programs (of seven) were found to be nutritionally complete. Only two meal replacement programs (of 16) were nutritionally complete in comparison to the recommended dietary intakes and AIs for both a representative obese man and woman.
Conclusion:  The results highlight the important role of clinicians in ensuring programs followed by patients are nutritionally adequate and implemented and supervised as intended, in order to minimise side-effects and risks. There is a need for Standards Australia and New Zealand regulations governing very low energy diets, where formulated meal replacements are recommended for total diet replacement.