Made available in DSpace on 2016-08-10T10:44:18Z (GMT). No. of bitstreams: 1 JULIANA SOUZA E SILVA.pdf: 5512462 bytes, checksum: 6eb9649a41c4fc1234a638bbb53fcf1d (MD5) Previous issue date: 2012-06-14 / This research aimed to develop a process for the manufacture of gluten free cookies which can be ingested by celiac patients. Celiac disease is characterized by the non digestibility of gluten in the small intestine. Gluten is a protein fraction found in wheat, barley, rye and malt. In the world, there are millions of people prevented from consuming different products with gluten. Thus, in this work describes the process to remove gluten from wheat flour, characterization by physic-chemical and technological analysis, optimization formulation of cookies and evaluation of sensory acceptability. Four brands of wheat flour type I obtained in Goiania (A, B, C and D). Was used in this work. The results showed that the best after the process deglutinization was sample C that was choose for to prepare the product. Gluten free-cookies was prepared using flour without gluten, sugar, margarine, eggs, baking powder, vanilla essence and chocolate chips. This formulation was submitted to a 40 member sensory panel to assess the attributes of appearance, texture, flavor and overall acceptance. Generally, the sensory analysis showed overall acceptance was 8,0 ( I like much ) for three attributes (flavor, texture and appearance). With regard to the variable flavor the result was 9 point in the hedonic scale (I like very much). Most members sensory wrote that they to intent to purchase the product. In evaluating the economic viability of the cookie, to verify the sustainability, it was observed that it is possible for patients with celiac disease, as well as the product was free of gluten with much more afford able price compared to existing products on the market reaching the main objective of the research to develop a sustainable product for diets restricted to gluten. / Esta pesquisa teve como objetivo desenvolver uma fórmula de cookie que possa ser consumida por pacientes celíacos. A doença celíaca é caracterizada pela não digestibilidade do glúten no intestino delgado. O glúten é a fração protéica presente no trigo, cevada, centeio e malte. Mundialmente existem milhões de pessoas impedidas em consumir diversos produtos com glúten. Desta forma, neste trabalho desenvolveu-se uma metodologia para retirar o glúten da farinha de trigo, caracterizar por análises físico-químicas e reológicas, aperfeiçoar a formulação dos cookies sem glúten e avaliar a aceitação sensorial. Foram utilizadas quatro marcas de farinhas de trigo especial tipo I, obtidas no comércio de Goiânia/GO (A, B, C e D). A farinha que apresentou melhores características após o processo de desglutinização foi a C, a qual foi utilizada na formulação que teve como base a farinha sem glúten, açúcar, margarina, ovos, fermento, essência de baunilha e gotas de chocolate. A análise sensorial de aceitação evidenciou que o produto foi bem aceito, já que a maioria dos provadores atribuiu média global 8 para os três atributos: sabor, textura e aparência, que na escala hedônica de 9 pontos usada, corresponde à descrição gostei muito . A maioria dos provadores também apresentaram intenção de compra do produto em questão, comprovando a sua boa aceitação. Ao avaliar a viabilidade econômica do cookie sem glúten, para verificação da sustentabilidade, observou-se que o mesmo é viável para portadores de doença celíaca, já que o produto, além de isento de glúten, ficou com o preço bem mais acessível que os produtos existentes no mercado, atingindo o objetivo principal da pesquisa de desenvolver um produto sustentável para dietas restritas ao glúten.

