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Found 9 results

  1. Celiac.com 08/08/2018 - A number of studies have cataloged the numerous challenges faced by adolescents with celiac disease attempting to comply with a gluten-free diet. A team of researchers recently set out to reevaluate gluten-free dietary compliance and the current clinical condition of 123 now teenage celiac patients, who were diagnosed in the first three years of life and were followed up for at least 10 years to determine whether a less strict approach to a gluten-free diet can actually increase gluten-free dietary compliance. The research team included M Mayer, L Greco, R Troncone, S Auricchio, and M N Marsh. They are variously affiliated with the University Department of Medicine, Hope Hospital, Salford, Manchester, UK. The team used computerized image analysis to assess mucosal structure and lymphocytes in small intestinal biopsy specimens obtained from 36 subjects. Of these adolescents with celiac disease, 65% were adhering to a strict gluten free diet, 11.4% followed a gluten-free diet with occasional gluten intake, while nearly 25% ate a gluten containing diet. Patients on a gluten containing diet had more frequent clinical gluten-related symptoms, while patients on a semi-strict diet did not. Occasional intake of small amounts (0-06-2 g/day) of gluten did not produce increased concentrations of anti-gliadin antibodies, but did result in a substantially greater crypt epithelial volume and expanded crypt intraepithelial lymphocyte numbers. So, could a semi-strict gluten-free diet benefit celiac teenagers who eat a gluten containing diet? These numbers suggest that a semi-strict gluten-free diet may be better than no gluten-free diet at all. Of course, the best choice would always be a 100% gluten-free diet. Source: Gut
  2. Celiac.com 11/01/2017 - Recent product testing by the FDA shows overwhelming compliance with FDA's requirement that foods labeled "gluten-free" have less than 20 parts per million detectable gluten. According to the FDA, more than 99.5 percent of "gluten-free" food products met the agency's gluten-free standard, according to Carol D'Lima, a food technologist in FDA's Office of Nutrition and Food Labeling. The FDA collected and analyzed 702 samples from more than 250 products labeled "gluten free." So far, D'Lima noted, only one product labeled as gluten-free tested positive for gluten levels above 20 ppm. The FDA does not name the products that were tested, but does note that the failed product was "recalled and subsequent sampling by the FDA did not find levels of gluten that violated the regulation." Also, the FDA testing very likely includes products by major manufacturers. That's likely good news for manufacturers like General Mills, which made news recently when they announced that they will voluntarily remove the "Gluten-Free" label from their Cheerios products in Canada. The company says that it did not make the move due to any concerns about gluten levels, but due to a technicality over oat testing protocols under which oat products can be labeled "Gluten-Free." A statement from the company's website reads in part: "Each serving of Cheerios products in Canada are gluten free, as defined by the current regulatory standard of containing less than 20 ppm of gluten. General Mills Canada has made the decision to voluntarily remove the gluten-free label from our Cheerios products in Canada until Health Canada and The Canadian Food Inspection Agency (CFIA) publish a consistent testing protocol for products containing oats. At this time the product is not changing, just the label on the box." Absent any product recalls in the face of the FDA product testing, it's safe to assume that the consumers can take General Mills and other companies at their word, and trust that products labeled gluten-free meet FDA gluten-free standards, and are safe for people with celiac disease. Such high compliance levels by food manufacturers mean that the FDA may now put more of their resources into other enforcement measure, including ensuring that the supply chain remains free from cross-contamination. Even in the face of such encouraging test results, look for the FDA to remain diligent in validating "Gluten-Free" and other labeling claims. The FDA maintains "an ongoing compliance program," says D'Lima. Under that program, field staff in FDA district offices conduct inspections that include products labeled as gluten-free. If any products are found to be out of compliance for gluten standards, the FDA notifies the company to make appropriate corrections, and works with the company to recall any mislabeled products on the market. Source: foodnavigator-usa.com
