This diploma focuses on the selection of gluten-free foods from the perspective of a diagnosed celiac. In the theoretical part is described the history of celiac disease, anatomy and physiology of small intestine, pathogenesis, manifestation and forms of celiac disease, diagnosis, screening and complications from celiac disease. It also describes a treatment of celiac disease which shows inappropriate and appropriate aliments in gluten free diet. One chapter deals with labeling of gluten free foods in the Czech Republic and in Canada. There is also a comparison of the Czech Republic and Canada regarding health care, government and restaurants offering gluten free dishes. The aim of the research is to map the selection of gluten free foods in people with diagnosed celiac disease, the second target is to explore differences in food selection in the Czech Republic and Canada. The third objective is focused on factors influencing the choice of gluten free foods. The research was conducted through a questionnaire survey. The survey was filled in the Czech Republic by 78 celiacs and in Canada by 56 celiacs. In the Czech Republic the survey was online on page named Celiake and Mladí Celiaci on Facebook. The Canadian survey was online on page The Celiac scene on facebook and filled out by costumers in...

Orientadores: Gil Guerra Junior, Gabriel Hessel / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T04:12:05Z (GMT). No. of bitstreams: 1 Whitacker_FatimaCristinadeFreitas_M.pdf: 1719204 bytes, checksum: 7c00e2334204e8bd5e787cd47276ce2f (MD5) Previous issue date: 2008 / Resumo: Justificativa: Há quatro décadas é conhecida a associação entre Diabetes mellitus tipo 1 (DM1) e doença celíaca. Entretanto, a manifestação predominantemente atípica desta doença em diabéticos, dificulta seu diagnóstico e o reconhecimento de possíveis efeitos desta associação no controle do diabetes. Objetivos: Estimar a prevalência da associação entre DM1 e doença celíaca e verificar a presença de sintomas da doença celíaca, a ocorrência de outras doenças auto-imunes entre os pacientes e seus parentes de primeiro grau e as possíveis influências da doença celíaca no controle do diabetes. Casuística e métodos: Estudo transversal com 195 pacientes com DM1, que responderam um questionário sobre a presença de sintomas gastrintestinais e a ocorrência de doenças auto-imunes em familiares. Foi dosada a IgA e pesquisado o anticorpo anti-endomísio (EMA). Os pacientes com EMA positivo foram submetidos à biópsia intestinal. Aqueles com doença celíaca confirmada por biópsia (grupo casos) foram pareados com pacientes apenas diabéticos (grupo controle) segundo idade no momento da triagem, tempo de duração do diabetes e gênero. Resultados: O EMA foi positivo em nove pacientes. Em sete a biópsia confirmou DC (prevalência de 4%). No pareamento de casos (DM1 e doença celíaca) e controles (somente DM1), os sintomas gastrintestinais foram significativamente mais freqüentes no grupo casos, porém não houve diferença entre os grupos quanto ao controle do diabetes. Conclusões: A prevalência de doença celíaca neste grupo de pacientes com DM1 foi de 4%. A amostra de pacientes celíacos apresentou predomínio de sintomas gastrintestinais e a presença de doença celíaca não interferiu no controle do diabetes / Abstract: Justify: There were four decades that the association between Diabetes Mellitus type 1 (DM1) and celiac disease is known. However, the manifestation of celiac disease in diabetic patients is predominantly atypical, what difficult its diagnosis and the recognition of possible effect of this association in the control of diabetes. Objectives: To estimate the prevalence of DM1 and celiac disease association and to verify the existence of celiac disease symptoms, the occurrence of other autoimmune diseases among the patients and their first-degree relatives and the possible influences of celiac disease in diabetes control. Patients and methods: It was done a cross-sectional study with 195 patients that ansewered a questionnaire about gastrintestinal symptoms and the occurrence of autoimmune diseases in theirs first-degree relatives. IgA was measured and antiendomysial antibody (EMA) screened. The patients with positive EMA were submitted to intestinal biopsy. Those with celiac disease confirmed by biopsy (case group) were paired with DM1 patients without celiac disease (control group) according to age at the screening, time of diabetes duration and gender. Results: EMA was positive in nine patients. In seven of them the biopsy confirmed celiac disease (4.0%). Comparing the cases with controls, the gastrointestinal symptoms were significantly more frequent in the first group and there was no difference between the groups regarding to the control of diabetes. Conclusions: The prevalence found was 4.0%. This sample of celiac patients showed a predominance of gastrointestinal symptoms and the celiac disease did not influence the diabetes control / Mestrado / Pediatria / Mestre em Saude da Criança e do Adolescente

