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In recent years, celiac disease has become known to the public with the development of medical diagnosis possibilities and increased awareness of the celiac disease. The only cure for celiac disease is a gluten-free diet that must be strictly followed for perpetuity. Food products with gluten content lower than 20 ppm are considered gluten free products. With the increase in the number of people with celiac disease and people on a gluten-free diet, the amount and variety of gluten-free products have increased significantly. Rice and corn are the raw materials of gluten-free products. However, this situation causes people who follow a gluten-free diet to be exposed to a uniform diet and deficient in the intake of essential elements such as copper, iron, and manganese. In this study, 41 gluten free products in Turkey were examined with ICP-OES as copper, iron, manganese, zinc, and strontium content, and the results were reported. The samples with the highest Cu concentration were corn and puffed rice at 51.45 mg/kg and vermicelli at 32.40 mg/kg. Chocolate sauce and cornflakes were the samples at 137.43 mg/kg and 117.20 mg/kg, respectively, with the highest Fe concentration. The highest Mn concentration was precooked chickpea flour at 20.80 mg/kg. The highest strontium concentration value was 12.85 mg/kg in carob flour. The samples with the highest Zn concentration were determined in yeast at 91.98 mg/kg and pistachio croquant at 85.50 mg/kg.

AMAÇ: Gluten sensitif enteropati, genetik duyarlılığı olan kişilerde glutenli tahıllar olan buğday, çavdar ve arpanın neden olduğu intestinal ve ekstraintestinal sistem belirtileri olan otoimmün özellikler taşıyan sistemik bir hastalıktır.GEREÇ VE YÖNTEM: Bu çalışmada 2000-2012 yılları arasında Eskişehir Osmangazi Üniversitesi Tıp Fakültesi Gastroenteroloji Bilim Dalında tanı konulan ve takipte olan 69 hasta retrospektif olarak incelendi. Hastaların başvuru şikayetleri, fizik muayene bulguları, laboratuar bulguları, kemik mineral dansitometre incelemeleri, diyet uyumları, diyet uyumunu etkileyen faktörler değerlendirildi.BULGULAR: Hastalarımızın 48 tanesi kadın, 21 tanesi erkek idi. Hastaların yaş ortalaması 35,6±11,4 (yaş aralığı 19-81) ve hastaların ortalama tanı yaşı 29,6±13,1 olarak saptandı. Major semptom diyare olup (%49,3), karın ağrısı (%18,8), kaşıntı (%4,3) diğer başvuru semptomları olarak göze çarpmaktaydı. Hastalık farklı laboratuar bulgularına yol açmakta olup en sık görülenler demir eksikliği anemisi (%63,8), folik asit eksikliği (%39,1), ALT yüksekliği (%11,6), hipokalsemi (%11,6) ve vitamin B12 eksikliği (%10,1) idi. Bu çalışmada gluten sensitif enteropatiye otoimmün hastalık eşlik etme sıklığı %24,6 olarak bulundu. En sık otoimmün hastalıklar Tip 1 Diyabetes Mellitus (%5,7) ve otoimmün tiroid hastalığı (%7,2) idi. Demir eksikliği anemisi (%60,9) ve osteoporoz (%37,5) en yaygın komorbid durumlardı. Hastaların 24 tanesinin (%34,8) diyet uyumu iyi iken, 38 tanesinin (%55) kısmi diyet uyumu olduğu saptandı.SONUÇ: Gluten sensitif enteropati semptom ve bulgu spektrumunun geniş olması, atipik bulgularla seyredebilmesi, herhangi bir yaşta tanı konabilmesi nedeniyle tüm hekimleri ilgilendiren bir hastalıktır. Tanı gecikmesi hastalığın prognozunu olumsuz etkilemekte olup, uygun semptomlarda doktorlar gluten sensitif enteropatiyi akla getirmelidir., OBJECTIVE: Gluten-sensitive enteropathy is a systemic disease whit has autoimmune features which are intestinal and extraintestinal system symptoms caused by gluten grains such as wheat, rye, and barley in people with genetic sensitivity.MATERIAL AND METHODS: In this study, 69 patients who have been diagnosed and followed up in Eskişehir Osmangazi University, Faculty of Medicine, Department of Gastroenterology, between 2000 and 2012, have been analyzed retrospectively. Admission symptoms, physical examination symptoms, laboratory findings, bone mineral densitometry examinations, diet compliance of the patients, and factors which affect the diet compliance have been evaluated.RESULTS: 48 of our patients were female, and 21 were male. The average age of the patient was 35.6±11.4 (age range 19-81), and the average diagnosis age of the patients was 29.6±13.1. The major symptom was diarrhea (49.3%). Other presenting symptoms were abdominal pain (18.8%) and pruritus (4.3%). The disease can lead to different laboratory findings, but the most frequent findings are iron deficiency anemia (63.8%), folic acid deficiency (39.1%), elevated ALT (11.6%), hypocalcemia (11.6%), and vitamin B12 deficiency (10.1%). In this study, the frequency of autoimmune disease accompanying gluten-sensitive enteropathy was found to be 24.6%. The most frequent autoimmune diseases are Type 1 Diabetes Mellitus (5.7%) and autoimmune thyroid disease (7.2%). The most frequent comorbid diseases were iron deficiency anemia (60.9%) and osteoporosis (37.5%). It has been determined that the diet compliance of 24 patients (34.8%) was good, and 38 patients (55%) have partial diet adaptation.CONCLUSIONS: As the symptoms and finding spectrum of gluten-sensitive enteropathy are broad and can progress with atypical findings and can be diagnosed in at any age, it is a disease that concerns all physicians. Delay in diagnosis affects the prognosis of the disease negatively, and physicians should think about gluten-sensitive enteropathy in matching symptoms.

