Evaluation of different Starch Binders on physical quality of fish feed pellets / Avaliação de diferentes aglutinantes de amido na qualidade física de rações para peixes

Binders are the products that are used to bind, glue or hold the various feed ingredients together in order to maintain pellet integrity. For aqua-culturists, feed manufacturing is an expensive exercise due to the high cost of ingredients along with traditional artificial binders. The use of grain starches as aqua feed binders have advantages which include availability of that binder, nutritional contribution, and minimization of feed cost. A research trial was conducted to test physical properties such as palatability, water stability, dustiness, friability, settling velocity and floatation time of locally available starch i.e. wheat gluten, pea starch and guar gum and to assist their incorporation in on-farm aqua feed. Results revealed that among these three starch, the starch from pea source was proved superior over other two (wheat gluten and guar gum) as all physical quality parameters (dustiness, water stability and friability) revealed better performance of pea starch except pelletability in which guar gum performed best. Although not a single diet proved best in case of flotation time (Tf) and settling velocity (Vset) at varying lengths (6mm, 9mm and 12 mm). This finding indicates the significance of suitable binders for optimal water pollution and sustainable aquaculture. The use of these binders i.e. wheat gluten, pea starch and guar gum in fish feed pellets may also reduce dependence on synthetic binders and minimizes cost.

Aglutinantes são produtos usados para unir, colar ou manter juntos os vários ingredientes da ração, a fim de conservar a integridade do pellet. Para os aquicultores, a fabricação de ração é uma atividade difícil e cara por causa do alto preço dos aglutinantes artificiais tradicionais. O uso de amidos de grãos como aglutinantes de rações aquáticas tem vantagens que incluem acessibilidade, disponibilidade, contribuição nutricional e minimização do custo da ração. Um ensaio de pesquisa foi conduzido para testar propriedades físicas, como palatabilidade, estabilidade em água, pulverulência, friabilidade, velocidade de sedimentação e tempo de flutuação de amido disponível localmente, ou seja, glúten de trigo, amido de ervilha e goma de guar, e para auxiliar sua incorporação em rações aquáticas. Os resultados revelaram que, entre esses três amidos, o amido de ervilha se mostrou superior aos outros dois (glúten de trigo e goma de guar), pois todos os parâmetros de qualidade física (pulverulência, estabilidade da água e friabilidade) obtiveram melhor desempenho, exceto peletabilidade, em que a goma de guar se destacou. Nenhuma dieta se mostrou melhor no caso de tempo de flotação (Tf) e velocidade de sedimentação em comprimentos variados (6 mm, 9 mm e 12 mm). Essa descoberta indica a importância de aglutinantes adequados para a poluição ótima da água e a aquicultura sustentável. O uso desses aglutinantes, ou seja, glúten de trigo, amido de ervilha e goma de guar, em pellets de ração para peixes também pode reduzir a dependência de aglutinantes sintéticos e minimizar o custo.

Evaluation of different Starch Binders on physical quality of fish feed pellets

Abstract Binders are the products that are used to bind, glue or hold the various feed ingredients together in order to maintain pellet integrity. For aqua-culturists, feed manufacturing is an expensive exercise due to the high cost of ingredients along with traditional artificial binders. The use of grain starches as aqua feed binders have advantages which include availability of that binder, nutritional contribution, and minimization of feed cost. A research trial was conducted to test physical properties such as palatability, water stability, dustiness, friability, settling velocity and floatation time of locally available starch i.e. wheat gluten, pea starch and guar gum and to assist their incorporation in on-farm aqua feed. Results revealed that among these three starch, the starch from pea source was proved superior over other two (wheat gluten and guar gum) as all physical quality parameters (dustiness, water stability and friability) revealed better performance of pea starch except pelletability in which guar gum performed best. Although not a single diet proved best in case of flotation time (Tf) and settling velocity (Vset) at varying lengths (6mm, 9mm and 12 mm). This finding indicates the significance of suitable binders for optimal water pollution and sustainable aquaculture. The use of these binders i.e. wheat gluten, pea starch and guar gum in fish feed pellets may also reduce dependence on synthetic binders and minimizes cost.

Resumo Aglutinantes são produtos usados para unir, colar ou manter juntos os vários ingredientes da ração, a fim de conservar a integridade do pellet. Para os aquicultores, a fabricação de ração é uma atividade difícil e cara por causa do alto preço dos aglutinantes artificiais tradicionais. O uso de amidos de grãos como aglutinantes de rações aquáticas tem vantagens que incluem acessibilidade, disponibilidade, contribuição nutricional e minimização do custo da ração. Um ensaio de pesquisa foi conduzido para testar propriedades físicas, como palatabilidade, estabilidade em água, pulverulência, friabilidade, velocidade de sedimentação e tempo de flutuação de amido disponível localmente, ou seja, glúten de trigo, amido de ervilha e goma de guar, e para auxiliar sua incorporação em rações aquáticas. Os resultados revelaram que, entre esses três amidos, o amido de ervilha se mostrou superior aos outros dois (glúten de trigo e goma de guar), pois todos os parâmetros de qualidade física (pulverulência, estabilidade da água e friabilidade) obtiveram melhor desempenho, exceto peletabilidade, em que a goma de guar se destacou. Nenhuma dieta se mostrou melhor no caso de tempo de flotação (Tf) e velocidade de sedimentação em comprimentos variados (6 mm, 9 mm e 12 mm). Essa descoberta indica a importância de aglutinantes adequados para a poluição ótima da água e a aquicultura sustentável. O uso desses aglutinantes, ou seja, glúten de trigo, amido de ervilha e goma de guar, em pellets de ração para peixes também pode reduzir a dependência de aglutinantes sintéticos e minimizar o custo.

