The influence of carboxymethyl cellulose and hydroxypropyl methylcellulose on physicochemical, texture, and sensory characteristics of gluten-free pancake.

In this study, gluten-free pancakes were prepared using rice flour and potato starch at a ratio of 50:50. Due to a lack of gluten networks in these ingredients, the hydrocolloid gums including carboxymethyl cellulose (CMC) at 0.5%, 1%, and 1.5% and hydroxypropyl methylcellulose (HPMC) at 1%, 2%, and 3% were added to improve the quality of the final products. The effects of these hydrocolloid gums on the physicochemical, textural, and sensory properties of the gluten-free pancakes were evaluated. Pancakes prepared with wheat flour were used as a control sample. The results showed that the addition of both gums decreased the hardness and chewiness of the gluten-free pancakes while increasing the springiness and their moisture content. Increasing the concentration of the gums resulted in an L* value (lightness) reduction, which produced a darker crust on the pancakes. Moreover, the gluten-free pancakes containing CMC and HPMC had higher specific volumes than the gluten-free samples made without CMC and HPMC. From a sensory point of view, the samples containing 2%, 3% HPMC and 1% CMC received the highest overall acceptance score. Thus, CMC and HPMC can be used as improvers in gluten-free pancakes.

Nutritional and Nutraceutical Properties of Selected Pulses to Promote Gluten-Free Food Products.

The market for gluten-free products is increasing with an estimated 7.6% annual growth rate from 2020 to 2027. It has been reported that most gluten-free products, such as bread, cookies, and pasta, contain great amounts of simple carbohydrates and are low in fiber and protein, affecting people's health. Pulses such as common beans, chickpeas, lentils, and peas have been studied as an alternative for developing gluten-free products because of their high protein and fiber content. In addition, they contain bioactive compounds with nutraceutical properties, such as phenolics, saponins, dietary fiber, and resistant starch, among others. Most studies carried out with pulses in vitro and in vivo have displayed health benefits, proving that pulse-based food products are better than their counterparts, even those containing wheat, with proper sensory acceptance. This work reviews pulse's nutritional and nutraceutical properties to promote the development and consumption of gluten-free products and improve their formulations to promote people's health.

Consumer Awareness and Acceptance of Biotechnological Solutions for Gluten-Free Products.

Celiac disease is an immune-mediated disorder caused by the ingestion of gluten proteins. The gluten-free diet is currently the only therapy to achieve the symptoms' remission. Biotechnological approaches are currently being explored to obtain safer and healthier food for celiacs. This article analyzes consumer awareness and acceptance of advanced biotechnologies to develop gluten-free products. An online snowball sampling questionnaire was proposed to 511 Italian participants, selected among celiac and non-celiac people, from December 2020 to January 2021, during the second wave of the COVID-19 pandemic. Overall, 64% of respondents favor food biotechnology, as long as it has benefits for health or the environment. Moreover, biotechnology perception differs according to education level and type. A total of 65% of the survey participants would taste gluten-free products obtained through a biotechnological approach, and 57% would buy them at a higher price than the current market price. Our results show a change in public opinion about the usefulness of food biotechnology and its moral acceptability compared to 20 years ago. However, the study of public opinion is very complex, dealing with individuals with social, economic, and cultural differences. Undoubtedly, the scientific dissemination of genetic biotechnologies must be more effective and usable to increase the level of citizens' awareness.

Principles and recent applications of vacuum technology in the processing of dough-based cereal products: A comprehensive review.

Cereal-based foods have been essential elements in nutrition throughout history. Recently, there has been an increasing interest in the application of innovative strategies to improve technological and nutritional properties of dough-based cereal products. Literature studies indicate that the integration of vacuum technology into baking and noodle industry can significantly enhance the quality and feasibility of final products. The vacuum has direct impact on gluten network, gas distribution and interaction of components in food matrix, especially due to aerated structure of dough systems. In this respect, this review for the first time presents a comprehensive evaluation regarding to use of vacuum technology in processing steps (i.e., mixing, baking, and cooling) of dough-based products in light of recent studies. The implementation of vacuum in the processes provide desired impacts on productivity and profitability for manufacturing industries. Vacuum application provides many advantages including improved product quality, nutritive value, extended shelf life, and reduced energy consumption.

