Celiac Disease, A Silent Enemy: A Case Report / Enfermedad celiaca, un enemigo silencioso: a propósito de un caso

Abstract Celiac disease (CD) is an immune-mediated enteropathy with systemic compromise in genetically susceptible individuals, caused by an immune response to ingested gluten. The only therapy for CD is a gluten-free diet (GFD). A case of a 55-year-old woman who reported to the emergency room for early satiety, intolerance to legumes, abdominal distension, and chronic diarrhea, including paresthesias in the upper and lower limbs, was presented. In addition, she described a functional decline due to dyspnea and involuntary weight loss of approximately 20 kilograms in the last 2 years. An esophagogastroduodenoscopy with CD protocol was performed, along with serology for CD, which confirmed the initial diagnostic suspicion. Treatment with a gluten-free diet and nutritional supplementation was indicated, which yielded a significant improvement in the clinical picture.

Resumen La enfermedad celiaca (EC) es una enteropatía inmunomediada con compromiso sistémico en individuos genéticamente susceptibles, causada por una respuesta inmunitaria al gluten ingerido. La única terapia para la EC es una dieta libre de gluten (DLG). Se presenta el caso de una mujer de 55 años que acudió al servicio de urgencias por saciedad precoz, intolerancia a las leguminosas, distensión abdominal y diarrea crónica, además de parestesias en los miembros superiores e inferiores. Adicionalmente, describió una disminución de la clase funcional por disnea y pérdida involuntaria de aproximadamente 20 kilogramos de peso en los últimos 2 años. Se realizó una esofagogastroduodenoscopia con protocolo para EC, junto con serología para la misma, lo cual confirmó la sospecha diagnóstica inicial. Se indicó tratamiento con dieta libre de gluten y suplementación nutricional, que produjo una mejoría significativa del cuadro clínico.

Celiaquía y rendimiento deportivo. Una revisión sistemática / Celiac disease and sports performance. Systematic review

Introducción: La celiaquía es una patología multisistémica con base autoinmune que provoca una reacción a la proteína gluten encontrada en alimentos como o trigo, centeno, triticale, cebada, espelta y avena. Los síntomas más comunes de la celiaquía son la pérdida de peso, pérdida de apetito y fatiga general entre otros. A consecuencia de estos síntomas el rendimiento deportivo puede verse afectado. Objetivo: Para comprender como la celiaquía impacta en el rendimiento de los deportistas, el objetivo de este estudio es realizar una revisión sistemática relacionada con el rendimiento deportivo en personas celíacas. Materiales y métodos: Para ello, se utilizó la siguiente frase final de búsqueda: "Celiac" AND "Sport" AND "Performance", que fue introducida por igual en las bases de datos: Web of Science, Scopus y PubMed. Resultados: Los resultados muestran la existencia de escasos documentos relacionados con el objeto de estudio (n=11), dónde se muestra una variabilidad de tipos de diseño en los trabajos seleccionados. Por otro lado, se extrae que la única solución para mantener un adecuado rendimiento deportivo en una persona celiaca es llevar una dieta libre de gluten de por vida. Conclusiones: Los documentos seleccionados subrayan la importancia de que los deportistas con enfermedad celiaca mantengan una dieta sin gluten de manera constante a lo largo de su vida. Debido a la escasez de estudios relacionados con la temática, se recomienda aumentar el número de investigaciones relacionadas con el objeto de estudio, con la finalidad de mejorar los estilos y hábitos de vida de los deportistas celíacos(AU)

Introduction: Celiac disease is a multisystem autoimmune disorder that triggers a reaction to the protein gluten found in foods such as wheat, rye, triticale, barley, spelt, and oats. The most common symptoms of coeliac disease are weight loss, loss of appetite and general fatigue among others. As a result of these symptoms, athletic performance may be affected. Objetive: To understand how celiac disease impacts athletes' performance, the aim of this study is to conduct a systematic review related to sports performance in individuals with celiac disease. Materials and method: To do so, the following search phrase was used: "Celiac" AND "Sport" AND "Performance", which was entered equally in the following databases: Web of Science, Scopus and PubMed. Results: The results show the existence of few documents related to the object of study (n=11), where a variability of design types is shown in the selected works. On the other hand, the only solution to maintain adequate sports performance in a person with coeliac disease is to follow a gluten-free diet for life. Conclusions: The selected documents emphasize the importance of athletes with celiac disease maintaining a gluten-free diet consistently throughout their lives. Due to the scarcity of studies related to this topic, it is recommended to increase the number of research studies on this subject in order to improve the lifestyles and habits of athletes with celiac disease(AU)

Exploring typical and atypical variants of celiac disease: a narrative review

There are many different clinical manifestations of celiac disease (CD), including the classical form, in which intestinal symptomatology predominates on the contrary there is atypical forms, in which extra-intestinal clinical features predominate, and the silent form, in which there are no clinical symptoms. Few or no gastrointestinal symptoms and a predominance of extra-intestinal features, including liver, kidney, skeletal, psychiatric, neurologic, dermatologic, hematologic, endocrinological, and reproductive involvements, define the atypical forms of the disease. Through screening high-risk groups, silent presentations of CD may be found. It is crucial for healthcare professionals to have a high level of suspicion for the atypical presentations of CD because it is now well known that CD may account for a number of chronic health issues.