Piel y tubo digestivo: dermatitis herpetiforme y enfermedad celíaca / Small bowel and skin: celiac disease and dermatitis herpetiformis

La dermatitis herpetiforme, también denominada Enfermedad de Dühring-Brocq, es una dermatosis autoinmune crónica que evoluciona por brotes, caracterizada por la presencia de ampollas pequeñas que tienden a agruparse, en codos, rodillas y glúteos, con disposición simétrica, intensamente pruriginosas. Es considerada una manifestación cutánea de la enfermedad celíaca. Afecta a adultos jóvenes (20 a 50 años). El estudio histopatológico evidencia ampollas subepidérmicas. La inmunofluorescencia directa es característica: depósitos granulares de IgA en las puntas de las papilas dérmicas. Aún ante falta de sintomatología digestiva debe investigarse enfermedad celíaca en todos los pacientes. La dieta libre de gluten es la clave del tratamiento. En aquellos pacientes con intenso prurito o con una dermatosis muy extensa se puede utilizar dapsona vía oral, que alivia rápidamente las manifestaciones cutáneas, pero no modifica el curso de la enfermedad digestiva. Se presenta un paciente en quien a partir de las lesiones cutáneas se realizó diagnóstico de dermatitis herpetiforme primero y de enfermedad celíaca luego

Dermatitis herpetiformis, also known as Dühring-Brocq disease, is a chronic autoimmune dermatosis that evolves in outbreaks. It is characterized by the presence of small blisters that tend to cluster on the elbows, knees, and buttocks, with a symmetrical distribution and intense itching. It is considered a cutaneous manifestation of celiac disease. It affects young adults (20 to 50 years old). Histopathological examination reveals subepidermal blisters. Direct immunofluorescence is characteristic, showing granular deposits of IgA at the tips of the dermal papillae. Even in the absence of digestive symptoms, celiac disease should be investigated in all patients. A gluten-free diet is the key to treatment. In patients with intense itching or extensive dermatosis, oral dapsone can be used to quickly relieve cutaneous manifestations, but it does not alter the course of the digestive disease. We present a patient in whom the diagnosis of dermatitis herpetiformis was made initially, followed by a diagnosis of celiac disease based on the skin lesions

Hábitos alimentares e estado nutricional de pacientes com doença celíaca do sul do Brasil / Eating habits and nutritional status of patients with celiac disease in south brazil

ABSTRACT Background: Celiac disease is defined as a chronic autoimmune disease that affects the small intestine in genetically predisposed people, triggered by exposure to gluten. The only treatment for celiac disease to date is a lifelong gluten-free diet. Eating habits of celiacs play an important role in their nutritional status. Objective: To evaluate the eating habits and nutritional status of patients with celiac disease in Rio Grande do Sul. Methods: This is a cross-sectional study with patients diagnosed with celiac disease residing in Rio Grande do Sul (Brazil) over 18 years of age. An online questionnaire was applied with calls through social networks and also by the Associação dos Celíacos do Brasil - Rio Grande do Sul Section. Sociodemographic data, history of celiac disease, general medical history, reported weight and height and food consumption data (SISVAN food frequency questionnaire and general questions) were collected. Results: The sample consisted of 142 individuals with a mean age of 39.75±11.5 years, 94.4% were women and 93% were white. The patients showed care regarding a gluten-free diet, with the majority not ingesting gluten (82.2%) and being careful regarding cross-contamination by gluten in their homes (85.9%) and in restaurants (62, 4%). Most patients also had good eating habits, with frequent consumption of fruits, vegetables, meats, eggs and low frequency of processed foods and fats. Body weight before and after the diagnosis of celiac disease did not show significant changes (62.3±13.8 versus 63.6±11.7 kg; P=0.147); however, there was an improvement in the classification of nutritional status by body mass index (malnourished: 11.6% before versus 2.3% after; P=0.016). Conclusion: Most celiac disease patients in this study have good eating habits with a balanced gluten-free diet and improved nutritional status after diagnosis according to body mass index classification.

RESUMO Contexto: A doença celíaca é definida como uma doença crônica autoimune que afeta o intestino delgado em pessoas geneticamente predispostas, desencadeada pela exposição ao glúten. O único tratamento para doença celíaca até o momento é uma dieta isenta de glúten por toda a vida, levando em consideração que os hábitos alimentares de celíacos desempenham um papel importante em seu estado nutricional. Objetivo: Avaliar os hábitos alimentares e o estado nutricional de pacientes com doença celíaca do Rio Grande do Sul. Métodos: Trata-se de um estudo transversal com 142 pacientes com diagnóstico de doença celíaca residentes no Rio Grande do Sul (Brasil) e maiores de 18 anos. Para realização deste estudo, foi aplicado um questionário on-line com divulgação através de redes sociais e também pela Associação dos Celíacos do Brasil - Seção Rio Grande do Sul. Foram coletados dados sociodemográficos, histórico da doença celíaca, história clínica geral, peso e altura referidos e dados de consumo alimentar através de questionário de frequência alimentar do SISVAN e questões gerais. Resultados: A amostra foi constituída por 142 indivíduos com idade média de 39,75±11,5 anos, sendo 94,4% mulheres e 93% de etnia branca. Os participantes apresentaram cuidados em relação a dieta isenta de glúten, sendo que a maioria não ingere glúten (82,2%) e possuem cuidados em relação a contaminação cruzada por glúten em suas casas (85,9%) e em restaurantes (62,4%). A maioria da amostra também apresentou bons hábitos alimentares, com o consumo frequente de frutas, legumes, verduras, carnes, ovos e pouco frequente de industrializados e gorduras. O peso corporal antes e após o diagnóstico de doença celíaca não apresentou mudanças significativas (62,3±13,8 versus 63,6±11,7 kg; P=0,147); entretanto, houve melhora na classificação do estado nutricional pelo índice de massa corporal (11,6% versus 2,3% de desnutridos; P=0,016). Conclusão: A maioria dos pacientes com doença celíaca deste estudo apresentam bons hábitos alimentares com uma dieta isenta de glúten balanceada e com melhora do estado nutricional após o diagnóstico de acordo com a classificação do índice de massa corporal.