Food security of people with celiac disease in the Republic of Moldova through prism of public policies.

Food security is an important lever for the implementation of rights-based legislation, policies, and programs, while being a public health and socio-economic priority. Foodborne illnesses have a major impact on public health, and nutritional interventions are essential therapeutic strategies to combat them. Gluten ingestion has been linked to several clinical disorders, collectively called gluten-related disorders. The most serious of these is celiac disease. The only way to treat celiac disease is to stick to a gluten-free diet for life. Following a strict diet is also the only way to prevent the long-term consequences of the disease. Public policies are essential to ensure the food security of people with gluten-related disorders. The aim of the research is to assess the level of care for people with celiac disease in the Republic of Moldova, in terms of public policies, to ensure a sustainable sector that effectively satisfies the food security of people with disorders associated with gluten consumption. To assess the level of care for people with gluten-related disorders, the working algorithm was taken, with reference to global public policies in support of people with celiac disease, developed and validated by Falcomer et al., Focused on 6 items. The results of the study showed that the Republic of Moldova does not have adequate policy support to ensure food security for people with gluten-related disorders, which poses major challenges and, as a result, may increase the complications of these problems.

Gluten-Free Sorghum Pasta: Composition and Sensory Evaluation with Different Sorghum Hybrids.

Although whole grain (WG) sorghum is affordable and a healthier alternative to gluten-free pastas (GFPa), sorghum diversity requires evaluation for application in pasta. We aimed to develop GFPa using six sorghum hybrids. White commercial flour (WCF) and sorghums with brown (BRS 305 and 1167048), red (BRS 330 and BRS 332), and white (CMSXS 180) pericarp colors. Total phenolic content (TPC), total condensed tannins (TAN), total antioxidant activity (TAA-FRAP and DPPH), resistant starch (RS), cooking properties, texture, and sensory evaluation were carried out in sorghum pasta. The statistical analyses were ANOVA, Tukey and Friedman test, and multiple factorial analyses. Brown sorghum GFPa showed the best results for bioactive compounds (RS (1.8 and 2.9 g/100 g), TPC (69.9 and 42.8 mg/100 g), TAN (16.9 and 9.4 mg proanthocyanidin/100 g), TAA for FRAP (305 and 195 mM Teq/g), and DPPH (8.7 and 9.0 mg/mL)), but also the highest soluble solids loss (8.0 g/100 g) and lower flavor acceptance for BRS 305. BRS 332 was highlighted for its higher flavor acceptance and intermediary phenolics content. The most accepted pasta was obtained with WCF, and the least accepted with the brown BRS 305. Sweetness (SWE), soluble starch (SS), and DPPH were associated with liking. The main negative variables were WG_flavor, brown color, FRAP, sandy surface (SAN), WG_odor, and TAN. Sorghum hybrids of different pericarp colors are feasible for GFPa production, leading to differences in pasta quality. SAN and GRA, associated with disliking in antioxidant-rich GFPa, could be improved by milling process adjustments. Increasing the SS proportion and SWE with flavors can contribute to the balance between liking and nutritional advantages.

Novel Gluten-Free Bread with an Extract from Flaxseed By-Product: The Relationship between Water Replacement Level and Nutritional Value, Antioxidant Properties, and Sensory Quality.

The food industry generates a great amount of food waste and by-products, which in many cases are not fully valorized. Press cakes, deriving from oilseeds extraction, represent interesting co-products due to their nutritional value, high biopolymers content, and the presence of bioactive phytochemicals. Gluten-free breads (GFBs) are products that have disadvantages such as unsatisfactory texture, low nutritional value, and short shelf life, so natural additives containing proteins and hydrocolloids are in demand to increase GFBs value. In this study, extract from flaxseed by-product (FOCE-Flaxseed Oil Cake Extract) was used to replace water (25-100%) in GFBs formulations and their nutritional value, antioxidant properties, and sensory features were investigated. The results showed that GFBs with FOCE had an elevated nutritional and nutraceutical profile (up to 60% more proteins, significantly increased K, Mg, and P levels). Moreover, the addition of FOCE improved the technological parameters (increased specific volume, number of cells and height/width ratio, reduced density, average size, and perimeter of cells), antioxidant potential, and overall sensory quality of GFBs. This study showed an encouraging way of using a by-product that, due to its high content of proteins, polysaccharides, minerals, and antioxidants, can add value to GFBs.

