Diss. (sammanfattning) Linköping : Univ., 2006. / Härtill 4 uppsatser.

Doctor of Philosophy / Department of Grain Science and Industry / Sajid Alavi / Sorghum grain (Sorghum bicolor) is safe for consumption by individuals afflicted with celiac disease, and its proteins can be used as a supplement in gluten-free foods. However, utilization of sorghum in human foods is limited by the poor digestibility and lack of functionality of its proteins, which result from their entrapment in protein bodies, tight association with starch, and high degree of cross-linking induced by cooking. The first part of this study presents an extensive review of current methods for concentration and isolation of sorghum proteins, which are laboratory-scale techniques used for protein characterization and have no potential for commercial scale-up. Furthermore, these methods typically use non-food grade reagents and do not improve protein digestibility and functionality. In the second part, a novel extrusion-enzyme liquefaction (EEL) process was used to produce sorghum protein concentrates to overcome the aforementioned limitations. EEL involves extrusion pre-treatment of sorghum flour and starch liquefaction with a thermostable α-amylase, followed by enzyme inactivation, protein separation and drying. To demonstrate the concept, a laboratory-scale EEL process was used to produce concentrates with higher protein content (PC; 80% db) and digestibility (D; 74%) than those made by batch liquefaction. The optimum conditions for producing concentrates with both high PC and D were 32% wb in-barrel moisture content and 2.5% α-amylase added after extrusion. Using these conditions, EEL was scaled-up to a pilot-scale process to produce sorghum protein concentrates with 72-80% db PC and 62-74% D, while the batch liquefied control had only 70% db PC and 57% D. Dynamic oscillatory measurements of dough (55% moisture) and batter (65% moisture) containing sorghum protein concentrates (5 and 10%) and potato starch were performed to evaluate protein functionality. At lower moisture, pure potato starch and dough containing 10% sorghum protein concentrate had similar elastic and viscous moduli. At higher moisture, potato starch was more stable and exhibited significantly higher moduli than the batters with protein concentrates. Sorghum protein concentrates can improve the quality of some gluten-free foods. EEL shows promise for commercial production of sorghum protein concentrates because of its high throughput and potential for delivering high protein content and digestibility.

This thesis is focused on catering for pupils with celiac disease in school canteens. The first part, the theoretical one, deals with the disease itself; it gives basic information about the disease, its history, main symptoms, anatomy of healthy digestive system, and the most common health problems occurring when suffering from celiac disease. At the end of the theoretical part diagnosis of the disease is described as well as suitable and unsuitable diet food for celiac and food legislation. The practical part is a survey focused on catering for pupils with celiac disease at selected elementary schools. The survey was conducted in two regions in Valašské Meziříčí and in Prague. In the final part of my thesis special gluten-free menus for schools are suggested. The pedagogical outcome of my thesis is a lecture on celiac disease which can be held at elementary school s to help pupils find out basic information about this disease.

Celiac disease is an autoimmune disease which occurs in susceptible individuals after ingestion of food containing gluten. Gluten and its monomeric fraction gliadin induce inflammatory damage of the small intestine by activating the immune cells that react strongly to gluten peptides. Gluten peptides have the ability to activate cells of adaptive as well as innate immune system. This work is focused on the production of interleukin (IL)-1 in antigen presenting cells stimulated with peptic gliadin digest. We found that monocytes and peripheral blood mononuclear cells (PBMC) isolated from blood of celiac patients secrete significantly more IL-1α and IL-1β than cells of healthy donors after stimulation with gliadin digest. The gliadin-induced IL-1β expression is controlled by a signaling cascade that includes MAPK kinase family molecules and transcription factor NF-κB. Moreover, we found that the adaptor proteins MyD88 and TRIF as well as Toll-like receptor (TLR) 2 and 4 play a role in the signaling cascade underlying gliadin-induced IL-1β expression by using murine bone marrow derived dendritic cells (BMDC). The precursor form of IL-1β in gliadin- stimulated PBMC and murine BMDC is maturated by caspase-1. In celiac PBMC the gliadin- induced maturation and secretion of IL-1β depends on the potassium...