  3. Celiac.com 06/28/2017 - Tests to measure serum endomysial antibodies (EMA) and antibodies to tissue transglutaminase (tTG) were developed to screen for celiac disease in patients who are actively eating gluten. However, doctors often use them to monitor patients on a gluten-free diet. Now, making sure celiac patients are successfully following a gluten-free diet is important, as unconscious gluten ingestion can lead to complications over time. But how accurate are these tests for assessing gluten-free compliance in celiac patients? A team of researchers recently set out to assess the sensitivity and specificity of tTG IgA and EMA IgA assays in identifying patients with celiac disease who have persistent villous atrophy despite a gluten-free diet. The research team included Jocelyn A. Silvester, Satya Kurada, Andrea Szwajcer, Ciarán P. Kelly, Daniel A. Leffler, and Donald R. Duerksen. They are variously affiliated with the Farncombe Family Digestive Health Research Institute and Division of Gastroenterology, and the Department of Pathology and Molecular Medicine and Department of Medicine, McMaster University, Hamilton, Ontario. To begin their meta-analysis, the team searched PUBMED, EMBASE, BIOSIS, SCOPUS, clinicaltrials.gov, Science Citation Index, and Cochrane Library databases through November 2016. They included studies of subjects with biopsy-confirmed celiac disease, follow-up biopsies and measurement of serum antibodies on a gluten-free diet, biopsy performed on subjects regardless of symptoms or antibody test results. Their analysis excluded patients with refractory celiac disease, undergoing gluten challenge, or consuming a prescribed oats-containing gluten-free diet. They determined positive or negative findings based on manufacturer cut-off values. They defined villous atrophy a Marsh 3 lesion or villous height:crypt depth ratio below 3.0. They constructed forest plots to determine the sensitivity and specificity of detection for individual studies. For their meta-analysis, they used a bivariate random effects model to determine both sensitivity and specificity. Their search of abstracts revealed 5,408 unique citations, which yielded 442 articles for detailed review. Those reviewed articles yielded just 26 studies that met the team’s inclusion criteria (6 of tTG assays, 15 of EMA assays, and 5 of tTG and EMA assays). Inability to cross-tabulate histologic and serologic findings was the most common reason the team excluded a given study from analysis. They found that serum assays identified patients with persistent villous atrophy with high levels of specificity: 0.83 for the tTG IgA assay (95% CI, 0.79–0.87) and 0.91 for the EMA IgA assay (95% CI, 0.87–0.94). However, the tests showed low sensitivity for detecting villous atrophy: 0.50 for the tTG IgA assay (95% CI, 0.41–0.60) and 0.45 for the EMA IgA assay (95% CI, 0.34-0.57). Results were similar in both pediatric and adult patients. A meta-analysis of biopsy-confirmed celiac patients who received follow-up biopsy while on a gluten-free diet, showed that tests for serum tTG IgA and EMA IgA had low sensitivity, detecting persistent villous atrophy less than 50 percent of the time. The team supports the search for more accurate, non-invasive, markers of mucosal damage in celiac patients who follow a gluten-free diet. Source: Gastroenterology. DOI: http://dx.doi.org/10.1053/j.gastro.2017.05.015
  4. Celiac.com 12/08/2016 - People with celiac disease are supposed to follow a strict lifelong gluten-free diet. Celiac patients should receive regular follow-up dietary interviews and blood tests to make sure that they are successfully following the diet. However, none of these methods offer an accurate measure of dietary compliance. The only way to know for sure, is to test. A team of researchers recently set out to evaluate the measurement of gluten immunogenic peptides (GIP) in stools as a marker of gluten-free diet adherence in celiac patients and compare it with traditional methods of gluten-free diet monitoring. The team conducted a prospective, nonrandomized, multi-center study including 188 celiac patients on gluten-free diet and 84 healthy controls. Subjects were given a dietary questionnaire and fecal GIP quantified by enzyme-linked immunosorbent assay (ELISA). They simultaneously measured serological anti-tissue transglutaminase (anti-tTG) IgA and anti-deamidated gliadin peptide (anti-DGP) IgA antibodies. A total of 56 of the 188 celiac patients, about 30 percent, had detectable GIP levels in stools. There was significant association between age and GIP in stools that revealed increasing dietary transgressions with advancing age. Nearly forty percent occurred in in subjects 13 years of age or older, with 60% occurring in men 13 years of age or older. The team found no connection between fecal GIP and dietary questionnaire or anti-tTG antibodies. However, they did spot a connection between GIP and anti-DGP antibodies, with seven of the 53 GIP stool-positive patients testing positive for anti-DGP. The detection of gluten peptides in stool samples shows the limits of traditional methods for monitoring a gluten-free diet in celiac patients. The GIP ELISA provides direct and quantitative assessment of gluten exposure soon after consumption, and might improve diagnosis and clinical management of non-responsive celiac disease and refractory celiac disease. Basically, doctors need to take a much more hands on role in monitoring celiac patients who are following gluten-free diets. Source: Am J Gastroenterol 2016; 111:1456–1465; doi:10.1038/ajg.2016.439; published online 20 September 2016 The research team included Isabel Comino PhD1, Fernando