Gluten-Free Bread and Bakery Products Technology.

Gluten, a protein fraction from wheat, rye, barley, oats, their hybrids and derivatives, is very important in baking technology. The number of people suffering from gluten intolerance is growing worldwide, and at the same time, the need for foods suitable for a gluten-free diet is increasing. Bread and bakery products are an essential part of the daily diet. Therefore, new naturally gluten-free baking ingredients and new methods of processing traditional ingredients are sought. The study discusses the use of additives to replace gluten and ensure the stability and elasticity of the dough, to improve the nutritional quality and sensory properties of gluten-free bread. The current task is to extend the shelf life of gluten-free bread and bakery products and thus extend the possibility of its distribution in a fresh state. This work is also focused on various technological possibilities of gluten-free bread and the preparation of bakery products.

Gluten-Free Cereal Products and Beverages: A Review of Their Health Benefits in the Last Five Years.

In the past decades, food products and beverages made from gluten-free cereals were initially created for certain groups of people who experience gluten-related disorders such as wheat allergies, gluten ataxia, non-celiac gluten sensitivity, and the most well-known, celiac disease. Nowadays, the consumption of gluten-free products is not only restricted to targeted groups, but it has become a food trend for normal consumers, especially in countries such as the UK, the US, and some European countries, who believe that consuming a gluten-free product is a healthier choice compared to normal gluten-containing products. However, some research studies have disapproved of this claim because the currently available gluten-free products in the market are generally known to be lower in proteins, vitamins, and minerals and to contain higher lipids, sugar, and salt compared to their gluten-containing counterparts. The use of other gluten-free cereals such as sorghum, millet, and teff as well as pseudo cereals such as buckwheat and quinoa has gained significant interest in research in terms of their various potential health benefits. Hence, this review highlights the potential health benefits of some gluten-free cereals and pseudo cereals apart from corn and rice in the last decade. The potential health benefits of gluten-free products such as bread, pasta, crackers, and cookies and the health benefits of some other non-alcoholic beverages made from gluten-free cereals and pseudo cereals are reported.

Nutritional Imbalances in Adult Celiac Patients Following a Gluten-Free Diet.

Celiac disease (CD) is a chronic autoimmune disorder of the small intestine, whose only effective treatment is a gluten-free diet (GFD). It is characterized by the atrophy of the intestinal villi that leads to altered nutrient absorption. This study describes the nutritional imbalances which may be found in adults with CD following a GFD. During the first year of treatment, deficiencies will overcome as the intestinal mucosa recovers. Thus, biochemical data will show this progression, together with the decrease in symptoms. In contrast, in the long term, when a strict GFD is followed and mucosal recovery is achieved, analyzing nutrient intake makes more sense. Macronutrient consumption is characterized by its low complex carbohydrate and fiber intakes, and high fat (especially SFA) and sugar intakes. This profile has been related to the consumption of GFP and their nutritional composition, in addition to unbalanced dietary habits. The most notable deficiencies in micronutrients are usually those of iron, calcium and magnesium and vitamin D, E and some of group B. It is necessary to follow up patients with CD and to promote nutritional education among them, since it could help not only to achieve a gluten free but also a balanced diet.

Nutritional quality and costs of gluten-free products: a case-control study of food products on the Norwegian marked.