Celiac disease is an autoimmune disorder triggered by the ingestion of gluten, which is found in wheat, barley, and rye. The only treatment for celiac disease is a strict gluten-free diet (GFD), which eliminates common gluten-containing foods found in many cultures and cuisines. This research examined how families experienced celiac disease and the GFD in their households, focusing on the ripple effect of celiac disease for all members of the family and how families promoted adherence and quality of life (QOL). A mixed-methods approach used questionnaires, photographs, and semi-structured interviews with families recruited from the Celiac Disease Center at Columbia University Medical Center. Participants were 16 families with children ages 8-18 living at home who had physician-confirmed diagnoses of celiac disease. A total of 71 in-depth semi-structured interviews were conducted (n =16 reference children with celiac disease, 16 mothers, 15 fathers, 24 siblings). Results showed that the reference children with celiac disease had high GFD adherence (mean CDAT = 9) and QOL (mean CDPQOL 81 of 100). Mothers’ and fathers’ ratings of how their child’s celiac disease diagnosis affected their lifestyle, social life, and level of burden in caring for child’s dietary needs differed significantly (all p-values < 0.05), with mothers reporting more change and burden. Emerging themes related to a negative ripple effect included the burden of assuming the majority of food tasks related to GFD (mothers), the limited restaurant choices for the family (fathers), and feeling annoyed by having to limit certain foods at home (siblings). Emerging themes related to a positive ripple effect, included becoming more creative cooks (mothers), incorporating new family traditions (fathers), and developing empathy for others (siblings). Overall, there was substantial evidence of a ripple-effect of a child’s celiac disease diagnosis on other family members, including how mothers and fathers may experience the change in lifestyle and added responsibilities of maintaining the GFD differently. Including parents and siblings in research provides insight into the entire family experience and can help inform family-centered interventions on how to maximize QOL for everyone impacted by a child’s celiac disease diagnosis.

by Ho Wai-chun. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1998. / Includes bibliographical references. / Abstract also in Chinese. / Title / Dedication / Abstract --- p.i / Table of Contents --- p.iv / Glossary of abbreviation used in the thesis --- p.vi / List of figures --- p.viii / List of tables --- p.xvii / Acknowledgement --- p.xix / Statement of Originality --- p.xx / Chapter Chapter 1 ...... --- Introduction --- p.14 / Chapter Chapter 2...... --- Basic Principle / Chapter 2.1 --- The liver - a vital organ --- p.2-1 / Chapter 2.2 --- Blood supply to the liver --- p.2-7 / Chapter 2.3 --- Normal arterial anatomy of the coeliac axis --- p.2-11 / Chapter 2.4 --- Common anomalies of the coeliac axis --- p.2-17 / Chapter 2.5 --- Previous classification of coeliac anomaies --- p.2-24 / Chapter 2.6 --- Knowledge of arterial anomaly in relation to surgery --- p.2-31 / Chapter 2.7 --- Trans-catheter treatment of hepatocellular carcinoma --- p.2-33 / Chapter 2.8 --- Prevalence of hepatocellular carcinoma in H.K Chinese --- p.2-42 / Chapter 2.9 --- Management of hepatocellular carcinoma in Hong Kong --- p.2-43 / Chapter Chapter 3...... --- Definitions --- p.3-1 / Chapter Chapter 4...... --- Objectives of the study --- p.4-1 / Chapter Chapter 5...... --- "Materials, methods and subjects" / Chapter 5.1 --- Materials --- p.5-1 / Chapter 5.2 --- Methods --- p.5-3 / Chapter 5.3 --- Subjects --- p.5-10 / Chapter Chapter 6...... --- Results / Chapter 6.1 --- Coeliac axis --- p.6-5 / Chapter 6.2 --- Common hepatic artery --- p.6-9 / Chapter 6.3 --- Proper hepatic artery --- p.6-11 / Chapter 6.4 --- Right hepatic artery --- p.6-12 / Chapter 6.5 --- Middle hepatic artery --- p.6-20 / Chapter 6.6 --- Left hepatic artery --- p.6-28 / Chapter 6.7 --- Gastroduodenal artery --- p.6-33 / Chapter 6.8 --- Right gastric artery --- p.6-37 / Chapter 6.9 --- Left gastric artery --- p.5-45 / Chapter 6.10 --- Splenic artery --- p.6-49 / Chapter 6.11 --- Summary of results --- p.6-51 / Chapter Chapter 7...... --- Discussion / Chapter 7.1 --- Introduction --- p.74 / Chapter 7.2 --- Selective Internal Radiation --- p.7-3 / Chapter 7.3 --- Coeliac axis --- p.7-10 / Chapter 7.4 --- Common hepatic & proper hepatic artery --- p.7-7 / Chapter 7.5 --- Right hepatic artery --- p.7-14 / Chapter 7.6 --- Middle hepatic artery --- p.7-18 / Chapter 7.7 --- Left hepatic artery --- p.7-25 / Chapter 7.8 --- Gastroduodenal artery --- p.7-30 / Chapter 7.9 --- Right gastric artery --- p.7-35 / Chapter 7.10 --- Left gastric artery --- p.7-43 / Chapter 7.11 --- Splenic artery --- p.7-45 / Chapter 7.12 --- Comparison with the golden classics --- p.7-47 / Chapter 7.13 --- Comparison of subjects with HCC & without HCC --- p.7-50 / Chapter 7.14 --- Comparison of the male group and the female group --- p.7-51 / Chapter Chapter 8...... --- Conclusions / References --- p.B-1 / Bibliography --- p.B-1 / Appendix I Schematic diagram of histological anatomy of the liver --- p.A-l / Appendix II Embryology --- p.A-2 / "Appendix III Percentages of occurrence of the different types of coeliac axis, by Michels' study" --- p.A-3 / "Appendix IV Percentages of occurrence of the different types of the hepatic arterial blood supply, by Michels' study" --- p.A-4 / Appendix V No. of deaths from malignant liver cancer in Hong Kong froml984 to1993 --- p.A-5 / Appendix VI Flow chart for HCC management in PWH of Hong Kong --- p.A-6 / Appendix VII Comparison with Michels' study --- p.A-7 / Appendix VIII Comparison of the group with HCC and the group without HCC --- p.A-8 / Appendix IX Comparison of the male and female group --- p.A-9

O gânglio celíaco pertence ao plexo celíaco que consiste numa rede de nervos e tecidos de suporte. Os gânglios celíacos, pares, são alongados e situam-se ao longo da face caudal da origem da artéria celíaca. No lado esquerdo o gânglio está ligado por um ramo interganglionar. Ele está intimamente em contato com a superfície da aorta. A inervação autônoma da maioria dos órgãos abdominais faz-se pelo plexo celíaco e estes incluem o pâncreas, fígado, rim, vesícula biliar, epíplon, mesentério, estômago, intestino delgado e porções ascendente e transversa do cólon. A desnutrição protéico-calórica é um dos maiores problemas de saúde pública no mundo, representando nas nações subdesenvolvidas cerca de 40% das causas dos pacientes hospitalizados. Desta forma o estudo da inervação extrínseca do trato gastrintestinal (representada pelo gânglio celíaco) de ratos, sob os aspectos estereológicos e morfométricos, durante estados de desnutrição protéica será fundamental para aferir objetivamente (e não empiricamente) os possíveis danos neuronais ocasionados pela mesma. Ainda, o conhecimento destas informações quantitativas pode ser útil no entendimento da patogênese da neuropatia autonômica hipoproteica e conseqüentemente no seu tratamento, melhorando a qualidade de vida de pacientes animais e humanos. No decorrer deste estudo foram utilizados seis gânglios celíacos esquerdos provenientes de ratos Albinus Wistar neonatos machos provenientes de acasalamento durante um período de sete a dez dias. Três dos ratos eram desnutridos e três clinicamente saudáveis (ausência clínica de neuropatias) que foram usados como controle. Para os animais foram oferecida água sem restrições e uma dieta protéica (20% de proteína-caseina) para as fêmeas que gerarem o grupo controle constituído por três animais que serão denominados nutridos (N) e uma dieta hipoproteica (5% de caseína) para as fêmeas que gerarem o grupo desnutrido também composto por de três animais (D). A amostragem foi realizada de modo uniforme, sistemático e aleatório, volume ganglionar ou volume do gânglio (vg), número total de neurônios (n), densidade neuronal (nv), volume neuronal (vn), densidade de volume neuronal (vv). Todos