Mendelian randomization study on the correlation between gluten free diet and rheumatoid arthritis / 中华风湿病学杂志

Objective:To evaluate the relationship between gluten-free diet and rheumatoid arthritis (RA).Methods:Data were obtained from large-scale genome-wide association studies (GWAS), and genetic loci that are independent of gluten-free diet and RA of people of Europe2 were selected as instrumental variables. The gluten-free diet GWAS data included 64 949 individuals and 9 851 867 controls. Data were obtained from GWAS of 58 284 RA patients and 13 108 512 controls. The inverse variance weighted (IVW), MR Egger, weighted median method and weighted model were used to conduct two sample Mendelian randomization (MR) analysis. Cochran Q test and mendelian randomness pleiotropy residual sum and outlier (MR-PRESSO) were used to assess SNP heterogeneity. Applying the MR Egger intercept to test the level pleiotropy of SNP. The sensitivity analysis of the "leave one method" that evaluates whether MR studies were influenced by a single SNP. Results:After matching GFD and RA data, three SNPs were included as instrumental variables in the study. IVW showed that GFD could significantly reduce the risk of RA ( β=-60.83, s x=3.82, P<0.001). The weighted median method and weighted pattern also showed that the gluten free diet could reduce the risk of RA ( β=-57.97, s x=4.41, P<0.001; β=-55.81, s x=5.10, P=0.008). Sensitivity analysis of the correlation between GFD and RA showed that there might be heterogeneity between SNPs (Cochran Q test, Q=12.80, P=0.002). The MR-PRESSO results showed that no abnormal SNP was detected ( P=0.174). The forest map showed that SNPs was closely related to GFD and RA stability. The method comparison chart showed that the results of multiple testing methods were basically consistent. The funnel plot showed that SNPs were basically symmetrical, indicating that there was no pleiotropy in MR analysis. The MR Egger intercept test showed no horizontal pleiotropy in MR analysis (intercept value was-0.24, P=0.174). The sensitivity analysis of the "leave one method" is suggested that no single SNP had a significant impact on the overall results. Conclusion:Gluten free diet is related to the risk reduction of RA.

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.

Relationship Between Celiac Disease and Dental Caries in Children and Adolescents: A Systematic Review and Meta-Analysis

ABSTRACT Objective: To assess the relationship between celiac disease and the prevalence of dental caries in children and adolescents and also evaluate if dental enamel defects in celiac children predispose to dental caries. Material and Methods: Searches were performed in the following databases: PubMed, Scopus, Cochrane Library, Latin American and Caribbean Literature on Health Sciences, and OpenGrey. The risk of bias was assessed using the Newcastle-Ottawa Scale. DMFT/dmft and DMFS/dmfs data of observational studies that compared the prevalence of caries between children and adolescents with celiac disease and healthy individuals. Meta-analysis was performed using a random effects model. Heterogeneity between studies was estimated using Cochran's Q test, and inconsistency was measured using I2 statistics. Results: Of the 121 studies retrieved, 17 were selected, and 12 were included in the meta-analysis. The prevalence of caries in the primary dentition (dmft) did not differ between celiac patients and controls [SMD = -0.35; 95% CI (-0.83; 0.13); p = 0,15; I2 = 89%]. There was also no difference in the prevalence of caries in permanent teeth (DMFT) between groups [SMD = -0.44; 95% CI (-1.02; 0.14); p = 0.14; I2 = 95%]. Conclusion: Celiac disease is not a determinant factor in the development of dental caries in children and adolescents compared to the control group.

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.