Clinical spectrum & changing presentation of celiac disease in Indian children

Background & objectives: Celiac disease (CD) is a genetic immune mediated disorder characterised by gluten intolerance. This single centre study, from north India was aimed to assess the clinical, serological and histological profile of CD in a large cohort of children and the changing trends in its presentation. Methods: A review of clinical details of CD children diagnosed between 2000 and 2019 and currently on follow up was performed. Information on demography, symptoms, associated conditions, serology, biopsy findings and gluten-free diet were analyzed. Results: The mean age (±standard deviation) of 891 children included in the study, at onset and at diagnosis was 4.0±2.7 and 6.2±3.1 yr, respectively. Growth faltering, abdominal pain, abdominal distension and diarrhoea were presenting symptoms in 70, 64.2, 61.2 and 58.2 per cent, respectively. A positive family history of CD was present in 14 per cent and autoimmune conditions in 12.3 per cent of children. Thyroid disorders were seen in 8.5 per cent of children and Type 1 diabetes mellitus (T1DM) in 5.7 per cent. The duration of breastfeeding had a weak positive correlation with age at onset and diagnosis of CD (P<0.001). Non-classical CD was significantly more common in children aged >10 yr and in those presenting after 2010 (P<0.01). T1DM and hypothyroidism occurred more frequently in non-compliant children. Interpretation & conclusions: This was the largest single centre study, pertaining to the presentation and follow up of CD in children. Infants and young children were more likely to present with classical symptoms of diarrhoea, abdominal distension and growth failure while older children presented with non-classical CD. There was a trend towards non-classical forms of CD in recent years.

Impasses do diagnóstico precoce da doença celíaca e suas repercussões clínicas e sociais / Impasses in the early diagnosis of celiac disease and its clinical and social repercussions / Impasos del diagnóstico temprano de la enfermedad celámica y su impacto clínico y social

A turva Doença Celíaca (DC) demonstra sua opacidade através dos aspectos clínicos de difícil detecção precoce. Essa delonga em identificar o enfermo e orientá-lo acerca dos hábitos de vida indispensáveis à saúde do portador de DC, acarreta desdobramentos prognósticos negativos, visto que o consumo crônico dos agentes irritantes gera lesões inflamatórias insistentes que, paulatinamente agridem o tecido gastrintestinal em diferentes níveis. Para além das lesões epiteliomucosas, as dores enfrentadas por esses pacientes permeiam a exclusão e a fobia social, as patologias psiquiátricas e as síndromes de humor deprimido. Além da demora diagnóstica que compromete de curto a extenso prazo os doentes, nota-se evidente falha nos dados epidemiológicos, que parecem se relacionar com o subdiagnóstico. Assim, reunimos estudos de epidemiologia de diferentes regiões e, em progressão de tempo, que demonstram aumento nos índices diagnósticos, além de teorias fisiopatológicas que parecem contribuir para o aumento de diagnósticos precoces. Para isso, extensas revisões literárias em livros referência dentre a prática médica e pesquisas complementares, tanto em artigos de aprofundamento e atualização literária, quanto diretrizes nacionais de manejo, constroem o presente estudo. Enfim, demonstra-se as importantes lacunas de conhecimento acerca dessa patologia cada vez mais prevalente.

The blurred celiac disease demonstrates its opacity through clinical aspects that are difficult to detect early. This delay in identifying the patient and guiding him about the life habits essential to the health of the CD patient, leads to negative prognostic consequences, since the chronic consumption of irritating agents generates persistent inflammatory lesions that, gradually attack the gastrointestinal tissue at different levels . In addition to epitheliomucosal lesions, the pain faced by these patients permeates exclusion and social phobia, psychiatric pathologies and depressed mood syndromes. In addition to the diagnostic delay that compromises patients in the short to long term, there is an evident failure in the epidemiological data, which seems to be related to underdiagnosis. Thus, we gathered epidemiology studies from different regions and, over time, that demonstrate an increase in diagnostic rates, in addition to pathophysiological theories that seem to contribute to the increase in early diagnoses. For this, extensive literary reviews in reference books within medical practice and complementary research, both in deepening articles and literary updating, as well as national management guidelines, build the present study. Finally, it demonstrates the important gaps in knowledge about this increasingly prevalent pathology.

La Enfermedad Celular Nublada (DC) demuestra su opacidad a través de los aspectos clínicos de difícil detección en una etapa temprana. Este retraso en la identificación del enfermo y en el asesoramiento sobre los hábitos de vida indispensables para la salud del portador de DC, trae consigo un desarrollo pronóstico negativo, ya que el consumo crónico de agentes irritantes genera lesiones inflamatorias insistente que, gradualmente, dañan el tejido gastrointestinal a diferentes niveles. Además de las lesiones epiteliomucosiales, el dolor que enfrentan estos pacientes permea la exclusión social y la fobia, los trastornos psiquiátricos y los síndromes deprimidos. Además del retraso en el diagnóstico que pone en peligro a los pacientes en el corto y largo plazo, es evidente que los datos epidemiológicos, que parecen estar relacionados con el subdiagnóstico, han fracasado. Por lo tanto, reunimos estudios epidemiológicos de diferentes regiones y, en una progresión del tiempo, que demuestran un incremento en los índices diagnósticos, además de teorías fisiopatológicas que parecen contribuir a un aumento en los diagnósticos precoces. Para ello, se construyen en este estudio amplias revisiones literarias en libros de referencia entre la práctica médica y las investigaciones complementarias, tanto en artículos de profundización y actualización literaria como en directrices nacionales para su manejo. En resumen, se están demostrando las importantes lagunas de conocimiento sobre esta patología cada vez más prevalente.

Coeliac disease knowledge and treatment: Potential factors associated with adherence to gluten-free diet

@#Introduction: Lack of adherence to a strict gluten-free diet (GFD) is the main reason for poorly controlled disease in patients with coeliac disease (CD). This study aimed to assess the association between knowledge of CD and its medical diet to the adherence of GFD among adult patients with CD. Methods: A cross-sectional study was carried out with a total of 90 adult patients with CD (aged between 18-65 years). The data collecting instruments were a combination of four questionnaires as follows: assessment of knowledge of coeliac disease (AKCD), gluten-free diet knowledge scale (GFD-KS), coeliac disease adherence test (CDAT), and questions on potential factors influencing GFD adherence among patients. Results: An average knowledge score of five points out of seven was obtained from 46 participants (51%). Mean score for knowledge on gluten-free diet was seven points out of 17 in 59 participants (65%). Adequate adherence to GFD was observed in 56% of the participants. No association was found between knowledge of CD and GFD to the adherence of GFD (p>0.050). Participants who had higher adherence scores were discussing GFD with a specialist, obtaining educational materials, had enhanced symptoms associated with CD, and did not complain about the taste of GFD (p<0.050). Conclusion: Patients with CD has adequate knowledge of CD and adherence of GFD. No association was found between the knowledge of CD and GFD to the adherence of GFD. Further research might explore other potential factors influencing the adherence to GFD.