BACKGROUND: Celiac disease is a chronic autoimmune disease triggered by gluten exposure in genetically predisposed individuals. A life-long intake of a gluten-free (GF) diet is required for its management. Wheat, rye and barley are eliminated in a GF diet and the nutritional adequacy of the diet has been questioned. In Norway, cereals and bread constitute a key role of the diet and are the main source of fiber intake. Gluten restrictions may therefore offer important implications for nutrient adequacy especially linked to fiber intake in people with celiac disease. OBJECTIVE: The aim of the study was to investigate the nutritional quality and price of GF products and compare with gluten-containing counterparts available at instead of in the Norwegian market. DESIGN: The macronutrient content of 423 unique GF products were compared with 337 equivalents with gluten. All products were selected from grocery stores and web-based shops, with the aim of including as many GF products as possible. Listed macronutrients content and price in 11 different food categories were compared to gluten-containing counterparts with Wilcoxon signed rank test. RESULTS: The GF products contained less protein and fiber, and higher content of saturated fat, carbohydrate and salt compared to the gluten-containing products. The total amount of fat was not different between the groups. A similar pattern was found within several of the food categories. More gluten-containing products met the nutrition claim "high in fiber" (fiber > 6 g/100 g) compared to the GF products. The price of the GF products was higher; ranging from 46%-443% more expensive than the gluten-containing products. CONCLUSION: GF products are less nutritious and have a higher price compared to equivalent gluten-containing products. Knowing that an unhealthy diet is the most important risk factor for developing non-communicable diseases, the nutritional quality of a GF diet needs to be addressed and should be improved.

[Selenium content in gluten-free products].

Special diets are used for the treatment and prevention of diseases of the digestive system, taking into account individual food intolerance and possible allergic reactions. The monotony of the diet due to the limited range of recommended foods and dishes negatively affects both the effectiveness of the treatment of gluten intolerance, and the provision of the body with essential and replaceable nutrients. The aim of this study was to determine the selenium content in the flour of gluten-free crops (rice, corn, buckwheat and amaranth), their mixtures, as well as in dishes (pancakes) from a mixture of amaranth and buckwheat flours. Material and methods. The following raw materials were used in the study: amaranth flour, unboiled buckwheat groats, whole grain rice flour and corn flour. By mixing the components in a laboratory mixer, dry gluten-free compositions were obtained: a mixture of amaranth flour and flour from native buckwheat; a mixture of amaranth and rice flour and a mixture of amaranth and corn flour in the ratio of 1:2 and 1:1; and a mixture of amaranth, buckwheat and corn flour in equal proportions. In laboratory baking of pancakes, mixtures of amaranth flour and flour from native buckwheat were used. The selenium content was determined by atomic absorption spectroscopy with electrothermal atomization after wet mineralization of the samples. Results. The results of the study showed that amaranth, buckwheat and corn are rich sources of selenium. The most valuable source of selenium was amaranth flour (515 µg/kg). Selenium content in native buckwheat flour and corn flour was 405 and 458 µg/kg, respectively. The lowest selenium content among the studied crops was found in rice flour (135 µg/kg). Selenium content in flour mixtures of the studied cultures ranged from 258 to 522 µg/kg. The highest values of selenium content were observed in mixtures of amaranth with corn flour (516-522 µg/kg). The lowest content of this trace element was found in mixtures containing rice flour (from 258 to 325 µg/kg). Selenium content in pancakes made from mixtures of amaranth flour and native buckwheat flour varied from 290 to 326 µg/kg. The calculation showed that the consumption of a portion of pancakes (50 g) by school-age children will satisfy their daily requirement for selenium by 7.3-8.1%. Conclusion. Regular inclusion of amaranth-based foods in the diet of children with gluten intolerance can positively affect the elimination of selenium deficiency.

Aporte de energía, macronutrientes y fibra de alimentos farináceos libres de gluten elaborados a partir de premezclas comerciales / Energy, macronutrients and fiber contribution of gluten free farinaceous products produced from commercial premix