Introdução e Objetivos: A maior prevalência de doença celíaca (DC) em indivíduos com diabetes mellitus tipo I (DM1) já é reconhecida. Ambas as doenças tem causa autoimune, em que os genes HLA classe 2 representam o principal fator genético de risco. Porém, existe uma considerável parcela da população que não manifesta tais doenças e são portadores desses genes. Estudo de associação genômica (GWAS) identificaram polimorfismos de susceptibilidade às duas doenças em genes diferentes do sistema HLA, que poderão auxiliar na compreensão da causa e das suas variabilidades clínicas. Os objetivos desse estudo foram avaliar as frequências dos polimorfismos HLA e não HLA em pessoas como DM1 e com DC e relacionar esses dados com a ocorrência de sintomas gastrointestinais, com a idade do diagnóstico da DM1 e com história alimentar. Métodos: Delineamento transversal, com avaliações retrospectivas e prospectivas, em pessoas com DM1 com e sem DC. Foram realizadas entrevista e revisão de prontuário dos pessoas, seguido de coleta de sangue ou saliva. A pesquisa dos genes RGS1, IL2-IL21, BACH2, TLR7/TLR8 e IL18RAP foi realizada por PCR Real-Time. Os alelos DQA1* 0501 e DQB1* 0201 para DQ2.5 e o alelo DQB1*0302 para DQ8 foram identificados a partir da técnica de genotipagem de HLA Tag-single-nuleotide polymorphism (Tag SNP). Resultados: As frequências alélicas e genotípicas entre 273 pessoas com DM1 sem DC e 39 pessoas com DM1 e DC não apresentaram diferença significativa. A presença de sintoma gastrointestinal foi mais frequente nos portadores dos polimorfismos dos genes RGS1 e IL18RAP. O tempo de aleitamento materno, a idade de introdução do glúten e a idade do diagnóstico da DM1 foram semelhantes entre os grupos. A comparação dos cinco polimorfismos com a combinação dos haplótipos para DQ2.5 e DQ8 não apresentou diferença significativa. Nos 312 indivíduos, com DM1 com e sem DC e nos 66 indivíduos portadores de DC sem DM1 foi identificado alelos DQ2.5 e ou DQ8 em 97% dos casos, enquanto que nos indivíduos com DC sem DM1 identificou-se em 76% dos casos. DQ2.5 foi mais frequente entre pessoascom DC e DQ8 foi mais frequentes entre pessoas com DM1. Conclusões: A presença dos polimorfismos dos genes estudados não modificou a chance do indivíduo com DM1 ter ou não DC. Houve associação dos genes RGS1 e IL18RAP com sintomas gastrointestinais. A pesquisa dos alelos DQ2.5 e DQ8, pela técnica Tag-SNP, permitiu determinar um alto valor preditivo negativo no diagnóstico de DC na população com DM1 e com DC, semelhante ao descrito na literatura com a técnica convencional. / Introduction and Objectives: The higher prevalence of celiac disease (CD) in individuals with diabetes mellitus type I (T1D) is already recognized. Both diseases have autoimmune cause, where HLA genes class 2 represent the major genetic risk factor. However, there is a considerable portion of the population that does not manifest such diseases and are carriers of these genes. Genome-wide association studies (GWAS) have identified susceptibility polymorphisms to both diseases in different genes of the HLA system that may assist in understanding the etiology and in its clinical variabilities. The objectives of this study were to evaluate the frequencies of HLA and non-HLA polymorphisms in patients with T1D and CD, related to the occurrence of gastrointestinal symptoms, the age of diagnosis of T1D and food history. Methods: Mixed design with retrospective and prospective evaluations in patients with T1D with and without DC. They were conducted interview and review of medical records of patients, followed by collecting blood or saliva. The search for genes RGS1, IL21-IL2, BACH2, TLR7 / TLR8 and IL18RAP was performed by Real-Time PCR. The alleles DQA1 * 0501 and DQB1 * 0201 for DQ2.5 and DQB1 * 0302 for DQ8 were identified from the Tag-single-nucleotide polymorphism (tag SNP) genotyping HLA technique Results: The allelic and genotypic frequencies between 273 T1D patients without CD and 39 patients with T1D and CD showed no significant difference. The presence of gastrointestinal symptoms were more frequent in patients with polymorphisms of genes RGS1 and IL18RAP. The duration of breastfeeding, the age of introduction of gluten and the age of diagnosis of T1D were similar between the groups. The comparison of the five polymorphisms with the combination of haplotypes for DQ2.5 and DQ8 showed no significant difference. In 312 individuals with DM1 with and without CD and 66 individuals with CD without T1D was identified alleles DQ2.5 and/or DQ8 in 97% of cases, whereas in individuals with CD without T1D was identified in 76% of cases . DQ2.5 was more frequent among patients with CD and DQ8 was more frequent among patients with T1D Conclusions: The presence of polymorphisms of genes studied did not modify the chance of T1D whether or not DC. There was an association of RGS1 and IL18RAP genes with gastrointestinal symptoms. The survey of DQ2.5 and DQ8 alleles by Tag-SNP technique allowed determining a high negative predictive value in the diagnosis of CD in the population of patients with T1D and DC, similar to that described in the literature with the conventional technique.