Does a Gluten-free Diet Improve Metabolic Syndrome Parameters? A Systematic Review

Abstract To review scientific evidence on the effects of a gluten-free diet on body composition and improvement of clinical and biochemical parameters of metabolic syndrome. The Preferred Reporting Items for Systematic Reviews and Meta-Analyzes - PRISMA guidelines were followed. A literature search was performed in the PubMed, ScienceDirect, Trip Database, Bireme and Scielo databases, without language restriction, until March 2021. The terms "gluten-free diet", "obesity", "metabolic syndrome", and "weight loss", and Boolean operators (AND/OR) were used. The clinical hypothesis was structured according to the acronym PICOT. Randomized clinical trials with adult and elderly humans without a diagnosis of celiac disease, consuming a gluten-free diet, evaluating associations of the effects of this diet on weight loss and metabolic syndrome components were considered eligible. To assess the risk of bias, the RoB2 was used. A total of 3,198 articles were identified and, after the screening and evaluation of pre-defined eligibility criteria, four studies were included in the qualitative analysis. Weight loss was not associated with a gluten-free diet. However, individuals under a gluten-free diet had lower mean waist circumference, fat percentage (-2.3%) and serum triglyceride levels. The impact of a gluten-free diet on metabolic syndrome parameters is still controversial. In individuals without gluten sensitivity or celiac disease, the consumption of a gluten-free diet appears to provide no nutritional benefit.

Celiac disease and bone

Abstract Celiac disease (CD) is an autoimmune disorder characterized by small intestinal inflammation triggered by gluten ingestion in genetically-predisposed individuals. A frequent extra-intestinal manifestation of CD is metabolic bone disease which contributes to an increased risk of fracture. The mechanisms underlying bone disease in CD remain incompletely understood, but multiple processes have been proposed including (1) malabsorption of calcium and vitamin D leading to secondary hyperparathyroidism and increased skeletal resorption, (2) pro-inflammatory cytokines altering the osteoprotegerin and receptor activator of nuclear kappa-B ligand ratio favoring osteoclastogenesis, (3) hypogonadism, and (4) low weight and malnutrition. Most studies show reduced bone mineral density in patients with CD. Bone microarchitecture is also deteriorated leading to reduced whole bone stiffness. Many, but not all investigations, have shown an increased risk of fracture associated with CD. The main stay of therapy for CD is maintaining a gluten-free diet. Improvement in bone mineral density with adherence to a gluten-free diet has been well-established. Bone mineral density remains lower, however, compared to controls and increased fracture risk can persist. There is no consensus on the timing of dual-energy x-ray absorptiometry for bone mineral density assessment in patients with CD. Routine screening for CD in patients with osteoporosis is not recommended. Little data are available on the use or efficacy of prescription osteoporosis therapeutics in patients with CD. Studies are needed to develop standardized guidelines for screening and treatment of metabolic bone disease in patients with CD to identify those who may need early intervention with prescription osteoporosis therapy. Arch Endocrinol Metab. 2022;66(5):756-64

Evaluación del contenido, dializabilidad y aporte potencial de hierro, zinc y calcio en panificados libres de gluten elaborados a partir de premezclas comerciales / Evaluation of the content, dialyzability and potential contribution of iron, zinc and calcium in gluten-free bakery products made from commercial premixes

Resumen La población que debe consumir una dieta libre de gluten de por vida se encuentra en constante aumento. Es importante que la misma no sea deficiente en nutrientes, entre ellos, los minerales. En el presente trabajo se evaluó el contenido, dializabilidad, aporte potencial y porcentaje de cobertura del requerimiento diario de hierro, zinc y calcio en bizcochuelos, panes, galletitas y pizzas libres de gluten elaborados a partir de premezclas comerciales. Estos contenidos se compararon con un homólogo elaborado con harina de trigo enriquecida con sulfato ferroso. Se empleó un método in vitro con posterior cuantificación por espectroscopía de absorción atómica. Si bien se observó una amplia variación en los contenidos de los tres minerales para los cuatro grupos de alimentos elaborados a partir de premezclas, las dializabilidades porcentuales fueron bajas. Los porcentajes de cobertura de los requerimientos diarios de hierro, zinc y calcio resultaron muy bajos, a excepción del hierro de las pizzas cuyas coberturas por porción fueron considerables. Los resultados obtenidos para hierro en los homólogos reflejan el impacto del enriquecimiento de la harina de trigo con sulfato ferroso. Sería conveniente contemplar la utilización de harinas de pseudocereales para mejorar su calidad mineral, así como evaluar la implementación de políticas públicas para que la población que debe consumir alimentos libres de gluten tenga acceso a alimentos enriquecidos, como ocurre con la harina de trigo.

Abstract The number of people that must consume a gluten-free diet is constantly increasing. It is, however, important that this diet is not deficient in nutrients, in particular some key minerals. The present work focuses on the contents of iron, zinc and calcium in gluten-free sponge cakes, breads, cookies and pizzas made from commercial premixes. Other properties analysed were the dialyzability, the potential contribution and the percentage of coverage of the daily requirement of the mentioned minerals in each of the products. These properties were contrasted and compared with those of equivalent products elaborated with wheat flour enriched with ferrous sulfate. An in vitro methodology of mineral bioavailability was utilised, with subsequent quantification by atomic absorption spectroscopy. Even though a wide variation in the three minerals' content in each of the four products was observed, the percentage of dialysability was low. In terms of meeting the daily requirements, only the iron in the pizzas covered a considerable proportion. In all the other cases only very small parts of the daily requirements were covered. The results obtained for iron in the equivalent products reflect the impact of the enrichment of wheat flour with ferrous sulfate. It would be convenient to contemplate the use of pseudocereal flours to improve their mineral quality. In addition, it would be advisable to evaluate the implementation of public policies so that the population that should consume gluten-free foods has access to enriched foods, as is the case with wheat flour.