A doença celíaca (DC) é uma doença inflamatória induzida pela ingestão de glúten em indivíduos geneticamente predispostos e seu tratamento é baseado em uma dieta sem glúten por toda a vida. A doença celíaca refratária é um problema comum que afeta de 10% a 19% dos pacientes célicos tratados. Provavelmente, a contaminação da dieta por glúten é uma das razões principais para a persistência de sintomas em pacientes celíacos tratados, assim como a ingestão inadvertida de glúten, devido a rotulagem incorreta. Assim, o objetivo deste estudo foi avaliar a confiabilidade dos rótulos dos alimentos brasileiros processados, através de testes de contaminação de glúten nos seguintes grupos (a) produtos \"livres de glúten\" - preparados especificamente para a população celíaca; (b) produtos \"naturalmente sem glúten\" feitos com arroz, milho, soja e mandioca, utilizados por toda a população e (c) produtos rotulados com \"contém glúten\", mas que não apresentam glúten em sua composição no rótulo. Foram analisados 213 produtos alimentícios agrupados em: 115 produtos do grupo \"sem glúten\"; 86 produtos do grupo \"naturalmente sem glúten\" e 12 produtos do grupo rotulados com \"contém glúten\". O teor de glúten foi detectado e quantificado por ELISA-R5 (Ridascreen®gliadin) e os resultados foram expressos em ppm e mg/100 g de alimento. A linha de corte foi estabelecida em 20 ppm para a contaminação de glúten. Todas as contaminações por glúten foram confirmadas por Western-blotting. Resultados: (a) alimentos livres de glúten 15 das 115 (13%) apresentaram contaminação por glúten (20 ppm), (b) grupo de alimentos naturalmente sem glúten - 8 de 86 (9,3%) apresentaram contaminação por glúten (20 ppm); (c) grupo de alimentos rotulados com contem glúten - somente 2 de 12 (16,7%) apresentaram contaminação por glúten (20 ppm). A análise de Western-blotting confirmou 36 das 38 (95%) contaminações encontradas no ELISA-R5. CONCLUSÕES: Ambos os grupos de alimentos \"sem glúten\" e \"naturalmente sem glúten\" comercializados no Brasil apresentaram razoável porcentagem de contaminação por glúten, o que dificulta a realização de uma dieta adequada ao paciente celíaco. O grupo de alimentos rotulado \"com glúten\" não apresentou 100% de contaminação, o que revela que a rotulagem desses produtos deve ser feita como uma medida preventiva. Uma maior chance de contaminação pelo glúten foi observada para os produtos a base de arroz (13,6x), soja (13,3x) e milho (9,3x), mas não naqueles à base de mandioca. Em média, encontramos 10,8% (23 de 213) de contaminação de glúten para os alimentos analisados, um panorama positivo para a população brasileira celíaca, principalmente devido ao uso da mandioca, uma alternativa para a farinha de trigo. No entanto, a contaminação de glúten encontrada mostra a importância da quantificação de glúten em todos os alimentos industrializados. / Celiac disease (CD) is an inflammatory disorder induced by ingestion of gluten in genetically predisposed individuals and its treatment is based on a life-time gluten-free diet. Nonresponsive celiac disease is a common problem affecting from 10% to 19% of treated celiac patients. Probably a gluten contamination in diet is one of the major reasons for symptoms persistence in celiac patients as well as an inadvertent gluten intake due to a misleading nutritional label. The aim of this study was to evaluate the reliability of Brazilian processed food labels by testing gluten contamination in (a) gluten-free products - prepared specifically for the celiac population; (b) in naturally gluten-free products made with rice, corn, soy bean and cassava and used by all population and (c) in not gluten-free products labeled to contain gluten but not having it in their composition. We analyzed 213 food samples grouped accordingly to its type: 115 samples of \"gluten-free food, 86 samples of \"naturally gluten-free food and 12 samples of not-gluten free labeled products. The gluten content was detected and quantified by ELISA-R5 (Ridascreen® Gliadin) and the results were expressed in ppm and mg/100 g of food. A cut-off line was established in 20 ppm for gluten contamination. All gluten contaminations were confirmed by Western-blotting. Results: (a) Gluten-free foods - we found 100 of 115 samples (87%) with no contamination (< 20 ppm) and 15 of 115 (13%) showed gluten contamination 20 ppm; (b) Naturally Gluten-free foods - we found 78 of 86 samples (90,7%) showing no contamination (< 20 ppm) and 8 of 86 (9,3%) with gluten levels 20 ppm; (c) Not gluten-free foods - we found 10 of 12 samples (83,3%) showing no contamination (< 20 ppm) and 2 of 12 (16,7%) with gluten contamination 20 ppm. The Western-blotting analysis confirmed 36 of 38 (95%) contaminations found in the ELISA-R5. CONCLUSIONS: Both \"gluten-free and \"naturally gluten-free foods commercialized in Brazil have presented some gluten contamination making a restricted gluten-free diet hard to be achieved by the celiac population. Unexpectedly the not gluten-free group was not entirely contaminated showing a preventive measure in labeling by food companies. A higher odds ratio for gluten contamination was observed for products made with rice (13.6), soy bean (13.3) and corn (9.3) but not to cassava products (not significant). In general, we found a 10.8% (23 of 213) of gluten contamination for all food products analyzed, a positive panorama for the Brazilian celiac population mainly due to cassava products, an alternative for wheat starch. Nevertheless the gluten contamination found here leads us to the importance for a gluten quantification in all industrialized food to guarantee an appropriated diet to the Brazilian celiac group

