abstract: Background: Research has found that nearly a quarter of the American population follows a gluten-free diet in some capacity, while only about 1% of the population is diagnosed with celiac disease. Although the amount of research-based evidence supporting any health benefits of a gluten-free diet in an individual without a gluten- related disorder is limited, the number of people claiming to follow a gluten-free diet continues to rise. Also, despite an increasing belief that gluten is harmful for health, the potentially undesirable effects of gluten substitutions used in gluten-free foods are largely unknown. Due to the protein network encapsulating starch granules, gluten is thought to lengthen the amount of time needed during starch digestion, thereby reducing postprandial glycemia. Therefore, it is predicted that breads containing gluten will produce a lower glycemic response compared to gluten-free breads. Aim: The aim of this study was to investigate the glycemic response of gluten-free bread made with different types of flour compared to bread made with gluten-containing wheat flour. Methods: This study involved a 3-week, randomized, single blind crossover study in which 17 healthy individuals were asked to consume a different type of bread each week, 2 of which were gluten-free. Blood glucose was taken by finger prick at fasting as a baseline measurement, then for 2 hours after bread consumption in 30-minute increments. Results: Across the three groups, there was no significant difference in iAUC values after 120 minutes (p=0.192 ). The greatest mean was seen in the gluten-containing bread (145.3 ± 82.6), then the gluten-free bread made with rice flour (125.5 ± 62.8), and lastly the gluten-free bread made with potato and fava bean flour (112.4 ± 64.5). Conclusion: The inconsistent results of this study compared to previous, similar studies suggests that the postprandial glycemic response of gluten-free products can not be generalized as a whole, but instead is dependent on the type of product and the ingredients used to replace the gluten. Although the results did not show a significant difference, it does argue against the belief that gluten-free products are invariably better for health in the general, non-gluten sensitive population. / Dissertation/Thesis / Masters Thesis Nutrition 2019

Celiac disease is a lifelong disorder characterised by permanent intolerance to gluten and typical inflammatory changes in the small intestine. These changes lead to malabsorption of all nutrients, minerals, vitamins and water. The first attack of this disorder mostly occurs in childhood because the small intestine is greatly stressed by other nutrition supply. The only effective treatment is a lifelong gluten-free diet. This thesis, called Primary, secondary and tertiary prevention in children with celiac disease, consists of two parts; a theory part for which both professional publications and internet have been used and an empirical part, that comprises research itself with its results. The research target of this thesis was the sector of celiac disease occurring in children. Within the research, there were determined four objectives. The first objective was about to find out how primary, secondary and tertiary prevention is provided to children with celiac disease in GP ambulances for children and teenagers. Another task was to trace what profits the regime education brings to parents of children having celiac disease. We also dealt with the impact of the disease on the life of the child, his/her family and surrounding society. Then we investigated whether respondents take the help from outside, state support, institutions and in-kind assistance. In the empirical part of the thesis we used a method of qualitative research. For this research we chose a method of questionings through individual semi-structured interviews with two groups of respondents. The first group was made of nine nurses working in GP ambulances for children and teenagers having celiac disease. The second group was formed by nine children with celiac disease and their parents. The outcome of the research indicates that for quality health care supply it is important to obtain family anamnesis, carry out regular physicals in stated intervals within growth measurement monitoring and breastfeeding education and add other nutrition to diet. Monitoring suspicious symptoms, such as failure to thrive, inexplicable weight loss, growth retardation, abdominal pain, recurrent diarrhoea, digestive discomfort, dermatitis, stomatitis, anaemia, can soon detect celiac disorder. The secondary prevention is expressed by the work of nurses, such as biological material analysis, education, advice, help and support. Great urgency is given to risk factor monitoring, such as diabetes mellitus, Down syndrome, thyroid disorder, or genetic predispositions. The tertiary prevention is focused on the adaptation support of the child and his/her family to this chronic disorder, normal growth, and whole constitution examining and complication prevention. The outcomes indicate that the biggest problem of celiac people is financial burden of gluten-free food and also frequent limits in out-of- home eating. The financial burden of the diet influences, for example, vacation planning. It is necessary for the society to respect their disease, for example, canteens and teachers should have knowledge of the diet restrictions and provide suitable feeding. Furthermore, our findings show that only few families use financial support, because they are afraid of negative allowance examination because of their comfortable income. They mainly use allowance from Health Insurance Companies. On the grounds of the acquired information has been created an informative handout for the parents of the children with the celiac disease. The results of our research will be provided to the nurses who work in general practitioner ambulances.