Resumo A população que deve consumir uma dieta sem glúten por toda a vida está aumentando constantemente. É importante que ela não seja deficiente em nutrientes, incluindo minerais. No presente trabalho foram avaliados o conteúdo, dialisabilidade, contribuição potencial e porcentagem de cobertura da necessidade diária de ferro, zinco e cálcio em bolos, pães, biscoitos e pizzas sem glúten elaborados com pré-misturas comerciais. Esses conteúdos foram comparados com uma contraparte feita com farinha de trigo enriquecida com sulfato ferroso. Foi utilizado um método in vitro com posterior quantificação por espectroscopia de absorção atômica. Embora se tenha observado uma grande variação no conteúdo dos três minerais para os quatro grupos de alimentos elaborados a partir de pré-misturas, as dialisabilidades porcentuais foram baixas. Os percentuais de cobertura das necessidades diárias de ferro, zinco e cálcio foram muito baixos, com exceção do ferro das pizzas cuja cobertura por porção foi considerável. Os resultados obtidos para o ferro nos homólogos refletem o impacto do enriquecimento da farinha de trigo com sulfato ferroso. Seria conveniente contemplar o uso de farinhas de pseudocereais para melhorar sua qualidade mineral, bem como avaliar a implementação de políticas públicas para que a população que deve consumir alimentos sem glúten tenha acesso a alimentos enriquecidos, como acontece com a farinha de trigo.

High protein, gluten-free cookies made with rice, beans and avocado

Cookies are versatile foods that can supply specific needs and can be used as food vehicles to increase the intake of various nutrients. The objective was to create a gluten-free butter cookie based on rice flour (Oryza sativa). A central composite design 22 was used for analyzing the substitution of rice flour for bean flour (Phaseolus vulgaris, L.) (0-60%) and the substitution of butter for avocado puree (Persea americana) (0-100%). Response Surface Methodology were used to analyze the data with a significance of 10% (p<0.1) and a minimum R2 of 0.6. Variables analyzed were protein content (%), fat content (%), spread ratio, weight loss (%), water activity, moisture content (%), and ash content (%). Increases in the percentage of substitution of bean flour and avocado puree increased the amount of protein, ash, and moisture significantly. Fat content increased significantly following the decrease in avocado substitution. The minimum weight loss was obtained on intermediate values of bean flour. Water activity and spread ratio were not affected by changes in the variables measured. Three different formulas were obtained for the optimization: 46% bean flour and 86% of avocado puree, a formulation with an appropriate moisture range by reducing the lipid oxidation (59% bean flour and 82% avocado puree), and a formulation with 100% avocado (40% bean flour and 100% avocado puree). Sensory evaluation results of optimized treatments indicated that the formula with 46% bean flour and 86% avocado puree presented the highest global acceptance. Results from this study showcase the possibility of producing gluten-free cookies with good protein content.

Las galletas son alimentos versátiles que pueden suplir necesidades específicas y ser utilizados como vehículos para aumentar la ingesta de distintos nutrientes. El objetivo fue elaborar galletas de mantequilla libres de gluten a base de harina de arroz. Se realizó un diseño central compuesto 22 donde se estudió la sustitución parcial de harina de arroz por harina de frijol (Phaseolus vulgaris, L.) (0-60%) y la sustitución de la mantequilla por puré de aguacate (Persea americana) (0-100%). Los resultados fueron analizados por la Metodología de Superficie de Respuesta con un nivel de significancia del 10% (p<0.1) y con un mínimo R2 de 0.6. Las variables de respuesta fueron: proteína (%), grasa (%), diámetro/altura, pérdida de peso (%), humedad (%) y cenizas (%). A valores altos de las dos variables estudiadas la cantidad de proteína, de cenizas y de humedad aumentó significativamente. La cantidad de grasa se incrementó al utilizar bajos niveles de puré de aguacate. Los menores valores de pérdida de peso se obtuvieron en niveles intermedios de harina de frijol. La relación diámetro/altura no fue afectada por las variables estudiadas. Al optimizar se obtuvieron 3 formulaciones diferentes: 46% de harina de frijol y 86% puré de aguacate; 59% de frijol y 82% de puré de aguacate y otra (no estadística) 40% de frijol y 100% de puré de aguacate. Los resultados del análisis sensorial de las muestras optimizadas indicaron que la formulación con mayor aceptación global fue la elaborada con 46% de harina de frijol y 86% de puré de aguacate, concluyendo que es posible elaborar una galleta libre de gluten y con una adecuada cantidad de proteína.

Enfermedad celíaca: un reto diagnóstico en Colombia / Celiac disease: a diagnostic challenge in Colombia

Introducción: la enfermedad celíaca (EC) es una patología sistémica inmunomediada por el gluten en la dieta en personas genéticamente susceptibles con un amplio rango de manifestaciones clínicas, respuesta serológica específica y un daño variable de la mucosa intestinal. Objetivo: revisar la fisiopatología, manifestaciones clínicas, diagnóstico, tratamiento, seguimiento y pronóstico de la EC, resaltando la importancia de reconocerla y proponer un algoritmo diagnóstico para la población colombiana. Materiales y métodos: revisión crítica de la literatura científica en las bases de datos Medline y buscadores específicos PUBMED, SCIENCE DIRECT, SCIELO, filtrando resultados a revisiones sistemáticas, metaanálisis, ensayos controlados aleatorios y guías de práctica clínica, con un total de 1209 artículos, de los cuales se priorizaron 53. Resultados y discusión: la prevalencia de la EC viene en aumento en países en vía de desarrollo. El diagnóstico tiene tres pilares fundamentales: la identificación de casos de alto riesgo o sospecha por manifestaciones clínicas, un perfil serológico de anticuerpos específicos y hallazgos histológicos característicos. El tratamiento se basa en una dieta sin gluten, en la detección temprana de complicaciones y el manejo de las alteraciones nutricionales. Conclusión: en Colombia no existen protocolos de diagnóstico y tratamiento de la EC, como tampoco una legislación clara con respecto al etiquetado de productos libres de gluten. Hay que establecer estrategias para impactar el curso natural de la enfermedad, las morbilidades asociadas y la calidad de vida de los pacientes.