Des réseaux aléatoires de nanoélectrodes ont été utilisés comme plateformes analytiques pour développer de nouveaux biocapteurs enzymatiques ou d’affinité. Dans ce travail de thèse, il s’est agi de préparer un biocapteur à glucose miniaturisé et des immunocapteurs électrochimiques et électrochimiluminescents (ECL) pour le diagnostic de la maladie de coeliaque. Dans un premier temps, un biocapteur enzymatique de seconde génération a été développé en exploitant les propriétés de réseaux aléatoires de nanoélectrodes. Ces réseaux ont été préparés par dépôt d’or au niveau de membranes "track-etched" de polycarbonate. Le capteur à glucose a été obtenu en immobilisant la glucose oxydase sur la surface de polycarbonate non-conductrice alors que les nanoélectrodes d’or sont exploitées comme transducteur. Le cation (ferrocènylmethyl)triméthylammonium a servi comme médiateur redox dans cette configuration expérimentale qui a conduit à une limite de détection de 36 μM pour le glucose.Dans un second temps, ce travail a porté sur l’élaboration d’outils de diagnostic pour la maladie de coeliaque. C’est une maladie auto-immune qui induit une concentration anormalement élevée de l’anticorps anti-transglutaminase (anti-tTg) dans le sang. Cette molécule anti-tTG est un biomarqueur adapté pour le diagnostic de cette pathologie. Les techniques de diagnostic actuelles souffrent d’une spécificité et d’une sensibilité insuffisantes. Pour améliorer ces aspects analytiques, deux types d’immunocapteurs ont été développés. Ils différent par la nature du signal, soit électrochimique soit ECL. La première étape commune est l’immobilisation, à la surface du polycarbonate entourant les nanoélectrodes, de la protéine tTG qui permet de capturer l’anticorps anti-tTg. Pour la détection électrochimique, un anticorps secondaire marqué par la peroxydase du raifort peut réagir avec un méditeur redox tel que l’hydroquinone et ainsi induire un signal électrochimique au niveau des nanoélectrodes. Pour le capteur ECL, la capture de l’anticorps cible anti-tTG permet de fixer ensuite un anticorps secondaire biotinylé qui se lie avec le luminophore, Ru(bpy)3+2, modifié par une streptavidine. L’imposition d’un potentiel suffisamment anodique au niveau des nanoélectrodes oxyde le co-réactif, la tri-n-propylamine, et génère ainsi des flux importants de radicaux qui diffusent et induisent l’émission ECL en réagissant avec le luminophore immobilisé. Cela conduit à une limite de détection de 0,5 ng.mL-1 qui est inférieure à celle obtenue par la voie électrochimique. Les 2 immunocapteurs ont été appliqués à l’analyse d’échantillons de sérum sanguins de patients et cela a permis de discriminer les échantillons des patients sains de ceux atteints de cette pathologie. / Nanoelectrode ensembles (NEES) are prepared, functionalized and tested to prepare enzymatic and affinity sensors suitable for advanced molecular diagnostics purposes, namely the development of a miniaturized glucose biosensor and the preparation of novel electrochemical and electrochemiluminescence immunosensors for celiac disease diagnostics.For the first goal, a second generation enzymatic microbiosensor was developed exploiting the properties of NEEs prepared by electroless gold deposition in track-etched polycarbonate (PC) membrane. The micro-NEE glucose biosensor (overall radius of 400 μm) was obtained by immobilizing glucose oxidase (GOx) on the nonconductive PC component of the NEE, while the Au nanoelectrodes were used exclusively as transducers. The (Ferrocenylmethyl)trimethylammonium cation (FA+) was used as the redox mediator. The proposed biosensor showed outstanding analytical performances with a detection limit of 36 μM for glucose.The second goal concerns celiac disease (CD) diagnostics. CD is an auto-immune disorder which reflects in abnormally high blood levels of the anti-tissue transglutaminase (anti-tTG) antibody, suitable as biomarker for CD diagnosis. Existing diagnostic techniques lack the desired level of sensitivity and specificity so that a confirmatory biopsy test is required. To overcome this limit, in this work electrochemical (EC) and electrogenerated chemiluminescence (ECL) immunosensors are proposed and studied. The two kinds of sensor employ the same biorecognition platform, based on tTG as biorecognition layer and NEEs as electrochemical transducers. EC and ECL sensors differ by the label used to develop the detection signal. By exploiting the high affinity of PC for proteins, the capture agent tTG is at first immobilized on the PC of the NEEs obtaining a tTG-NEEs which captures anti-tTG. For EC detection, the label is a secondary Ab labeled with horseradish peroxidase, using hydroquinone as redox mediator to generate the detection signal. For ECL, the sensor, after capturing anti-tTG, is reacted with a biotinylated secondary antibody to bind streptavidinatede Ru(bpy)3+2 luminophore. Application of an oxidizing potential in tripropylamine (TPrA) solution generates an intense ECL suitable for the sensitive ECL detection of anti-TG. Note that TPrA acts as redox mediator and ECL co-reactant. Both EC and ECL sensors are applied to human serum samples, showing to be suitable to discriminate between healthy and celiac patients. A comparison between the two approaches indicates that the lowest detection limit, namely 0.5 ng mL-1 of anti-TG, is achieved with the ECL immunosensor.