Fernández-Bañares MD, PhD2, María Esteve MD, PhD2, Luís Ortigosa MD, PhD3, Gemma Castillejo MD, PhD4, Blanca Fambuena MS5, Carmen Ribes-Koninckx MD, PhD6, Carlos Sierra MD, PhD7, Alfonso Rodríguez-Herrera MD, PhD8, José Carlos Salazar MD9, Ángel Caunedo MD10, J M Marugán-Miguelsanz MD, PhD11, José Antonio Garrote MD, PhD12, Santiago Vivas MD, PhD13, Oreste lo Iacono MD, PhD14, Alejandro Nuñez BSc13, Luis Vaquero MD, PhD13, Ana María Vegas MD12, Laura Crespo MD12, Luis Fernández-Salazar MD, PhD11, Eduardo Arranz MD, PhD11, Victoria Alejandra Jiménez-García MD10, Marco Antonio Montes-Cano MD, PhD15, Beatriz Espín MD, PhD9, Ana Galera MD8, Justo Valverde MD8, Francisco José Girón MD7, Miguel Bolonio MSc6, Antonio Millán MD, PhD5, Francesc Martínez Cerezo 4, César Guajardo MD3, José Ramón Alberto MD3, Mercé Rosinach MD, PhD2, Verónica Segura BSc1, Francisco León MD, PhD16, Jorge Marinich PhD17, Alba Muñoz-Suano PhD17, Manuel Romero-Gómez MD, PhD5, Ángel Cebolla PhD17 and Carolina Sousa PhD1 They are variously affiliated with the Department of Microbiology and Parasitology, Faculty of Pharmacy, University of Seville, Seville, Spain; the Department of Gastroenterology, Hospital Universitari Mutua Terrassa, and CIBERehd, Terrassa, Barcelona, Spain; the Pediatric Gastroenterology, Hospital Universitario Nuestra Señora de La Candelaria, Tenerife, Spain; Pediatric Gastroenterology, Hospital Universitari de Sant Joan de Reus, IISPV, URV, Reus, Spain; the Unit for the Clinical Management of Digestive Diseases and CIBERehd and Gastroenterology and Nutrition Unit, Hospital Universitario Virgen de Valme, Seville, Spain; the Pediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Universitario y Politécnico La Fe, Celiac Disease and Digestive Inmunopatology Unit, Instituto de Investigación Sanitaria La Fe, Valencia, Spain; the Pediatric Gastroenterology and Nutrition Unit, Hospital Materno-Infantil, Malaga, Spain; the Gastroenterology and Nutrition Unit, Instituto Hispalense de Pediatría, Seville, Spain; the Servicio de Gastroenterología Pediátrica, Hospital Universitario Virgen del Rocío, Seville, Spain; the Hospital Universitario Virgen Macarena, Seville, Spain; the Mucosal Immunology Laboratory, Instituto de Biología y Genética Molecular (IBGM), University of Valladolid, CSIC and Gastroenterology Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; the Clinical Analysis and Pediatrics, Hospital Universitario Río Hortega, Valladolid, Spain; the Servicio de Aparato Digestivo, Hospital Universitario de Leon, Leon, Spain; the Sección de Aparato Digestivo, Hospital del Tajo, Madrid, Spain; the Servicio de Inmunología, CIBER de Epidemiología y Salud Pública, Hospital Universitario Virgen del Rocío/IBiS/CSIC/Universidad de Sevilla, Seville, Spain; with Celimmune, Bethesda, Maryland, USA, and with Biomedal SL, Seville, Spain
  5. Celiac.com 02/24/2012 - Currently, testing for anti tissue-transglutaminase antibodies is the standard of celiac disease blood testing. The test has a high sensitivity in patients who are eating a diet that contains gluten, but poor sensitivity for people on a gluten-free diet. So, it's not much use for measuring gluten-free diet success in people with celiac disease. A research team set out to determine if a new test might be more useful than current standard in assessing long-term gluten exposure in celiac disease patients attempting to follow a gluten-free diet. The new test measures Immunoglobulin-A antibodies to catalytically active open conformation tissue-transglutaminase. The study team included K. Pallav, D. A. Leffler, M. Bennett, S. Tariq, H. Xu, T. Kabbani, A. C. Moss, M. Dennis, C. P. Kelly, D. Schuppan. They are affiliated with the Celiac Center of the Beth Israel Deaconess Medical Center at Harvard Medical School in Boston. The team made a preliminary dietary assessment of 147 patients with celiac disease, and grouped them according to good or poor compliance to a gluten-free diet. The team used 50 patients with inflammatory bowel disease as a control group. The team then measured both open (new test) and closed (conventional) tissue-transglutaminase levels using standard enzyme linked immunosorbent assay. The team's initial dietary review indicated that 128 of the celiac patients had followed a gluten free diet for more than six months. They found 19 to have poor compliance to a gluten-free diet. Of the 19 who had poor adherence to a gluten-free diet, the team found 13 patients (68.4%) who tested positive using open conformation assay (p=0.51), while ten of the 19 patients (52.6%) tested positive using conventional assay (p=0.51). In the control group, just two patients tested positive using closed assay, while one tested positive using open assay. The team concluded that, compared to conventional testing, open conformation tissue-transglutaminase may offer greater sensitivity in the poor gluten-free diet adherence group and higher specificity in the control population. The team suggests studies on larger populations to determine whether open conformation tissue-transglutaminase assay may be superior to the conventional assay in measuring compliance with a gluten-free diet. Source: Dig Liver Dis. 2012 Jan 17.