os parâmetros estereológicos apresentaram valores superiores (bastante significativos). Os resultados sugerem a existência de diferenças biológicas, ou seja, os animais desnutridos apresentavam neurônios maiores e em maior número, mas distribuídos e mais afastados uns dos outros, já os desnutridos possuíam neurônios menores, menos numerosos e distribuídos em um número menor no gânglio. / The celiac ganglion belongs to the celiac plexus which consists of a net of nerves and supportive tissues. The celiac ganglia, even, are alonged and locate along the caudal face of the origin of the celiac artery. On the left side the ganglion is linked by an interganglionar branch. It is intimately in contact with the surface of the aorta. The autonomous innervation of most of the abdominal organs is made by the celiac plexus and these include the pancreas, liver, kidney, gall bladder, epíplon, mesentery, stomach, small intestine and ascendant and transversal portions of the colon. The proteic-caloric undernourishment is one of the largest problems of public health in the world, representing about 40% of the hospitalized patients in underdeveloped nations. Thus, the study of the extrinsic innervation of the gastrointestinal treatment (represented by the celiac ganglion) of rat, under the stereological and morphometric aspects, during states of proteic denutrition will be fundamental to objectively precise (and not empirically) the possible neuronal damages caused by the undernourishment. Still, the knowledge of these quantitative information can be useful in the understanding of the pathogenesis of the autonomous hipoproteic neuropathy and consequently in its treatment, improving the quality of life of patients, animals and humans. During this study, six left celiac ganglions of newborn male rats Albinus Wistar coming from coupling during a period from seven to ten days were used. Three of the mice were undernourished and three clinically healthy (clinical absence of neuropathies) were used as control. For the animals it was offered water with no restrictions and a proteic diet (20% of protein-casein) for the females that generated the group of control constituted by three animals which will be denominated nurtured (N) and a hipoproteic diet (5% of casein) for the females that generate the undernourished group also composed of three animals (D). The sampling was accomplished uniformly, systematic and aleatory, ganglionar volume or volume of the ganglion (Vref), total number of neurons (N), neuronal density (NV), neuronal volume (Vn), density of neuronal volume (Vv). All stereological parameters presented superior values (quite significant). The results suggest the existence of biological differences, in other words, the undernourished animals presented larger neurons and in larger number, but distributed one far from the other, the undernourished ones presented smaller and less neurons, and distributed in a smaller number in the ganglion.

O gânglio celíaco pertence ao plexo celíaco que consiste numa rede de nervos e tecidos de suporte. Os gânglios celíacos, pares, são alongados e situam-se ao longo da face caudal da origem da artéria celíaca. No lado esquerdo o gânglio está ligado por um ramo interganglionar. Ele está intimamente em contato com a superfície da aorta. A inervação autônoma da maioria dos órgãos abdominais faz-se pelo plexo celíaco e estes incluem o pâncreas, fígado, rim, vesícula biliar, epíplon, mesentério, estômago, intestino delgado e porções ascendente e transversa do cólon. A desnutrição protéico-calórica é um dos maiores problemas de saúde pública no mundo, representando nas nações subdesenvolvidas cerca de 40% das causas dos pacientes hospitalizados. Desta forma o estudo da inervação extrínseca do trato gastrintestinal (representada pelo gânglio celíaco) de ratos, sob os aspectos estereológicos e morfométricos, durante estados de desnutrição protéica será fundamental para aferir objetivamente (e não empiricamente) os possíveis danos neuronais ocasionados pela mesma. Ainda, o conhecimento destas