Introduction: celiac disease (CD) is a systemic diet-gluten-immune-mediated enteropathy occurring in genetically susceptible individuals featuring a broad range of clinical manifestations, a specific serological response and variable intestinal mucosal damage. Objective: to review CD pathophysiology, clinical manifestations, diagnosis, treatment, follow-up and prognosis, highlighting the importance of awareness about this disorder and development of a diagnostic algorithm for Colombian population. Materials and methods: scientific literature critical review in the Medline databases and PUBMED, SCIENCE DIRECT, SCIELO specific search engines, using filters to retrieve systematic reviews, metanalyses, randomized controlled trials and clinical practice guidelines, finding 1209 articles, prioritizing 53. Results and discussion: the prevalence of CD is increasing in developing countries. Diagnosis is based on 3 fundamental pillars: identification of higher-risk populations or suspicion based on clinical manifestations, serological profile of specific antibodies and characteristic histological findings. Treatment is based on a gluten-free diet, early detection of complications and nutritional alterations management. Conclusion: there are no CD diagnosis and treatment protocols, nor clear regulations on labelling gluten-free products, in Colombia. Establishing strategies to impact the natural course of CD, associated morbidities and quality of life, is required

Dermatitis herpetiforme: manifestación específica de la enfermedad celiaca / Dermatitis herpetiformis: specific manifestation of celiac disease

Resumen La enfermedad celíaca es un trastorno sistémico con base autoinmune, secundario a la exposición continua al gluten en personas con susceptibilidad genética, que lleva a desarrollo de anticuerpos específicos, afectando principalmente el intestino delgado con la subsecuente enteropatía. Las manifestaciones clínicas incluyen síntomas digestivos y manifestaciones extra intestinales. En este último grupo se destacan las manifestaciones dermatológicas, específicamente la dermatitis herpetiforme, la cual es considerada específica de la enfermedad celíaca. Clínicamente, se presenta como un exantema papulovesicular pruriginoso. El diagnóstico se basa en la biopsia de piel con inmunofluorescencia directa y la presencia de anticuerpos anti-transglutaminasa tisular 2 y solo en casos específicos se debe complementar con otros estudios. El tratamiento se basa en dieta libre de gluten, que mejora la sintomatología, controla y previene las complicaciones de la enfermedad celíaca, como las neoplasias digestivas y el desarrollo de otras enfermedades autoinmunes.

Abstract Celiac disease is a systemic disorder with an autoimmune basis, secondary to continuous exposure to gluten in people with genetic susceptibility, which leads to the development of specific antibodies mainly affecting the small intestine with subsequent enteropathy. The clinical manifestations include digestive symptoms and extra intestinal manifestations. In this last group, the dermatological manifestations stand out, specifically dermatitis herpetiformis, which is considered specific to Celiac disease. It presents clinically as a pruritic papulovesicular rash. The diagnosis is based on a skin biopsy with direct immunofluorescence and the presence of anti-tissue transglutaminase 2 antibodies, only in specific cases it should be complemented with other studies. Treatment is based on a gluten-free diet, which improves symptoms, controls and prevents complications of Celiac disease, such as digestive neoplasms and the development of other autoimmune diseases.

Adherencia a la dieta sin gluten y calidad de vida en relación con la salud en los celiacos del Paraguay, 2021 / Adherence to a Gluten-Free Diet and Health-Related Quality of Life in Celiac Patients from Paraguay, 2021

Resumen Antecedentes: la calidad de vida en relación con la salud de las personas con enfermedad celiaca puede estar influenciada por la adherencia a la dieta sin gluten. Objetivos: describir las características demográficas y clínicas de los celiacos, evaluar la adherencia dietética con el cuestionario CDAT de Leffler y medir la calidad de vida autopercibida utilizando el cuestionario CD-QOL. Métodos y materiales: diseño observacional, transversal y prospectivo. Se aplicó una encuesta telemática a adolescentes y adultos de Paraguay diagnosticados con enfermedad celiaca, entre febrero y abril del año 2021, que accedieron a participar del estudio. La adherencia dietética se determinó con el cuestionario Celiac Dietary Adherence Test de Leffler y la calidad de vida con el CD-QOL de Dorn. Se midieron además variables demográficas y clínicas. La investigación fue aprobada por el Comité de Ética de la Universidad Privada del Este, en Paraguay. Resultados: la muestra estuvo constituida por 344 sujetos de estudio, de los cuales el 87 % pertenecía al sexo femenino. La edad media de los adolescentes fue de 15,1 años, y la de los adultos de 38±13 años. La adherencia a la dieta sin gluten se encontró en el 78 % (n=268) de los encuestados; fue buena en el 59 %, moderada en el 19 % y mala en el 22 % de los encuestados. La calidad de vida fue buena en el 30 % (n=103) de los sujetos y mala en el 70 % (n=241). Se encontró asociación entre los sujetos sin o mala adherencia a la dieta con la mala calidad de vida (p<0,006). Conclusión: en los celiacos estudiados, la mala adherencia a la dieta sin gluten se asocia con menor calidad de vida en relación con la salud.

Abstract Background: The health-related quality of life of people with celiac disease may be influenced by adherence to a gluten-free diet. Objectives: To describe the demographic and clinical characteristics of celiac patients, to evaluate dietary adherence with the Leffler CDAT questionnaire, and to measure self-perceived quality of life using the CD-QOL questionnaire. Material and Methods: Observational, cross-sectional, and prospective design. A telematic survey was applied to adolescents and adults in Paraguay, diagnosed with celiac disease, between February and April 2021, who agreed to participate in the study. Dietary adherence was determined with the Celiac Dietary Adherence Test of Leffler and quality of life with the test CD-QOL of Dorn. Demographic and clinical variables were also measured. The research was approved by the Ethics Committee of the Universidad Privada del Este, in Paraguay. Results: The sample consisted of 344 study subjects of which 87% belonged to the female sex. The mean age of the adolescents was 15 ±1 years, and that of the adults was 38 ±13 years. Adherence to a gluten-free diet was found in 78% (n=268) of those surveyed, it was good in 59%, moderate in 19%, and bad in 22%. The quality of life was good in 30% (n=103) of the subjects and bad in 70% (n 241). It was found an association between subjects with no or bad adherence to the diet with bad quality of life (p<0.006). Conclusion: In the celiac patients studied, poor adherence to the gluten-free diet is associated with worse health-related quality of life.