Introdução: O envolvimento hepático na doença celíaca (DC) é amplamente reconhecido e atualmente é uma das manifestações extra-intestinais mais freqüentes. Com o advento de marcadores sorológicos de elevada especificidade e sensibilidade, sobretudo o anticorpo antiendomísio (EMA), a DC tem sido descrita em associação a várias hepatopatias. Objetivos: caracterizar as formas de triagem de DC em portadores de hepatopatia crônica; caracterizar e estudar os pacientes cujo diagnóstico de DC foi realizado durante a investigação de uma doença hepática; pesquisar a reatividade do antiendomísio em pacientes com hepatite auto-imune, cirrose biliar primária, colangite esclerosante primária e hipertensão portal não cirrótica; avaliar o comportamento da doença hepática na vigência de dieta sem glúten. Métodos: Os pacientes foram triados pela detecção dos anticorpos anti-reticulina e anticorpo antimatriz extracelular durante a rotina de imunofluorescência de pesquisa dos auto-anticorpos hepáticos; pela presença de manifestações de DC em hepatopatas crônicos, pelo aspecto endoscópico sugestivo de DC e pela pesquisa sistemática do EMA nas patologias referidas anteriormente. Todos os pacientes foram submetidos à pesquisa do EMA, anti-reticulina IgG ou antimatriz de fibroblastos IgG na presença de deficiência de IgA. Em caso de positividade desses marcadores, foram submetidos à endoscopia digestiva alta para biópsia intestinal e caracterizados do ponto de vista clínico, laboratorial e histopatológico. A evolução desses dados permitiu a caracterização da evolução da doença hepática e da doença celíaca a partir da introdução da dieta sem glúten. Resultados: Foram identificados 43 pacientes com auto-anticorpos relacionados à DC (em 42 o EMA IgA e em um o antimatriz extracelular IgG em associação com deficiência de IgA). A rotina de pesquisa de auto-anticorpos hepáticos identificou 31 pacientes; seis apresentavam hepatopatia crônica e manifestação de DC; em três o exame endoscópico foi sugestivo de DC e a pesquisa sistemática do EMA foi positiva em três casos. O diagnóstico de DC foi confirmado em 37 de 40 pacientes (92,5%) em que a biópsia intestinal foi realizada. A idade dos pacientes variou de 2 a 68 anos, com mediana de 35 anos. Houve maior prevalência de acometimento no sexo feminino (65%). A DC foi mais prevalente na raça branca (87%), mais foi identificada em quatro mulatos e um negro. As doenças hepáticas mais freqüentes foram hipertransaminasemia criptogênica, hepatite auto-imune, hiperplasia nodular regenerativa e hepatite pelo vírus C. Conclusões: 1) A reatividade do anti-reticulina, a presença de diarréia inexplicada e a análise endoscópica da mucosa duodenal foram as formas de seleção mais efetivas de se identificar a DC em hepatopatas crônicos. 2) A ausência de manifestações clínicas de DC nesse grupo de pacientes foi bastante expressiva. 3) A pesquisa sistemática do EMA em cirrose biliar primaria, hepatite auto-imune, colangite esclerosante primária não contribuiu para o diagnóstico de DC em um número significativo de pacientes, ao contrário do observado no grupo de hipertensão portal não cirrótica, especialmente hiperplasia nodular regenerativa 4) As doenças hepáticas em que mais freqüentemente foi diagnosticada a DC foram a hiperplasia nodular regenerativa, hepatite auto-imune, hipertransaminasemia criptogênica, hepatite pelo vírus C e cirrose biliar primária antimitocôndria negativo. 