Background: Celiac disease (CD) is an autoimmune disorder that affects genetically susceptible individuals and is induced by dietary gluten. Treatment consists of a lifelong gluten-free diet. CD is common and affects about 1% of the general population. The classic symptoms include diarrhea and malabsorption, but many patients have only mild symptoms or no symptoms at all. The proportion of individuals presenting with atypical symptoms or discovered only when investigating an associated condition of CD is increasing. Aims: The aim of this thesis was to investigate the risk of possible associated disorders through Swedish population-based registers. The objective was to gain more information on the consequences of having CD and to identify high risk groups where screening may be considered. Materials and methods: We used the Swedish hospital discharge register to examine the risk of liver disease, autoimmune heart disease, Addison’s disease and thyroid disorders in a cohort of about 14,000 individuals with CD and an age and sex matched reference population of 70,000 individuals. In the last study we used all regional pathology registers and the cancer registry to examine the risk of hematopoietic cancer, including lymphoma in three different cohorts: I) 28,810 individuals with CD; II) 12,681 individuals with small intestinal mucosal inflammation but without villous atrophy; and III) 3552 individuals with latent CD (a positive serology test for CD with a normal small intestinal biopsy). Results: CD is statistically significantly associated with an increased risk of liver disease, Addison’s disease, thyroid disease and lymphoma. We also found an increased risk of lymphoma in individuals with small intestinal mucosal inflammation. There was no statistically significant association between autoimmune heart disease or leukemia and CD. Latent CD was not associated with any hematopoietic cancers. Conclusion: This thesis found a positive association between CD and a number of autoimmune and inflammatory disorders. Clinicians need to have a high awareness of this association and to test for these conditions when symptoms appear.