Resumen La dieta libre de gluten (DLG) es el único tratamiento frente a la enfermedad celíaca, la alergia al trigo y la sensibilidad al gluten no celíaca. Se reporta a la DLG como una dieta desbalanceada, escasa en fibra y alta en grasas y carbohidratos. El objetivo del estudio fue evaluar el aporte de energía, de macronutrientes y de fibra de alimentos libres de gluten (bizcochuelos, panes estilo inglés, galletitas dulces y pizzas) elaborados a partir de diferentes premezclas comerciales, disponibles en el mercado local. Además, los resultados fueron comparados con un homólogo comercial elaborado con harina de trigo. Para la determinación de la composición centesimal se aplicó la metodología oficial AOAC 2016. El valor energético se calculó utilizando los factores de Atwater. Los resultados obtenidos para los bizcochuelos fueron: 6,0-8,3 g% de proteína; 9,2-11,3 g% de grasas; 1,5-2,3 g% de fibra dietaria; 40,0-53,1 g% de carbohidratos y 285-339 Kcal% de valor energético. Para los panes: 3,0-6,6 g% de proteína; 3,1-12,7 g% de grasas; 2,7-4,0 g% de fibra dietaria; 36,8-50,1 g% de carbohidratos y 217-290 Kcal% de valor energético. Para las galletitas: 3,5-8,5 g% de proteína; 25,9-31,0 g% de grasas; 0,9-5,9 g% de fibra dietaria; 53,9-60,1 g% de carbohidratos y 483-527 Kcal% de valor energético. Para las pizzas: 7,4-9,3 g% de proteína; 7,3-11,2 g% de grasas; 2,8-8,0 g% de fibra dietaria; 19,1-29,6 g% de carbohidratos y 172-240 Kcal% de valor energético. Los alimentos elaborados con premezclas formuladas únicamente con harina de arroz y féculas contribuyen poco a cubrir el valor diario recomendado de fibra. Los que contienen otras fuentes farináceas (harina de sorgo, trigo sarraceno y teff) reflejan un mayor contenido de fibra. La presencia de harina de arveja, soja y teff refleja un aumento del contenido proteico. Los alimentos estudiados frente a su homólogo comercial con harina de trigo presentan, en general, igual o menor aporte proteico, similar aporte energético y de carbohidratos y un mayor aporte de grasas y fibra dietaria.

Abstract The gluten free diet (GFD) is the only treatment for celiac disease, wheat allergy and non-celiac gluten/wheat sensitivity. GFD is reported as an unbalanced diet, low in fibre and high in fat and carbohydrates. The aim of this study was to evaluate energy, macronutrients and fiber contribution of gluten-free cereal products (pound cake, tin loaf, cookies and pizza) coming from different commercial premixes, available at the local market. Also, the results were compared with a commercial equivalent made with wheat flour. For centesimal composition determination, AOAC Official Method 2016 was applied. The energy was calculated using Atwater factors. The results obtained for pound cake were: 6.0-8.3g% protein; 9.2-11.3g% fat; 1.5-2.3g% dietary fibre; 40.0-53.1g% carbohydrate and 285-339Kcal% energy. For tin loaf: 3.0-6.6g% protein; 3.1-12.7% fat; 2.7-4.0g% dietary fibre; 36.8-50.1g% carbohydrate and 217-290Kcal% energy. For cookies: 3.5-8.5g% protein; 25.9-31.0g% fat; 0.9-5.9g% dietary fibre; 53.9-60.1g% carbohydrate and 483-527Kcal% energy. For pizza: 7.4-9.3g% protein; 7.3-11.2g% fat; 2.8-8.0g% dietary fibre; 19.1-29.6g% carbohydrate and 172-240Kcal% of energy. Products made with premix that only contains rice flour and starches contribute little to meeting recommended daily intake. The ones that contain other farinaceous sources (sorghum flour, buckwheat and teff) show higher dietary fibre content. The presence of pea flour, soybean and teff show an increase of protein content. The analysed products present same or lower protein intake, similar energy and carbohydrate intake and higher fat and dietary fibre intake, compared to their commercial equivalent made with wheat flour.

Special Issue: Rheology and Quality Research of Cereal-Based Food.

New trends in the cereal industry deal with a permanent need to develop new food products that are adjusted to consumer demands and, in the near future, the scarcity of food resources. Sustainable food products as health and wellness promoters can be developed redesigning traditional staple foods, using environmentally friendly ingredients (such as microalgae biomass or pulses) or by-products (e.g., tomato seeds) in accordance with the bioeconomy principles. These are topics that act as driving forces for innovation and will be discussed in the present special issue. Rheology always was the reference discipline to determine dough and bread properties. A routine analysis of cereal grains includes empirical rheology techniques that imply the use of well-known equipment in cereal industries (e.g., alveograph, mixograph, extensograph). Their parameters determine the blending of the grains and are crucial on the technical sheets that determine the use of flours. In addition, the structure of gluten-free cereal-based foods has proven to be a determinant for the appeal and strongly impacts consumers' acceptance. Fundamental rheology has a relevant contribution to help overcome the technological challenges of working with gluten-free flours. These aspects will also be pointed out in order to provide a prospective view of the relevant developments to take place in the area of cereal technology.