  6. Celiac.com 11/23/2011 - Osteopenia and osteoporosis, both conditions in which bone density is less than optimal, are often seen in people with celiac disease at the time of their diagnosis. There have been conflicting data as to whether a gluten free diet can improve bone density. Researchers in Argentina set out to determine if celiac patients suffer more peripheral fractures than a control population, and to assess the effects of a gluten free diet on fracture risk. Their results are reported in the July 7, 2011 issue of the World Journal of Gastroenterology. They recruited 256 people who had been diagnosed with celiac at least five years before the study began in March, 2007, asked them if they had ever broken any bones and, if so, which. They then compared their answers to answers obtained from 530 age- and sex- matched controls with functional gastrointestinal disorders. People with other disorders that could reduce bone health – like thyroid dysfunction, rheumatoid arthritis, inflammatory bowel disease, and diabetes – as well as those taking vitamin D, steroids, calcium supplements or other medications that could affect bone metabolism were excluded. They found that celiacs had a higher rate and risk of first peripheral fracture before diagnosis – but this effect only achieved statistical significance for men. This increased risk was also associated with a classical clinical presentation; those with atypical or silent forms of celiac did not exhibit the same risk. Although the finding that being male increases a celiac’s risk of peripheral fractures is intriguing, it must be borne out by larger studies – only 42 of the 256 celiacs included in this study were male. After maintaining a gluten free diet for five years, the elevated risk of fractures was gone. The authors speculate that eliminating gluten may reduce the risk of fractures in celiac patients not necessarily by increasing bone mass and mineral density, but by improving body mass and fat/ muscle composition, nutritional status, and bone architecture. Despite its limited scope, the take home message of this study is clear; if you have celiac disease, strictly adhering to a gluten free diet is good not just for your intestines, immune system, and skin; it is also good for your bones. Source: Sanchez et al. Risk of fracture in celiac disease: Gender, dietary compliance, or both? World J. Gastroenterol 2011 July 7; 17(25).
  7. Celiac.com 10/13/2009 - The standard method of measuring successful observance of a gluten-free diet in patients with celiac disease is through a dietary interview performed by health professional. However, there is currently have no simple, objective method for conducting such a dietary interview. To address this discrepancy, a team of researchers recently designed an easy, quick questionnaire based on four simple questions which yield a five-level score (0–IV). The score provides the test individual with an indication of their compliance level. The research team was made up of Federico Biagi, Alida Andrealli, Paola Ilaria Bianchi, Alessandra Marchese, Catherine Klersy, and Gino Roberto Corazza. The team recently set out to assess the accuracy of the questionnaire. They ran the questions past 168 celiac patients, 126 females and 42 males, with a median age of 42·4 (SD 12·9) years. All subjects were allegedly following a gluten-free diet (median 82, 25th–75th percentile 50–108, range 15–389 months). They compared the resulting scores with the persistence of both villous atrophy and endomysial antibodies while on a gluten-free diet. They also compared patient survival rates. Non-expert personnel interviewed patients by telephone. The questionnaire took less than one minute to complete. The lowest results were markedly more common among the patients with a persistence of both villous atrophy and positive endomysial antibodies. Those patients also had significantly higher rates of death overall. From these results, the researchers conclude that the questionnaire offers a simple, accurate way to verify compliance with a gluten-free diet for patients with celiac disease. Source: British Journal of Nutrition (2009), 102, 882–887
  8. Celiac.com 07/20/2010 - Anyone who's tried to maintain a gluten-free diet for celiac disease or other reasons can likely tell stories about the difficulties and challenges they face on a regular basis. Still, very little research has been done regarding the psychological and social challenges faced by people with celiac disease who are attempting to follow a gluten-free diet. Scientists in India recently conducted just such a study. A research team set out to assess psychological and social challenges faced by Indian children with celiac disease who are attempting to follow a gluten-free diet. The research team included Srikanta Basu, J. C. Chauhan, A. K. Dutta, Praveen Kumar, and Arun Kumar from the Division of Gastroenterology, Department of Pediatrics at Lady Hardinge Medical College and Associated Kalawati Saran Children Hospital in New Delhi, India. Their goal was to assess dietary compliance to gluten-free diet, to identify