Abstract Food hypersensitivities are becoming increasingly common worldwide. Previous studies indicate that cell mediated immunity has a role in delayed paediatric gastrointestinal food hypersensitivities, but the exact pathogenetic mechanisms are unknown. Cytotoxic activation of T-lymphocytes is known to play an important role in the pathogenesis of celiac disease (CD). The pathogenetic mechanisms of cow's milk protein sensitive enteropathy (CMSE) are largely unknown. CMSE is a non-IgE related type of food hypersensitivity with variable gastrointestinal symptoms but no visible mucosal abnormalities on light microscopy. The diagnosis is based on an open or blinded elimination/challenge test, as the endoscopic, histological and laboratory findings are generally non-specific. This thesis aims to characterize the role of lymphocyte cytotoxicity in the pathogenesis and diagnosis of CMSE in preschool and school aged children, including comparison with CD where the pathogenetic significance of cytotoxicity is well established. The study cohort consisted of 151 children, including 57 with untreated CMSE, 18 with treated CMSE, 24 with CD, and 52 controls. Using immunohistochemistry, the mucosal expressions of cytotoxic T cell-restricted intracellular antigen type 1 (TIA-1), perforin, granzyme A and B were analysed in the duodenal bulb and descending duodenum. Intraepithelial T-lymphocytes were labelled with CD3, alpha/beta and gamma/delta T cell receptor antigens. To determine the rates of overall and epithelial apoptosis as well as proliferation, the immunohistochemical TUNEL technique, M30 and Ki-67 antibodies were used. Serum levels of granzymes, CD30 and soluble Fas were studied using ELISA method. The number of intraepithelial lymphocytes with TIA-1, perforin and granzyme A containing granules was increased in CMSE. This increase was related to antigen challenge and not a constitutional abnormality. The cytotoxic reaction in CMSE differed from that in CD by being of lesser magnitude, concerning predominantly the descending duodenum and not showing signs of cytotoxicity related epithelial destruction. The serum levels of GrA, GrB and CD30 were increased in both CMSE and CD, correlating with the number of duodenal CD3+, alpha/beta and gamma/delta+ intraepithelial lymphocytes. The results strongly support the role of cell-mediated immunity in the pathogenesis of CMSE. Mucosal cytotoxic activation seems to be manifested by the release of cytoxicity related proteins in serum. This provides a new approach to the monitoring of intestinal immune activation which could help in diagnosis and in objectively monitored treatment response.

Electrical stimulation of the vagus nerve attenuates tumor necrosis factor (TNF) synthesis by macrophages and reduces the systemic inflammatory response. Current evidence suggests that the α7 nicotinic acetylcholine receptor present in the celiac/superior mesenteric ganglia is a key component in vagus nerve signaling to the spleen; however, there is currently no direct anatomical evidence that the α7 receptor is present in the murine celiac/superior mesenteric ganglia. Our study addresses this deficiency by providing anatomical evidence that the α7 receptor is expressed within the celiac/superior mesenteric ganglia and splenic nerve fibers using immunohistochemistry and quantitative polymerase chain reaction (qPCR). α7 receptor mRNA is highly expressed in the celiac/superior mesenteric ganglia and at low levels in the spleen compared to the brain. Double-labeling for α7 and tyrosine hydroxylase shows that α7 receptor protein is present on noradrenergic neurons within the ganglia and prejunctionally on noradrenergic nerve fibers within the spleen. The α7 receptor in the ganglia provides a possible location for the action of α7-selective agonists, while prejunctional α7 receptor expressed on splenic nerves may induce an increase in norepinephrine release in a positive feedback system enhanced by lymphocyte-derived acetylcholine.

While many health benefits have been associated with increased whole grain consumption, current researchers have not considered if the consumption of whole grains in currently recommended or higher amounts actually leads to health problems, specifically to a correlated increase in gluten sensitivity. The purpose of this study was to determine if diets high in whole grains or those that met the recommended daily intake of whole grains help minimize or increase gluten sensitivity, and when whole grains are consumed as recommended if they cause more harm than good. The theoretical basis for this quantitative, cross sectional design was the precaution adoption process model, allowing for the examination of preventive behaviors as a series of cognitive steps over time. Individuals (N = 5,746) from the National Health and Nutrition Examination Survey 2007 to 2012 were assessed for daily intake of whole grains before and after the release of the 2010 Dietary Guidelines for Americans, and from 2007 to 2010 for bowel health and sensitivity to whole grains. SAS correlations and regression analysis at p < .05 were analyzed. There was an increase in whole grain intake by 7.4% and in bowel sensitivity with 50% reporting increases in gas, but more data are needed to determine exact amounts that caused these increases in symptoms. Understanding the complete picture, policy makers and others will be more informed about current recommendations and the way that Americans eat, as well as if changes are needed for the future.