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...

Background Sweden has experienced a unique epidemic of celiac disease (CD) in children younger than 2 years of age. The epidemic was partly explained by changes over time in infant feeding and indicated a multifactorial aetiology. In CD, a strict lifelong gluten-free diet (GFD) is crucial for health but noncompliance is often reported among adolescents. Knowledge is limited regarding their own perspectives and experiences of managing the disease and adhering to GFD. Objectives To analyse the incidence of CD in epidemic and post epidemic birth cohorts, and explore and understand how adolescents with CD perceive and manage their everyday lives in relation to the GFD. Methods A population-based incidence register of CD in children covering the entire nation from 1998 to 2003, and part of the country back to 1973. ESPGHAN diagnostic criteria for CD and NUTS classification of regions were used. Incidence rates for each year of diagnosis, age group, gender and region, and cumulative incidence by age for each birth cohort were calculated. Ten focus groups were conducted with 47 CD adolescents aged 15-18 years. Transcribed interviews were analysed to illustrate and explain adolescents’ own perspectives concerning life with a GFD, and to search for recurrent stigma-related themes across the groups. Results A considerable gap in the cumulative incidence of CD at comparable ages was demonstrated between birth cohorts of the epidemic and post-epidemic periods. The gap persisted during pre-school years, although it decreased somewhat with age. During the final years of follow-up there was again a gradual increase in incidence rate among children younger than 2 years of age. The childhood populations in ‘West Sweden’ and ‘Småland and the islands’ had a significantly higher incidence rate compared to ‘North Middle Sweden’ and ‘Stockholm’. CD adolescents described an awareness of being different from others produced by meal appearance and the poor availability of gluten-free (GF) food. Eating in public had the effect of making an invisible condition visible and thereby creating a context for felt or enacted stigma. Maintaining invisibility avoided the negative consequences of stigma. The probability of compliance with the GFD was compromised by insufficient knowledge of significant others, problems with the availability and sensory acceptance of GF food, insufficient social support and their perceived dietary deviance. Three different approaches to the GFD emerged: compliers, occasional non-compliers, and non-compliers. Conclusions The difference in CD risk between birth cohorts at comparable ages may suggest an opportunity for primary prevention. Based on post-epidemic incidence trends, the Swedish epidemic might not have been as unique as previously thought, even though its magnitude was striking. The regional variation in CD risk supports multifactorial aetiology. Continued efforts are warranted to define factors besides gluten exposure that modulate CD risk. CD adolescents experience various dilemmas related to the GFD. It can produce stigma experiences in adolescence, and dietary compliance (or lack of) can be understood in terms of dealing with GFD concealment and disclosure. The increase in CD prevalence over time and unmet needs in young celiacs require resources to attain adequate levels of dietetic provision, regulated subsidies for covering additional costs for GF food, evidence-based practice, and increased general CD awareness for optimum clinical outcomes.

Theoretic part is concerned with coeliac disease, its symptoms and diagnostic. There is also described basic principal of coeliac disease and are mentioned some gluten-free products available in the Czech Republic. This part is concluded by theoretic description of sensory analysis. Practical part is focused on sensory analysis of samples of gluten-free pastry according selected recipes which contain apple fibres and apple flour. The backed pastry was assessed with suitable methods of sensory analysis - in this case, a sequence preferential test. This assessment shows which sample is the most preferable and the best recipe is described in detail.

The Dissertation deals with educational materials for patients with celiac disease. It describes general requirements for teaching materials and the didactical principles suitable for educational materials for patients with celiac disease. It presents a draft criteria for assessment of web sites intended for people suffering of celiac disease. Five Czech, as well as foreign Internet-based resources, have been selected and assessed for compliance with the criteria given by technical properties, contents, page structures, criteria evaluating credibility of the sites and educational criteria. All the sites assessed can be used for education of patients with celiac disease, but they are rather information sites with a low content of educational characteristics.