informações quantitativas pode ser útil no entendimento da patogênese da neuropatia autonômica hipoproteica e conseqüentemente no seu tratamento, melhorando a qualidade de vida de pacientes animais e humanos. No decorrer deste estudo foram utilizados seis gânglios celíacos esquerdos provenientes de ratos Albinus Wistar neonatos machos provenientes de acasalamento durante um período de sete a dez dias. Três dos ratos eram desnutridos e três clinicamente saudáveis (ausência clínica de neuropatias) que foram usados como controle. Para os animais foram oferecida água sem restrições e uma dieta protéica (20% de proteína-caseina) para as fêmeas que gerarem o grupo controle constituído por três animais que serão denominados nutridos (N) e uma dieta hipoproteica (5% de caseína) para as fêmeas que gerarem o grupo desnutrido também composto por de três animais (D). A amostragem foi realizada de modo uniforme, sistemático e aleatório, volume ganglionar ou volume do gânglio (vg), número total de neurônios (n), densidade neuronal (nv), volume neuronal (vn), densidade de volume neuronal (vv). Todos os parâmetros estereológicos apresentaram valores superiores (bastante significativos). Os resultados sugerem a existência de diferenças biológicas, ou seja, os animais desnutridos apresentavam neurônios maiores e em maior número, mas distribuídos e mais afastados uns dos outros, já os desnutridos possuíam neurônios menores, menos numerosos e distribuídos em um número menor no gânglio. / The celiac ganglion belongs to the celiac plexus which consists of a net of nerves and supportive tissues. The celiac ganglia, even, are alonged and locate along the caudal face of the origin of the celiac artery. On the left side the ganglion is linked by an interganglionar branch. It is intimately in contact with the surface of the aorta. The autonomous innervation of most of the abdominal organs is made by the celiac plexus and these include the pancreas, liver, kidney, gall bladder, epíplon, mesentery, stomach, small intestine and ascendant and transversal portions of the colon. The proteic-caloric undernourishment is one of the largest problems of public health in the world, representing about 40% of the hospitalized patients in underdeveloped nations. Thus, the study of the extrinsic innervation of the gastrointestinal treatment (represented by the celiac ganglion) of rat, under the stereological and morphometric aspects, during states of proteic denutrition will be fundamental to objectively precise (and not empirically) the possible neuronal damages caused by the undernourishment. Still, the knowledge of these quantitative information can be useful in the understanding of the pathogenesis of the autonomous hipoproteic neuropathy and consequently in its treatment, improving the quality of life of patients, animals and humans. During this study, six left celiac ganglions of newborn male rats Albinus Wistar coming from coupling during a period from seven to ten days were used. Three of the mice were undernourished and three clinically healthy (clinical absence of neuropathies) were used as control. For the animals it was offered water with no restrictions and a proteic diet (20% of protein-casein) for the females that generated the group of control constituted by three animals which will be denominated nurtured (N) and a hipoproteic diet (5% of casein) for the females that generate the undernourished group also composed of three animals (D). The sampling was accomplished uniformly, systematic and aleatory, ganglionar volume or volume of the ganglion (Vref), total number of neurons (N), neuronal density (NV), neuronal volume (Vn), density of neuronal volume (Vv). All stereological parameters presented superior values (quite significant). The results suggest the existence of biological differences, in other words, the undernourished animals presented larger neurons and in larger number, but distributed one far from the other, the undernourished ones presented smaller and less neurons, and distributed in a smaller number in the ganglion.