Sorghum, germinated millet and chia cookies: development, chemical composition and sensory analysis

The objective of this work was to develop cookies using sorghum, germinated millet and chia flours. Four formulations (F) were used: F-sorghum (100% sorghum flour); F-Sorghum + chia (50% sorghum flour and 50% chia flour), F-millet (100% millet flour) and F-millet + chia (50% millet flour and 50% chia flour). The germinated millet flour was submitted to microbiological analysis. All cookies were evaluated in relation to chemical and sensory analyses, according to AOAC and hedonic nine-point scale, respectively. The statistical analysis was performed by the variance analysis and Tukey test at 5% probability. The F-millet formulation showed the least humidity content (4.59 ± 0.25g/100g), while chia containing cookies showed lesser concentrations of carbohydrates (F-sorghum + chia: 44.35 ± 4.34g/100g and F-millet + chia: 41.03 ± 1.40g/100g) and higher ash content (F-sorghum + chia: 3.80 ± 0.02g/100g and F-millet + chia: 3.42 ± 0.24g/100g) and of protein (F-sorghum + chia: 15.38 ± 0.44 g/100g and F-millet + chia: 18.06 ± 0.53 g/100g). The caloric value and the lipids content did not differ among formulations. The sensory analysis had 57 evaluators. The cookies produced with chia and germinated millet had higher rates for flavor, texture and general impression. In general, all tested biscuits had good sensory acceptance and nutritional quality being an alternative to increase the consumption of bioactive compounds and antioxidants(AU)

El objetivo fue desarrollar galletas utilizando harina de sorgo, mijo germinado y chía. Se utilizaron cuatro formulaciones (F): F-sorgo (100% harina de sorgo); Sorgo F + chía (50% harina de sorgo y 50% harina de chía), mijo F (100% harina de mijo) y mijo F + chía (50% harina de mijo y 50% harina de chía). La harina de mijo germinada se sometió a análisis microbiológico. Las galletas fueron sometidas a análisis químico y sensorial, según la AOAC y una escala hedónica de nueve puntos, respectivamente. El análisis estadístico se realizó mediante análisis de varianza y prueba de Tukey al 5% de probabilidad. La formulación F-mijo tuvo menor contenido de humedad (4,59 ± 0,25 g/100g), mientras que las galletas que contenían chía tuvieron concentraciones más bajas de carbohidratos (F-sorgo + chía: 44,35 ± 4,34 g/100g y F-mijo + chía: 41,03 ± 1,40 g / 100g), mayor contenido de cenizas (F-sorgo + chía: 3,80 ± 0,02 g/100g y F-mijo + chía: 3,42 ± 0,24 g/100g) y proteínas (F-sorgo + chía: 15,38 ± 0,44 g/100g y F mijo + chía: 18,06 ± 0,53 g/100g). El valor calórico y el contenido de lípidos no difirieron entre las formulaciones. El análisis sensorial contó con 57 evaluadores. Las galletas producidas con chía y mijo germinado tenían notas más altas de sabor, textura e impresión general. Las galletas testadas tuvieron buena aceptación sensorial y calidad nutricional, siendo una alternativa para incrementar el consumo de compuestos bioactivos y antioxidantes(AU)

Características clínicas, demográficas y acceso a los productos sin gluten de pacientes con enfermedad celíaca registrados en la FUPACEL / Clinical and demographic characteristics, and access to gluten free products of patients with celiac disease registered in the FUPACEL

La enfermedad celíaca (EC) es una enfermedad inflamatoria autoinmune que afecta la mucosa del intestino delgado que lleva a un estado de mal absorción en pacientes genéticamente susceptibles desencadenada por la ingesta de gluten. Tiene síntomas inespecíficos, complicaciones asociadas y no existe a nivel nacional una ley de apoyo económico para las personas con dificultad para seguir una dieta libre de gluten. El objetivo de este estudio observacional, descriptivo, de corte transversal fue describir las características clínicas, demográficas y acceso a productos sin gluten de 237 pacientes con enfermedad celíaca registrados en la Fundación Paraguaya de Celiacos (FUPACEL) en el 2020 y que aceptaron responder una encuesta en línea publicada en la página oficial de la FUPACEL. El 70,4% de los participantes era del sexo femenino, la edad de diagnóstico fue en el 34,5% entre 20-30 años, 48 % tenía algún familiar con EC, el 69,1% presentó distensión abdominal como sintomatología inicial, 16,8% presentó hipotiroidismo como patología asociada, y 42% fue hospitalizado al menos una vez. El 82,7% de los encuestados respondió que la dieta era suficiente como tratamiento, 48% tenía un trabajo y podía solventar los gastos, sin embargo, el 79,3% opinó tener acceso limitado a los productos sin gluten, el 92% que los alimentos sin gluten eran costosos y que se necesitaba una ley de apoyo económico para solventar los gastos. La mayoría reconoció que la dieta sin gluten como tratamiento era suficiente, sin embargo, por su alto costo se necesita una ley de apoyo económico para las personas con enfermedad celiaca

Celiac disease (CD) is an autoimmune inflammatory disease that affects the mucosa of the small intestine that leads to a state of malabsorption in genetically susceptible patients triggered by the ingestion of gluten. It has nonspecific symptoms, associated complications, and there is no national financial support law for people with difficulty following a gluten-free diet. The objective of this observational, descriptive, cross-sectional study was to describe the clinical, demographic characteristics and access to gluten-free products of 237 patients with celiac disease registered in the FUPACEL in 2020 who accepted to answer a online survey published in the official FUPACEL webpage. Seventy-point four percent of the patients were female, their age of diagnosis was between 20-30 years in 34.5%, 48% had relatives with CD, 69.1% presented abdominal distension as initial symptoms, hypothyroidism was present in 16.8% as associated pathology, and 42% were hospitalized at least once. Eighty-two-point seven percent of those surveyed answered that diet was sufficient as a treatment, 48% had a job and could afford expenses, however, 79.3% said they had limited access to gluten-free products, 92% that gluten-free foods were expensive and a financial support law was needed to cover the costs. Most recognized that a gluten-free diet as a treatment was sufficient, however, due to its high cost, a law of financial support is needed for people with celiac disease