Proximate Assessment and Pasting Properties of Gluten-Free and Refined Wheat Flour

The present study focused on the nutritional evaluation and pasting properties of gluten-free and refined wheat flour. Gluten-free kodo and kutki flour and refined wheat flour were used as raw materials for the experiment. Nutritional content was estimated using an Association of Official Analytical Chemists (AOAC) approved method of analysis. The pasting properties of flour samples were determined with a Rapid Visco Analyzer (RVA). Results of the nutritional analysis of gluten-free flours indicated higher mineral content in kodo, followed by kutki and refined wheat flour, while ash content was highest for kodo flour and lowest for wheat flour among the investigated flours. The higher amount of protein, minerals, biomolecule components, and high fiber content in millet flour makes it a good alternative among other flours to develop millet-fortified, healthier food products. The higher peak viscosity observed for kutki compared to kodo and wheat flour may be due to the lower protein content and higher ash content present in kodo flour. The final viscosities ranged from 2186 to 6453 cP, with the highest for kutki flour, followed by kodo and refined wheat flour. FV increases significantly with an increase in protein and fat content. The greater breakdown viscosity was found for kutki flour, followed by kodo and refined wheat flour, indicating that kutki flour has a low ability to withstand shear stress and heat. Lower setback values indicate a low rate of starch retro gradation and synerisis in refined wheat flour. The greater pasting temperature was shown by kutki flour, depicting the higher energy and time required for cooking and correlating with higher amylose content.

Optimization of Colour Parameters of Different Gluten-free Pasta Samples Using Response Surface Methodology

Colour plays an important role in consumer’s perception and acceptability of the food product. Therefore, colour measurement and analysis is one of the most important quality attributes to optimize the quality and value of food. Different blends of gluten-free maize flour, finger millet (Ragi) flour and quinova flour were used as raw materials for the development of pasta. Hunter Lab Colorimeter was used for measuring the surface color of the uncooked pasta samples. High quality pasta (either fresh or dried) is normally yellow in colour and the degree of yellowness can be calculated by using b* and L* values. Quality of pasta developed by different blend ratio of maize, ragi and quinova flours with different levels of CMC, Karaya Gum and dried at different drying temperature and air flow rates were evaluated in terms of L* values (lightness), b* values (yellowness) and Yellowness Index (YI). Results of colour analysis of gluten-free pasta samples indicated a significant effect of flours on L*, b* and YI while drying air temperature have a significant effect on b* values. Pasta samples prepared following optimized formulation 50:25:25 (Maize flour: Ragi, flour: Quinova flour) blend ratio, 5g CMC per 100g of blend ratio, 2.5g Karaya Gum per 100g of blend ratio, 60 0C drying air temperature and 0.78 m/sec. air flow rate provided optimum L*, b* and YI values with overall desirability of 0.545.

The effect of gluten-free diet on mean platelet volume levels as a short-term follow up biomarker in biopsy proven celiac disease patients and its comparison with IgA-tissue transglutaminase antibody levels

Background: Celiac disease is an autoimmune disease for which there is a known environmental trigger i.e., gluten. Adherence to gluten-free diet is the mainstay of treatment.

Methods: This observational prospective study was conducted in the Department of Paediatrics, SP Medical College, Bikaner between August 2020 to August 2021. Newly diagnosed celiac disease patients below 14 years of age were included in the study excluding patients with any associated co-morbid conditions like Diabetes, Hypertension and Hypothyroidism. IgA-tTG titre and complete blood counts were performed at the time of diagnosis, and repeated after 3 months of strict gluten-free diet. The collected data were coded, tabulated and analysed. P values < 0.05 were statistically significant.

Results: The mean IgA-tTG decreased from 116.28 at the time of diagnosis to 50.98 after 3 months of the gluten-free diet (p = <0.001). Also, the mean MPV decreased from 9.58 to 9.19 and the change was statistically significant (p = 0.032). When two biomarkers i.e., MPV and IgA-tTG were compared as being better biomarkers for the gluten-free diet, a weak positive correlation was observed but was not statistically significant (p = 0.212).

Conclusions: This study showed that Mean Platelet Volume (MPV) levels can be used as a short-term biomarker to check adherence to the gluten-free diet.

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.

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

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.

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.

New Horizons in Treatment of Celiac Disease / 胃肠病学

Celiac disease is a common immune-mediated disorder that may present with various heterogeneous symptoms following gluten ingestion.It accounts for 0.7%-1.4%of the global population.The prevalence of celiac disease in China was once considered extremely low.However,in recent years,several cases of celiac disease have been reported one after another,which has gradually attracted people's attention.A gluten-free diet is the only effective treatment for celiac disease,but it has limitations in certain patient groups and is difficult to maintain over time.This is why studying alternative treatment options for celiac disease is of great clinical importance.In recent years,the treatment of celiac disease has seen the emergence of several novel therapies that provide ideas and directions for clinical treatment in terms of removing or reducing the factors that cause abnormalities in immune tolerance,suppressing one's immune response to gluten,and re-establishing immune tolerance to gluten.This review focuses on the research progress of new therapies for celiac disease.