Els Departaments de Salut Laboral proporcionen prevenció i tractament de patologies relacionades amb l’entorn laboral, però alhora també ajuden a detectar patologies freqüents de les que se’n pot realitzar prevenció. La incorporació d’autoanticossos específics de la malaltia celíaca (MC) al perfil analític dels Departaments de Salut Laboral és útil per detectar la malaltia celíaca i per revertir les complicacions associades a aquesta. La prevalença de MC a Catalunya no ha estat mai avaluada i no hi ha dades a la literatura mèdica que demostrin de manera inequívoca si hi ha diferències en la prevalença relacionades amb l’edat. La MC de l’adult és més prevalent del que es pensava prèviament i les seves característiques clíniques i histològiques difereixen de les del nen. Aquesta tesi conté dos estudis diferenciats, els objectius dels quals són: A) Objectius de l’estudi 1 1) Avaluar la freqüència i la rellavància clínica de l’ESG (tant de Marsh I com de Marsh III) detectada per serologia en un programa de cribratge poblacional sistemàtic de població en edat laboral. 2) Comparar la sensibilitat dels tTGA i EmA per detectar tot l’espectre de l’ESG (de Marsh I a Marsh III) 3) Avaluar el grau d’adherència al programa de cribratge sistemàtic i l’efectivitat de la instauració de DSG en els individus detectats per cribratge. B) Objetius de l’estudi 2 1) Avaluar la prevalença global de la MC en la població general de Catalunya. 2) Avaluar si existeixen diferències en la prevalença de la MC relacionades amb l’edat i el sexe.

Background: Celiac disease occurs worldwide in approximately 1% of the population, whereof the majority of cases are undiagnosed. Sweden experienced an epidemic (1984-1996) of clinically detected celiac disease in children below 2 years of age, partly attributed to changes in infant feeding. Whether the epidemic constituted a change in disease occurrence and/or a shift in the proportion of diagnosed cases remains unknown. Moreover, the cause of the epidemic is not fully understood. Objective: To increase the knowledge regarding the occurrence of celiac disease in Sweden, with focus on the epidemic period and thereafter, as well as the etiology of celiac disease in general, by investigating the Swedish epidemic and its potential causes. Methods: We performed a two-phased cross-sectional multicenter screening study investigating the total prevalence, including both clinically- and screening-detected cases, of celiac disease in 2 birth cohorts of 12-year-olds (n=13 279): 1 of the epidemic period (1993) and 1 of the post-epidemic period (1997). The screening strategy entailed serological markers analyses, with subsequent small intestinal biopsy when values were positive. Diagnosis was ascertained in clinical cases detected prior to screening. Infant feeding practices in the cohorts were ascertained via questionnaires. An ecological approach combined with an incident case-referent study (475 cases, 950 referents) performed during the epidemic were used for investigating environmental- and lifestyle factors other than infant feeding. Exposure information was obtained via register data, a questionnaire, and child health clinic records. All studies utilized the National Swedish Childhood Celiac Disease Register. Results: The total prevalences of celiac disease were 2.9% and 2.2% for the 1993 and 1997 cohorts, respectively, with 2/3 cases unrecognized prior to screening. Children born in 1997 had a significantly lower celiac disease prevalence compared to those born in 1993 (prevalence ratio, 0.75; 95% confidence interval [CI], 0.60-0.93). The cohorts differed in infant feeding; more specifically in the proportion of infants introduced to dietary gluten in small amounts during ongoing breastfeeding. Of the environmental and lifestyle factors investigated, no additional changes over time coincided with the epidemic. Early vaccinations within the Swedish program were not risk factors for celiac disease. Early infections (≥3 parental-reported episodes) were associated with increased risk for celiac disease (adjusted odds ratio [OR] 1.5; 95% CI, 1.1-2.0), a risk that increased synergistically if, in addition to having ≥3 infectious episodes, the child was introduced to gluten in large amounts, compared to small or medium amounts, after breastfeeding was discontinued (OR 5.6; 95% CI, 3.1-10). Early infections probably made a minor contribution to the Swedish epidemic through the synergistic effect with gluten, which changed concurrently. In total, approximately 48% of the epidemic could be explained by infant feeding and early infections. Conclusion: Celiac disease is both unexpectedly prevalent and mainly undiagnosed in Swedish children. Although the cause of the epidemic is still not fully understood, the significant difference in prevalence between the 2 cohorts indicates that the epidemic constituted a change in disease occurrence, and importantly, corroborates that celiac disease can be avoided in some children, at least up to 12 years of age. Our findings suggest that infant feeding and early infections, but not early vaccinations, have a causal role in the celiac disease etiology and that the infant feeding practice – gradually introducing gluten-containing foods from 4 months of age, preferably during ongoing breastfeeding – is favorable.