Updated Food Composition Database for Cereal-Based Gluten Free Products in Spain: Is Reformulation Moving on?

We developed a comprehensive composition database of 629 cereal-based gluten free (GF) products available in Spain. Information on ingredients and nutritional composition was retrieved from food package labels. GF products were primarily composed of rice and/or corn flour, and 90% of them included added rice starch. The most common added fat was sunflower oil (present in one third of the products), followed by palm fat, olive oil, and cocoa. Only 24.5% of the products had the nutrition claim "no added sugar". Fifty-six percent of the GF products had sucrose in their formulation. Xanthan gum was the most frequently employed fiber, appearing in 34.2% of the GF products, followed by other commonly used such as hydroxypropyl methylcellulose (23.1%), guar gum (19.7%), and vegetable gums (19.6%). Macronutrient analysis revealed that 25.4% of the products could be labeled as a source of fiber. Many of the considered GF food products showed very high contents of energy (33.5%), fats (28.5%), saturated fatty acids (30.0%), sugars (21.6%), and salt (28.3%). There is a timid reformulation in fat composition and salt reduction, but a lesser usage of alternative flours and pseudocereals.

Effect of analytically measured fiber and resistant starch from gluten-free products on the diets of individuals with celiac disease.

OBJECTIVE: The aim of the present work was to assess the content of fiber and resistant starch (RS) in several gluten-free products (GFPs), compare them with their gluten-containing analogs (GCP) analytically and with label data, and measure the contribution of these foodstuffs to the fiber content of a gluten-free diet. METHODS: Total dietary fiber and RS content in a large amount of GFP (n = 55) and their counterparts (n = 55) were measured by analytical techniques based on AOAC methods. Dietary assessment was carried out with a sample of 141 individuals (pediatric and adult patients with celiac disease) submitted to a food frequency questionnaire and a 24-h recall survey (three times on different days). RESULTS: In general terms, GFP and GCP showed similar fiber and RS content, with the exception of breads, which revealed a higher percentage of both in GFPs. This food group was the main contributor to fiber intake in both groups of patients. Even if GFPs were to be blamed for being nutritionally poorer than GCPs, this was not the case for fiber. CONCLUSIONS: The fiber and RS content were not different in the studied samples, except for the bread. It is noteworthy that label information can underestimate fiber consumption among those with celiac disease, and this must be considered for future database revision. Additionally, we demonstrated a significant effect on the fiber intake of children and adults due to GFPs, and especially to bread, a widely consumed basic product.

Set-Up of Bacterial Cellulose Production From the Genus Komagataeibacter and Its Use in a Gluten-Free Bakery Product as a Case Study.

The use of bacterial cellulose (BC) in food systems is still limited due to production costs. Nine clones belonging to Komagataeibacter hansenii, Komagataeibacter nataicola, Komagataeibacter rhaeticus, Komagataeibacter swingsii, and Komagataeibacter xylinus species were screened for cellulose productivity in growth tests with five different carbon sources and three nitrogen sources. The water-holding and rehydration capacities of the purified cellulose were determined. The structure of the polymer was investigated through nuclear magnetic resonance (NMR) spectroscopy, attenuated total reflection Fourier transform infrared (ATR-FT-IR) spectroscopy and X-ray diffraction (XRD) analysis, and observed by scanning electron microscope (SEM). Natural mutants of K. rhaeticus LMG 22126T and K. swingsii LMG 22125T showed different productivity. The factors "bacterial isolate" and "nitrogen source" significantly affected the production of cellulose (p < 0.01) rather than the factor "carbon source" (p = 0.15). However, on average, the best conditions for increasing yield were found in medium containing glucose and peptone. Water-holding capacity (WHC) values ranged from 10.7 to 42.3 (g water/g cellulose) with significant differences among strains (p < 0.01), while the rehydration capacity varied from 4.2 to 9.3 (g water/g cellulose). A high crystallinity (64-80%) was detected in all samples with Iα fractions corresponding to 67-93%. The ATR-FT-IR spectra and the XRD patterns confirmed the expected structure. BC made by GVP isolate of K. rhaeticus LMG 22126T, which was the strain with the highest yield, was added to a gluten-free bread formulation. Results obtained from measurements of technological parameters in dough leavening and baking trials were promising for implementation in potential novel foods.