Prior research on eating behaviors has shown that romantic partners actively merge their dietary preferences throughout the course of a relationship and find significant value in cooking and eating the same foods together at the same times. Yet, little is known regarding the impacts of specific dietary support processes involved in maintaining said communal diet when one partner drastically alters his or her eating patterns. The current study defined dietary sacrifice as a phenomenon within the context of Celiac Disease (CD): a chronic illness that requires strict adherence to the gluten-free diet (GFD). Drawing from existing research on sacrifice within romantic relationships (e.g., Impett & Gordon, 2008), this project examined whether non-Celiac partners' adherence to the GFD during shared mealtimes impacted relationship satisfaction for both couple members. Female Celiacs and their non-Celiac cohabitating partners (N=152 couples) were recruited for an online survey through various support organizations. Given the dyadic design of this study, the Actor-Partner Interdependence Mediation Model (APIMeM; Ledermann, Macho, & Kenny, 2011) was used to examine the mediating influence of Dietary Approach and Avoidance Motives. Results indicated that partner support in the form of shared GFD adherence bolstered couple happiness to the extent that it was performed for positive gains (e.g., promoting health and well-being) by the non-Celiac. While dietary sacrifice was positively associated with Celiacs' relationship satisfaction above and beyond non-Celiacs' endorsement of Dietary Avoidance Motives, both dyad members experienced significantly lower relationship satisfaction when non-Celiac partners adhered to the diet to deflect negative outcomes (e.g., rejection, fighting). This study serves as the first application of relationship sacrifice research to a specific health issue, and the first psychological exploration into intimate partners' dietary support processes within the Celiac population.

Celiac Disease (CD) is an autoimmune disorder that emerges due to the ingestion of gluten, a protein found in a variety of common grains such as wheat, rye, and barley. Approximately 1 in 100 individuals in the US suffer from CD, making it the most commonly diagnosed gastrointestinal disorder (Ciclitira et. al., 2005). These proline-rich gluten peptides are resistant to proteolysis and accumulate in the duodenum of the small intestine. Once in the duodenum, these peptides illicit an autoimmune response resulting in villous atrophy. Current treatment for CD requires a rigorous adherence to a gluten-free diet. Nevertheless, gluten-containing grains are ubiquitous in the western diet, so accidental exposure to gluten remains as a persistent threat. The approach of this project centers on genetically engineering a strain Lactobacillus reuteri to secrete a Myxococcus xanthus prolyl endopeptidase (PEP), an enzyme that hydrolyzes a peptide bond adjacent to an internal proline residue. The data from this study revealed that recombinant M. xanthus PEP purified from E. coli was effective in degrading Suc-Ala-Pro-pNA, a chromogenic substrate containing an internal proline residue. When introduced into a L. reuteri expression vector, mutations accumulated in the vector over the course of 5 days. These data suggested that toxicity was possibly associated with M. xanthus PEP and the amyl signal peptide.

Celiac disease (CD), an autoimmune disorder affecting millions of Americans, poses significant obstacles leading to a normal life. With no known cure, adherence to a strict glutenfree diet (GFD) is essential. However, the cost and limited availability of gluten-free alternatives can burden individuals with CD. Additionally, factors such as socioeconomic status, nutrient deficiencies, and the nature of the disease may contribute to mental health issues. This study aimed to investigate the influence of adherence to a GFD on depression in CD patients. The prevalence of depression among individuals with CD from diverse backgrounds was examined, along with the analysis of macro- and micronutrient distribution and the impact of the GFD. Data from the National Health and Nutrition Examination Survey spanning three cycles (2009-2014) were extracted, including 70 CD patients and 271 participants reporting general gluten issues. The dataset was analyzed using SAS v9.4 (SAS Institute, Inc., Cary, NC) with the three cycles merged using a unique identifier sequential number. Sample weights were applied to mitigate bias in national estimates due to unequal probability of selection, while oversampling was utilized to enhance the study’s reliability when examining subgroups or minorities. Survey weight and sampling design considerations were incorporated into the SAS syntax to safeguard participants’ privacy, as managed by the National Center for Health Statistics. Multiple linear regression analysis revealed no significant association between depression and adherence to the GFD or CD; however, ethnicity showed significance. Celiac disease exhibited a prevalence of 0.12% among White individuals, 3-6 times higher than other ethnic groups, and was twice as prevalent in females compared to males. Notably, deficiencies in macro- and micronutrients among CD and GFD cases were observed. Carbohydrate intake exhibited a negative association with GFD consumers and those with CD, while individuals adhering to a GFD showed an association with decreased polyunsaturated fat consumption, yet within adequate intakes. Deficiencies in micronutrients such as thiamin, vitamins B12, D, and E, and calcium were also observed within GFD group, while a low sodium intake was observed among CD group. This study provides insights into the complex interplay between diet, mental health, and CD management.