5) A retirada do glúten da dieta contribuiu de maneira efetiva para normalização das enzimas hepáticas nos casos de hipertransaminasemia criptogênica. Nos grupos de hiperplasia nodular regenerativa, hepatite B e C, cirrose biliar primária, álcool e hepatite auto-imune, o papel da dieta foi de difícil avaliação em razão da interferência da instituição do tratamento específico e da evolução natural da doença hepática de base. / Introduction: The hepatic involvement in Celiac Disease (CD) is well known and widely regarded as a frequent extra-intestinal manifestation. With the advent of highly specific and sensitive serological markers, especially the antiendomysial antibody (EMA), CD has been described in association with several liver conditions. Objectives: To characterize ways for screening patients with chronic liver conditions in order to diagnose CD, to characterize and study patients whose CD diagnoses were performed when investigating hepatic diseases, to test the reactivity of EMA in patients with autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis and non-cirrhotic portal hypertension, to evaluate the course of the hepatic disease in gluten-free diet. Methods: Patients were selected by the detection of antireticulin and anti-extracellular matrix antibodies during routine immunoflourescence determination for hepatic autoantibodies, by the presence of CD manifestations in chronic patients with liver diseases, by the endoscopic aspects suggestive of CD and by systematic search for EMA in the above mentioned pathologies. All patients were submitted to tests for EMA, antireticulin IgG or antimatrix of IgG fibroblasts in IgA deficiency. When testing positive for these markers, patients were submitted to upper digestive endoscopy for intestinal biopsy, and were also characterized from the clinical, laboratorial and histological point of view. The assessment of these data enabled the characterization of the hepatic condition as well as the CD from the onset of a gluten-free diet. Results: 43 patients with autoantibodies related to CD were identified (42 tested positive for IgA EMA and 1 for IgG extracellular antimatrix in the presence of IgA deficiency). Routine determination of hepatic autoantibodies identified 31 patients. Of those, 6 presented chronic liver diseases and CD manifestations. In 3 patients, the endoscopic exam was suggestive of CD; systematic EMA determination was positive in all three cases. The CD diagnosis was confirmed in 37 out of 40 patients (92.5%) that performed intestinal biopsy. Patients aged between 2 and 68 years (median: 35 years). Female patients were most affected (65%). CD was more prevalent in white patients (87%), but was also found in four mulattoes and 1 black person. The most common liver disorders were cryptogenic hypertransaminasemia, autoimmune hepatitis, nodular regenerative hyperplasia and chronic hepatitis C. Conclusions: 1) The reactivity of antireticulin, the presence of unexplained diarrhea and the endoscopic analysis of the duodenal mucous were the most effective ways to identify CD in chronic liver diseases. 2) The absence of CD clinical manifestations in this group of patients was impressive. 3) Contrary to what was observed in the group with non-cirrhotic portal hypertension, especially regenerative nodular hyperplasia, the systematic determination of EMA in primary biliary cirrhosis, autoimmune hepatitis and primary sclerosing cholangitis did not contribute to CD diagnosis in a significant number of patients. 4) CD was most frequently diagnosed in the following liver diseases: cryptogenic hypertransaminasemia, autoimmune hepatitis, nodular regenerative hyperplasia and chronic hepatitis C and negative antimitochondrial primary biliary cirrhosis. 5) The removal of gluten from the diet contributed effectively to bring the hepatic enzymes levels back to normal in cases of cryptogenic hypertransaminasemia. However, the role of diet was difficult to evaluate in nodular regenerative hyperplasia, autoimmune hepatitis, alcohol disease and primary biliary cirrhosis groups due to the nature of the specific treatments and the natural course of the hepatic conditions.