Nutritional Deficiencies in Children with Celiac Disease Resulting from a Gluten-Free Diet: A Systematic Review.

BACKGROUND: A strictly gluten-free diet (GFD) is the basis for managing celiac disease (CD). Numerous studies have reported nutritional deficiencies/imbalances ascribable to a GFD. The aim of this review is to describe nutritional deficiencies observed in children with celiac disease on a GFD, to discuss the clinical consequences related to these nutritional imbalances, and to identify strategies that may be adopted to treat them. METHODS: We reviewed the MEDLINE and EMBASE databases between January 1998 and January 2019. RESULTS: Children are, regardless of whether they are on a gluten-free diet or not, at risk of consuming too much fat and insufficient fiber, iron, vitamin D, and calcium. These imbalances may be exacerbated when children are on a gluten-free diet. In particular, the intake of folate, magnesium, zinc, and foods with a high glycemic index in children with CD who are on a GFD is significantly altered. CONCLUSIONS: Therapeutic protocols should include nutritional education to help teach subjects affected by disorders such as CD the importance of labels, the choice of foods, and the combination of macro- and micronutrients. Children with CD on a GFD should be encouraged to rotate pseudo-cereals, consume gluten-free commercial products that have been fortified or enriched, and use foods that are local and naturally gluten-free.

Persistent Economic Burden of the Gluten Free Diet.

Gluten free (GF) products have been reported to be more expensive and less available than their gluten containing counterparts. We examined the current U.S. cost and availability of GF products and made comparisons to the marketplace over a decade ago. Cost, determined by price per ounce and availability of a "market basket" of regular and GF products across four venues and five geographic regions was compared using a student's t test. GF products were more expensive (overall 183%), and in all regions and venues (p < 0.001). GF products from mass-market producers were 139% more expensive than the wheat-based version of the same product. Availability of GF products was greatest (66%) in the health food and upscale venues. In contrast to the results of the 2006 study, the cost of GF products has declined from 240% to 183% (adjusted for inflation). The introduction of mass-market production of GF products may have influenced the increase in availability and overall reduction of cost since 2006. The extent to which the cost of GF products impacts dietary adherence and quality of life for those on a GFD warrants exploration.

Gluten-free-rendered products contribute to imbalanced diets in children and adolescents with celiac disease.

PURPOSE: As well as adhering to the safe limit for gluten intake, a suitable gluten-free (GF) diet must also be nutritionally balanced. However, malnutrition has been observed in the population with celiac disease (CD). This is even more important in the case of children and adolescents, whose GF diet must also ensure their proper growth. The aim of the present study was to assess the diet quality of children and adolescents with CD to attain optimal nutritional status, determining the most relevant factors that affect a balanced diet. METHODS: Eighty-three children and adolescents with CD (9.2 ± 3.8 years) took part in the study. Height, weight and body composition were measured. An analysis of energy consumption and of the macronutrient distribution of their diet was carried out. Adherence to Mediterranean diet by KIDMED index was analyzed, and energy and nutrients intake. RESULTS: The diet of participants was not balanced, containing more fat and less carbohydrate than recommended. Most children and adolescents revealed adequate body mass index and suitable body fat percentage. Two-thirds of them showed moderate or poor KIDMED index, the case of girls being remarkable. When the GF diet, containing GF-rendered foodstuffs, was compared to a similar type of diet but substituting GF products with their analogs containing gluten, important nutritional differences were revealed. CONCLUSIONS: Even though celiac children and adolescents' diet is unhealthy due to its inappropriate dietary pattern, following a diet based on GF products raises extra difficulty in complying with the nutritional recommendations.