Evaluation of Genotoxic and Cytotoxic Effects of Gluten in Male Albino Mice

Gluten is a protein commonly found in daily diets in the form of wheat, barley, rye, and other grains. It serves as the structural component in flour, providing the binding qualities that maintain the shape and texture of food items. This study aimed to investigate the genotoxic and cytotoxic effects of gluten on bone marrow chromosomes and DNA of male albino mice. The animals were divided into four groups: a control group, a negative control group that received an oral dose of 0.02M glacial acetic acid, and two groups that were treated with gluten dissolved in 0.02M glacial acetic acid at doses of 1.5 g/kg and 3.0 g/kg body weight. The treated animals received oral doses with non-consecutively three times a week for a period of four weeks. The study evaluated chromosomal aberrations in the bone marrow, micronucleus test, and DNA damage using the comet assay. The results of the study showed that treatment with 1.5 and 3.0g/kg body weight of gluten induced chromosomal aberrations and damage in DNA content, with an increase in the severity of effects at a higher dose of gluten. The chromosomal aberrations seen included deletion, fragment, centromeric attenuation, centric fusion, ring formation, end to end association, chromosomal gap, beaded chromosomes, and polyploidy. The micronucleus test revealed toxicity in the bone marrow, as shown by appearance of micronuclei in polychromatic erythrocytes and a reduction in the ratio of polychromatic erythrocytes. The comet assay showed a significant increase of DNA damage in the tail length of the comet cells. This study concluded that the treatment with gluten has detrimental effects on the bone marrow chromosomes and DNA of mice, as demonstrated by the increased chromosomal aberrations, micronuclei, and DNA damage observed in the treated mice. So, the use of gluten should be within an acceptable and safe range.

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.

Estado nutricional integral de niños y adolescentes con enfermedad celíaca / Comprehensive nutritional status of children and adolescents with celiac disease

Introducción: La enfermedad celíaca (EC) es una enteropatía autoinmune desencadenada por la ingestión de gluten, en personas con predisposición genética. Su prevalencia está aumentando y el impacto nutricional de la enfermedad y de su tratamiento es objeto de numerosas publicaciones. Objetivo: analizar el estado nutricional integral de los pacientes con EC, atendidos en el Centro de Atención Nutricional Infantil Antímano CANIA, entre 1996 y 2016. Materiales y Métodos: investigación descriptiva, retrospectiva y transeccional. Las variables estudiadas: edad, sexo, diagnóstico nutricional integral, (indicadores antropométricos, de maduración ósea, dietéticos y bioquímicos) y cumplimiento de dieta sin gluten. Resultados: Se evaluaron 55 pacientes con EC, entre 2 y 7 años (58,2 %) con predominio de sexo femenino. El diagnóstico nutricional más frecuente fue la desnutrición en un 56,4 %, un 16,4 % presentó talla baja. El retardo en la maduración ósea se presentó en 33,3 %, y mostró asociación significativa con la desnutrición. El déficit de hierro sérico e hipocalcemia se registraron en 24,4 % y 18,8 % de los pacientes. El cumplimiento de la dieta sin gluten fue reportado en el 78,2 % de los casos. La dieta tuvo una tendencia al déficit de energía, macro y micronutrientes, especialmente grasas y calcio, independiente de su cumplimiento. Conclusión: los resultados evidenciaron que los pacientes son vulnerables desde el punto de vista nutricional. La dieta mostró déficit de energía, macronutrientes y calcio. La mayoría presentó algún grado de desnutrición. La atención nutricional debe ser ofrecida a esta población, desde el mismo momento en que se realiza el diagnóstico independiente de la edad(AU)

ackground: Celiac disease (CD) is an autoimmune enteropathy triggered by the ingestion of gluten, in people with a genetic predisposition. Its prevalence is increasing and the nutritional impact of the disease and its treatment is the subject of numerous publications. Objective: to analyze the comprehensive nutritional status of patients with CD, treated at the Centro de Atención Nutricional Infantil Antímano CANIA, between 1996 and 2016. Methods: descriptive, retrospective and transectional research. The variables studied: age, sex, comprehensive nutritional diagnosis (anthropometric, bone maturation, dietary and biochemical indicators) and compliance with a gluten- free diet. Results: 55 patients with CD were evaluated, the majority between 2 and 7 years (58.2%) with a predominance of females. The most frequent nutritional diagnosis was malnutrition in 56.4%, 16.4% had short stature. The delay in bone maturation occurred in 33.3%, and showed a significant association with malnutrition. Serum iron deficiency and hypocalcemia were recorded in 24.4% and 18.8% of patients. Compliance with the gluten-free diet was reported in 78.2% of cases. The diet had a tendency towards a deficit of energy, macro and micronutrients, especially fats and calcium, regardless of compliance. Conclusion: the results showed that patients are vulnerable from a nutritional point of view. The diet showed a deficit of energy, macronutrients and calcium. The majority presented some degree of malnutrition. Nutritional care must be offered to this population, from the moment the diagnosis is made, regardless of age(AU)

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.