Celiac disease (CD) is a common heritable immune related disorder where chronic inflammationof the small intestine is induced by the ingestion of gluten. The immune response leads to theinflammation and flattening of intestinal mucosa due to the damaged villi and thus results indefects in the absorption of nutrients. This defect can affect any organ or body system and exposeto the risk of lifelong complications such as cancer, autoimmune diseases and other complexdiseases. Now a day, celiac disease is becoming one of the well-studied models of complexdisorders.The PI3K- FOX signaling pathway is activated by many regulators and growth factors and playsa key role in cell cycle. Two components of this pathway, INSR and FOX, play crucial roles indiverse aspects of embryogenesis from the initial tissue genesis up to organ formation. INSR andFOX take part in development, differentiation, proliferation, apoptosis and stress resistance aswell as metabolism. SNP´s could affect the expression of neighboring genes. These SNP´s areshown to be as eQTLs, genomic loci that regulate the expression of genes. The aim of this studywas to detect and quantitate the expression of INSR and certain FOX genes in celiac disease.Quantitative real time PCR (QPCR) was used to analyze the expression of INSR, FOXO1,FOXO4 and FOXD3 genes in 38 celiac cases and 50 control samples. Three reference genesACTB, EPCAM and PGK1 were tested for their expression stability and their average was used inthe normalization procedure. Gene expression results were analyzed using the ΔCt method. Theexpression of INSR, FOXO1, FOXO4 and FOXD3 were described as their fold change in CDcompared to normal non-celiac mucosa. Our results indicated that FOXO4 and INSR wereexpressed less by 0.60 fold and FOXO1 was expressed less by 0.23 fold in CD samples. Theresults are preliminary and further studies will be needed to confirm if these findings are a resultof the intestinal inflammation in CD or if these genes are partly driving the disease itself.

Introduction: More and more children and young people get the diagnosis celiac disease established. Celiac is a life-long disease, which means that the child during the rest of its life has to be on a strictly gluten-free diet. There are few studies so far, which have examined how children having a life-long disease with food treatment and increasing prevalence really experience their health related quality of life (HRQoL). Purpose: The purpose of the study was to examine how children (8 – 18 years old) suffering from celiac valued their HRQoL and to illustrate as well whether the age of the child and its extent of disease when it was taken ill affected the child’s evaluation of HRQoL later in life. The purpose was also to compare whether the children’s parents valued the HRQoL of their children to the same extent as the children did. Method: 160 children, 54 boys and 102 girls were included in the study. Answers from 149 children/parents are being worked up in the result. DISABKIDS Chronic generic measure – DCGM – 12 in a short version for both children and parents is used to measure HRQoL during the last four weeks. Results: There was no difference between how boys and girls of different age experienced their total HRQoL during the latest four weeks. Nor were there any visible dissimilarities in the individual domains (mental, social and psychic health). The children who were diagnosed before the age of four being much affected by their disease at the time of the diagnosis valued their HRQoL higher than the children who were diagnosed after the age of four. The children who had been suffering from their disease during a longer period (>8, 7 years) showed a higher degree of HRQoL. The parental evaluation of their children’s HRQoL was lower than that of their own children, in the evaluation of the total HRQoL as well as in the individual domains (mental, social and psychic health). Conclusion: The test “DISABKIDS” shows that the majority of children suffering from celiac disease judged their HRQoL as very good during the last four weeks. Children suffering from celiac showed in this study a higher HRQoL than all the other groups of diagnosis having used DISABKIDS.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2010. / Härtill 4 uppsatser.

Background: The only treatment for celiac disease consists of excluding gluten. Gluten is a protein complex found in wheat, rye, and barley, which are cereals commonly used in bread, pasta, pizza, etc. The overall aims of this thesis were to study; what happens with food choices and nutrient intakes when individuals are prescribed a gluten-free diet and what consequences this has on the everyday lives of young women and young men dealing with this disease. Methods: A food frequency questionnaire (FFQ) was used to study nutrient intake and how food choices were affected after a change to a gluten-free diet. The FFQ was sent to 12-13 years-old adolescents who took part in a large Swedish celiac screening study. The following three groups were studied: previously diagnosed with celiac disease, screening-diagnosed and non-celiac controls. The first FFQ was sent out before the screening-diagnosed adolescents had been told they had celiac disease, and the second was sent 12-18 months after they had been prescribed the gluten-free treatment. Semi-structured interviews were performed five years later in order to study how everyday life was affected by celiac disease in seven young women and seven young men. The interviews were analyzed by content analysis. Results: The previously diagnosed celiac disease group reported a nutrient intake in line with the non-celiac control group. Most of the participants reported nutrient intakes above the estimated average requirements. A diagnosis of celiac disease altered the intake of some foods, and this was shown by comparing the results from the baseline FFQ before the diagnosis and the follow-up FFQ after. The young women and young men reported similar experiences of the gluten-free food, but the perceived consequences of living with celiac disease differed between genders. Conclusion: This thesis shows that after a diagnosis of celiac disease food changes are necessary in order to be compliant with the gluten-free diet. One common effect is that food options will be reduced. However, as long the food intake is gluten-free, varied, and in sufficient quantity there is no reason to worry more about the nutritional intake of adolescents diagnosed with celiac disease than there is for their non-celiac peers. The findings in this thesis also show that society’s gender order has a great impact on how young women and young men experience their everyday lives, with celiac disease, and with the gluten-free diet.