barriers to compliance, and to study the impact of diet on the psychosocial behavior of children with celiac disease. For the study, the team looked at children with clinically proven celiac disease, who had been observed for at least 6 months. They then evaluated the children for gluten-free diet compliance. Researchers who were blinded to initial results then interviewed patients using a self-administered questionnaire. The team measured psychosocial parameters using the standard 35-item Pediatric Symptom Checklist (PSC). To determine what factors might affect dietary compliance, the team compared the results of children who were compliant with their gluten-free diets to those who were not-compliant. They then compared the psychosocial parameters of both groups to those of healthy control subjects. The team measured a total of 70 patients for dietary compliance. They found 53 children to be compliant with a gluten-free diet (75%). They found 13 were non-compliant with a gluten-free diet (18%), while 4 children were likely non-compliant. A total of 64 children completed the full assessment. Final analysis showed that 4 of those children were likely non-compliant. Data for 2 patients with incomplete assessments was dropped. Younger kids showed higher compliance with a gluten-free diet than did teens. 80% of younger kids showed compliance with a gluten-free diet, compared with just 44% of teens. Gluten-free diet compliance was also higher in children with higher maternal education, and in parents with better knowledge and understanding of celiac disease, and in nuclear families. Higher family income raised compliance levels. Children with 2 or fewer siblings did better, with compliance rates of 68.3% and just 23% non-compliance. 72% of kids who were compliant with a gluten-free diet had presented classic symptoms of celiac disease, while only 15% of this group was non-compliant. Adjustment-related challenges, such as difficulty in maintaining diet at school, restaurants, trips, etc. are among the most common problems faced by celiac children. Nearly half (45%) of the children complained that teachers did not adequately understand the challenges of their condition. Researchers established a PSC cutoff point of 4 for children in the dietary non-compliant group. Generally, kids with celiac disease did not show higher levels of symptoms, such as complaints of aches and pains; being irritable/angry; not listening to rules, blaming other for mistakes; teasing others; refusing to share. The study findings show that about 1 in 5 (18%) people with celiac disease fail to comply with their gluten free diet, and that kids who comply with a gluten-free diet have better psychosocial parameters, as measured by PSC score. Also, adolescents, kids in joint families, and kids in larger families tend to have greater non-compliance levels. Successful treatment of celiac disease requires full compliance with a gluten-free diet. Non-compliance increases risk factors for numerous celiac-associated conditions. Knowing which factors are most likely to present challenges for maintaining compliance can provide celiac suffers and clinicians with useful tools for reducing those challenges and increasing compliance. Source: Indian Journal of Pediatrics 2010 Jun;77(6):649-54. DOI 10.1007/s12098-010-0092-3
  9. Aliment Pharmacol Ther. 2005;22(4):317-324. Celiac.com 09/14/2005 - In an effort to determine whether general screening for celiac disease should be conducted in high-risk groups, Finnish researchers conducted a 14 year follow-up study which focused on dietary compliance, quality of life, and bone mineral density in 53 consecutive screen-detected celiac disease patients who were diagnosed and treated around 14 years ago. The researchers assessed dietary compliance via an interview, a 4-day food record, and a blood antibody screening. Quality of life was measured via the Psychological General Well-Being and SF-36 questionnaires, while gastrointestinal symptoms were evaluated using the Gastrointestinal Symptom Rating Scale, and bone mineral density was measured using dual-energy x-ray absorptiometry. The researchers compared the results of these evaluations with those of 44 symptom-detected and treated celiac disease patients, 110 non-celiac disease subjects, and the general population. The researchers found that 96% of screen-detected and 93% of symptom-detected celiac disease patients adhered to a strict or fairly strict gluten-free diet. In the screen-detected group quality of life and gastrointestinal symptoms were similar to that of the symptom-detected patients and non-celiac disease controls, and their bone mineral densities were similar to that of the general population. The researchers conclude that dietary compliance in long-term screen-detected patients was good, and quality of life and bone mineral densities were comparable to that of the non-celiac disease subjects and the general population. Based on these results active screening for celiac disease in risk groups is beneficial and in no way harmful.
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