This thesis deals with the gluten-free diet and its possible enrichment. It is divided into two parts. The first part includes chapters such as history of gluten-free diet, basics of a gluten free diet, the first step in the introduction of a gluten-free diet, gluten-free food labeling legislation and the use of alcohol on a gluten-free diet. The practical part is focused on enriching the diet celiac patients. I focused on the preparation of bakery products for celiac, I have designed and practically tested recipes gluten-free pizza, buckwheat corpus, gluten-free sourdough seedcake and gluten-free cake with homemade pudding and caramel. The finished gluten-free products were submitted after baking consumers who rated their sensory quality. If necessary, an adjustment was made to the recipe and re-perform sensory evaluation. The prepared products were evaluated positively. Selected coeliacs decided suggested products to include in their diet.

Type 1 diabetes (T1D) is an autoimmune disease leading to destruction of insulin-secreting pancreatic -cells. Environmental factors e.g. exposures to infections, dietary components play a substantial role in etiopathogenesis of T1D and are responsible for rapid increase of T1D incidence in past decades, preferentially in developed countries. Despite long record of T1D research no causative cure or efficient prevention exists. While gluten displays proinflammatory properties, gluten-free diet (GFD) has been documented by several studies as a strong diabetes- preventive environmental factor in spontaneous animal models of T1D, mostly in NOD mouse. The aim of this thesis is to better characterize effects of GFD on the immune system of NOD mouse. Using flow cytometry, we compared effects of GFD vs standard (STD) Altromin diets on NK cell subsets, Tregs, as well as other regulatory cell subsets and their cytokine profile in prediabetic SPF NOD females that were exposed to the diets since "in utero". A reference diabetes incidence in NOD females in our SPF facility kept on STD and GFD was recorded. Diabetes-preventive capacity of GFD were tested by using the NOD-SCID model of diabetes transfer, in which splenocytes from at-onset NOD females kept on GFD or STD were transferred to NOD-SCID recipients....

The diploma thesis deals with the relationships and opinions of students of selected secondary schools, which are connected with alternative ways of eating. The theoretical part contains basic information about rational nutrition, individual nutrients, there is a comparison of the food pyramid and a healthy plate. Last but not least, alternative diets are also clarified and then information on five specific types of alternative diets is given. In the individual subchapters, vegetarianism, veganism, raw food, paleo diet and a gluten-free diet are mentioned. The aim of the practical part is to find out the opinion of students of selected secondary schools on alternative ways of eating. These are my chosen secondary schools in the Rakovnicko region. A questionnaire survey is used as a research tool. Based on the data obtained, the questionnaire was evaluated and the results were converted into tables and graphs, which are always commented. 187 respondents answered the questionnaire. It was found that 19 of all respondents have nutrition-related health restrictions. The surprising result is that students did not learn about alternative meals primarily at school, but from their own resources (friends, family, etc.). The results of the questionnaire survey point to the fact that secondary school students...

Yes / Objectives. Coeliac disease (CD) is an autoimmune condition managed by a lifelong therapeutic gluten-free diet. Previous research suggests that the chronicity of CD, the limitations imposed by the gluten-free diet, and the risk of other associated diseases can have a negative impact on health-related quality of life (HRQoL) and psychological well-being. The aim of this study was to explore the illness perceptions and self-efficacy beliefs of adults with CD in the United Kingdom and to report their subjective levels of HRQoL and psychological well-being. Design. The study employed a cross-sectional postal questionnaire design. Method. Participants (n= 288) were adults with CD recruited via Coeliac UK. Measures of well-being, HRQoL, self-efficacy, illness perceptions, and dietary self-management were analysed. Preliminary descriptive and univariate procedures were employed before bivariate tests of association or difference were carried out. Backward stepwise multiple regression analysis was used to investigate the predictive strength of variables on well-being, quality of life, and self-efficacy. Logistic regression was used to look at the influence of variables on adherence. Results. Results indicate that HRQoL and psychological well-being were comparable to those found in previous related studies. Participants with weak beliefs in the serious consequences of CD and poorer emotional reactions to the condition had a greater likelihood of having enhanced HRQoL, improved psychological well-being, and higher self-efficacy. Strong beliefs in personal control and a greater perceived understanding of CD were associated with greater self-efficacy. Conclusions. Perceived self-efficacy and illness perceptions could play a role in informing psychological interventions for individuals with CD.