The media has highlighted a proposed link between a gluten free diet (GFD) and weight loss. However, research related to weight gain and a GFD for persons with celiac disease (CD) has shown the opposite effect. A GFD is the only known treatment for persons with CD. If a patient with CD consumes a diet high in GF processed foods, weight management may be difficult to achieve. Participants with self-reported CD completed a modified GF food frequency questionnaire (FFQ) to assess typical dietary consumption of whole grains, sweets, fruits, vegetables and regular soda. Additionally, body mass index (BMI) and exercise were assessed. The results of this study found that whole grain, fruit and vegetable intakes were low among celiac patients. Additionally, BMI was on the high end of the normal weight range. The results of this study indicate that a greater emphasis should be placed on nutritional quality when counseling patients with CD. Registered dietitians should focus their diet counseling sessions with CD patients on a nutritious naturally GF diet in order to better manage weight.

Background  Celiac disease (CD) is a chronic disorder in genetically predisposed individuals in which damage to the small intestine is caused by eating foods containing gluten. The prevalence has been shown to vary from around 1-3%, but most people with CD are undiagnosed. An option for finding those with unrecognized CD would include screening the general population, i.e., mass screening. However, screening identifies a pre-disease or disease condition in people who are presumed healthy and have not sought help. Therefore, the impacts of the screening process and being diagnosed through screening should be explored before such a public health intervention is considered. A population-based CD screening study involving 12-year-olds was undertaken in Sweden and provided an opportunity to explore these issues related to CD screening. Aims To make inferences about the potential impacts mass screening for CD can have on participants by exploring experiences and outcomes for participants involved in CD screening study. Methods and Subjects  Both qualitative (short written narratives) and quantitative (questionnaires with EQ-5D instrument) methods were used. Children who participated in the CD screening study were invited to write narratives at the time of the screening, before screening results were known, describing their experience with the screening (n=240). The EQ-5D instrument was used to measure and compare health-related quality of life reported by participants at the time of the screening and one year after the screening-detected participants received their diagnosis (screening-detected n=103, referents n=483). Those with screening-detected CD were also invited to write narratives one and five years after their diagnosis. In these narratives the adolescents described how it felt to be diagnosed with CD, how it felt to live with CD, and if they thought all children should be screened (one-year follow-up n=91, five-year follow-up n=72). Results  Even though some children experienced fear and anxiety during the screening, overall they had, or were provided with, tools that allowed them to cope well with the screening. The health-related quality of life reported by those with screening-detected CD was similar before and one year after diagnosis (and similar to that of the referents). We also found that after five years of living with the diagnosis there had been maintenance and evolution in the beliefs and practices of these adolescents. Being detected through screening and the threat of complications impacted how they felt about the diagnosis, coped with the gluten-free diet, and what they thought about CD screening. Five years after the screening-detected diagnosis the adolescents have adjusted to the disease and adapted new habits and coping strategies to deal with the gluten-free diet. However, there are still those who doubt the accuracy and benefit of the diagnosis.   Conclusions  Our findings suggest that it is possible for participants to avoid excess anxiety during CD screening. However, there was not consensus among participants that being detected and treated had improved their health-related quality of life or that the immediate benefits outweighed the harm caused by being detected in this way. When considering mass screening, the affect on the participants is important to take into account and our findings shed light on some of the potential impacts a CD mass screening could have on participants.