Características clínicas y demográficas de la Enfermedad Celíaca en Panamá / Clinical and demographic characteristics of Celiac Disease in Panama

Introducción: La enfermedad celíaca es un proceso sistémico de carácter inmunológico, desencadenado por el consumo de gluten, que se da en sujetos genéticamente predispuestos. Es una condición prevalente a nivel mundial con síntomas comunes con otras patologías gastrointestinales y no gastrointestinales. En Panamá es una entidad conocida pero poco estudiada. Materiales y Método: El diseño del estudio fue observacional, descriptivo y de carácter retrospectivo en población pediátrica y adulta de la República de Panamá en unidades de gastroenterología públicas y privadas que proporcionaron sus archivos clínicos recolectados en un documento elaborado para uniformidad de las variables. Resultados: Se analizó la información de 171 expedientes. Se dividió la información en pacientes pediátricos y pacientes adultos encontrando 68 casos menores de 15 años y 103 casos mayores de 15 años. La proporción de casos masculinos y femenino fue de 1:1. De la totalidad de casos estudiados, la mayoría eran de la ciudad de Panamá en un 77% y de los extranjeros diagnosticados la población israelí fue la más frecuentemente encontrada en un 76%. Los síntomas gastrointestinales más frecuentemente encontrados fueron la distensión abdominal, diarrea crónica y pérdida de peso respectivamente. La dermatitis herpetiforme, patología tiroidea y las aftas orales fueron las condiciones no gastroenterológicas más frecuentemente encontradas. La Diabetes mellitus tipo I fue la patología encontrada que coexistió con enfermedad celíaca. Conclusión: Con este estudio de carácter epidemiológico, se ha demostrado que la enfermedad celíaca es prevalente en nuestro medio sin poder mostrar un porcentaje específico.

Introduction: celiac disease is a systemic process of an immunological nature, triggered by the consumption of gluten, which occurs in genetically predisposed subjects. It is a prevalent condition worldwide with symptoms common with other gastrointestinal and non-gastrointestinal pathologies. In Panama it is a known but little studied entity. Method and materials:The study design was observational, descriptive, and retrospective in pediatric and adult population of the Republic of Panama in public and private gastroenterology units that provided their clinical files collected in a document prepared for uniformity of the variables. Results: Information from 171 files that met the inclusion criteria was analyzed. The information was divided into pediatric patients and adult patients, finding 68 cases under 15 years of age and 103 cases over 15 years of age. The ratio of male and female cases was 1: 1. Of the totality of cases studied, the majority were from Panama City in 77% and of the foreigners diagnosed, the Israeli population was the most frequently found in 76%. The most frequently encountered gastrointestinal symptoms were abdominal distension, chronic diarrhea, and weight loss, respectively. Dermatitis herpetiformis, thyroid disease, and oral thrush were the non-gastroenterological conditions most frequently encountered. Type I Diabetes mellitus was the pathology found that coexisted with celiac disease. Conclusion: With this epidemiological study, it has been shown that celiac disease is prevalent in our environment without being able to show a specific percentage.

Factores que limitan la adherencia a la dieta y la calidad de vida en enfermos celiacos chilenos durante COVID-19 / Factors that limit adherence to diet and quality of life in Chilean celiac patients during COVID-19

La enfermedad por coronavirus (COVID-19) es altamente contagiosa y las medidas de confinamiento dinámico han demostrado que reducen significativamente el número de contagios, sin embargo, pueden alterar la disponibilidad de alimentos afectando la adherencia a la dieta libre de gluten (DLG) y la calidad de vida (CV) en la enfermedad celiaca (EC). El objetivo de este estudio fue evaluar los factores que limitan, la adherencia a la dieta libre de gluten y la calidad de vida en personas con enfermedad celiaca en periodo de pandemia por COVID-19. Métodos Se aplicaron encuestas on-line respecto a adherencia a la DLG, CV y acerca de los factores que han generado dificultad para llevar una DLG en este escenario. Resultados Se analizaron 216 encuestas de enfermos celiacos, mayores de 15 años, de los cuales un 91% eran mujeres con un promedio de edad de 36 + 10,7 años y con 5,8 + 6,0 años de enfermedad. El 56,48% tenía una excelente adherencia a la DLG y un 43,52% una buena CV. El costo elevado de los alimentos sin gluten fue la pregunta con mayor porcentaje de respuesta, asociándose con regular y mala adherencia a la DLG (valor p=0,001) y con pobre CV (valor p=0,023). Conclusión En periodo de pandemia por COVID-19, el costo de los alimentos se asocia con adherencia regular y mala a la DLG y con pobre CV(AU)

Coronavirus disease (COVID-19) is highly contagious and dynamic confinement measures have shown to significantly reduce the number of infections, however, they can alter the availability of food, affecting adherence to a gluten-free diet (GFD) and quality of life (QoL) in celiac disease (CD). The objective of this study was to evaluate the limiting factors, adherence to a gluten-free diet and quality of life in people with celiac disease in a COVID-19 pandemic period. Methods. On-line surveys were applied regarding adherence to the GFD, CV, and factors that have generated difficulty in carrying out a GFD in this setting. Results. 216 surveys of celiac patients over 15 years of age were analyzed, of which 91% were women with an average age of 36 + 10.7 years and with 5.8 + 6.0 years of the disease. 56.48% had excellent adherence to the GFD and 43.52% had a good QoL. The high cost of gluten-free foods was the question with the highest response percentage, associated with regular and poor adherence to the GFD (p-value = 0.001) and with poor QoL (p-value = 0.023). Conclusion. In a COVID-19 pandemic period, the cost of food is associated with regular and poor adherence to the GFD and with poor QoL(AU)

Refractory celiac disease type 2: how to diagnose and treat?

SUMMARY Refractory celiac disease is an uncommon condition which might be associated to poor prognosis. It is often treated with immunosuppressive medications, with poor results. It is divided in type 1 and type 2, the latter carrying a high risk for lymphoma and mortality. A case of a 41 year old female patient with refractory celiac disease type 2 is reported. She was treated with oral budesonide for six months, achieving histological remission.