Background Patients with chronic gastrointestinal (GI) disease such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), celiac disease, gastroesophageal reflux disease (GERD), pancreatitis, and chronic liver disease (CLD) often suffer from obesity because of coincidence (IBD, IBS, celiac disease) or related pathophysiology (GERD, pancreatitis and CLD). It is unclear if such patients need a particular diagnostic and treatment that differs from the needs of lean GI patients. The present guideline addresses this question according to current knowledge and evidence. Objective The objective of the guideline is to give advice to all professionals working in the field of gastroenterology care including physicians, surgeons, dietitians and others how to handle patients with GI disease and obesity. Methods The present guideline was developed according to the standard operating procedure for European Society for Clinical Nutrition and Metabolism guidelines, following the Scottish Intercollegiate Guidelines Network grading system (A, B, 0, and good practice point [GPP]). The procedure included an online voting (Delphi) and a final consensus conference. Results In 100 recommendations (3x A, 33x B, 24x 0, 40x GPP, all with a consensus grade of 90% or more) care of GI patients with obesity - including sarcopenic obesity - is addressed in a multidisciplinary way. A particular emphasis is on CLD, especially fatty liver disease, since such diseases are closely related to obesity, whereas liver cirrhosis is rather associated with sarcopenic obesity. A special chapter is dedicated to obesity care in patients undergoing bariatric surgery. The guideline focuses on adults, not on children, for whom data are scarce. Whether some of the recommendations apply to children must be left to the judgment of the experienced pediatrician. Conclusion The present guideline offers for the first time evidence-based advice how to care for patients with chronic GI diseases and concomitant obesity, an increasingly frequent constellation in clinical practice.

Background Patients with chronic gastrointestinal (GI) disease such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), celiac disease, gastroesophageal reflux disease (GERD), pancreatitis, and chronic liver disease (CLD) often suffer from obesity because of coincidence (IBD, IBS, celiac disease) or related pathophysiology (GERD, pancreatitis and CLD). It is unclear if such patients need a particular diagnostic and treatment that differs from the needs of lean GI patients. The present guideline addresses this question according to current knowledge and evidence. Objective The objective of the guideline is to give advice to all professionals working in the field of gastroenterology care including physicians, surgeons, dietitians and others how to handle patients with GI disease and obesity. Methods The present guideline was developed according to the standard operating procedure for European Society for Clinical Nutrition and Metabolism guidelines, following the Scottish Intercollegiate Guidelines Network grading system (A, B, 0, and good practice point [GPP]). The procedure included an online voting (Delphi) and a final consensus conference. Results In 100 recommendations (3x A, 33x B, 24x 0, 40x GPP, all with a consensus grade of 90% or more) care of GI patients with obesity - including sarcopenic obesity - is addressed in a multidisciplinary way. A particular emphasis is on CLD, especially fatty liver disease, since such diseases are closely related to obesity, whereas liver cirrhosis is rather associated with sarcopenic obesity. A special chapter is dedicated to obesity care in patients undergoing bariatric surgery. The guideline focuses on adults, not on children, for whom data are scarce. Whether some of the recommendations apply to children must be left to the judgment of the experienced pediatrician. Conclusion The present guideline offers for the first time evidence-based advice how to care for patients with chronic GI diseases and concomitant obesity, an increasingly frequent constellation in clinical practice.

Gluten-free diet is a nutrition model in which gluten-containing products such as wheat, oat, barley, or rye and foods made from these products are not consumed. While it is used as an essential treatment in diseases such as celiac disease, non-celiac gluten/wheat sensitivity, and wheat allergy, it is also used as a nutritional therapy in some inflammatory bowel diseases, type 1 diabetes, neurological disorders, autism, dermatitis, irritable bowel syndrome, rheumatoid arthritis, cardiovascular diseases. Considering that gluten has adverse effects on health, the gluten-free nutrition model is applied at a rate of up to 30% in healthy people. While there is a decrease in the intake of fiber, iron, vitamin B1, and folic acid in the gluten-free nutrition model, the fat and calorie content of the products may increase. As a result of the consumption of gluten-free products, changes may occur in the colon, which may negatively affect the activity of bifidobacteria and cause problems in the immune response. Based on previous studies, this review evaluated the effects of using the gluten-free nutrition model in children by considering current sources.

Gluten-free diet is a nutrition model in which gluten-containing products such as wheat, oat, barley, or rye and foods made from these products are not consumed. While it is used as an essential treatment in diseases such as celiac disease, non-celiac gluten/wheat sensitivity, and wheat allergy, it is also used as a nutritional therapy in some inflammatory bowel diseases, type 1 diabetes, neurological disorders, autism, dermatitis, irritable bowel syndrome, rheumatoid arthritis, cardiovascular diseases. Considering that gluten has adverse effects on health, the gluten-free nutrition model is applied at a rate of up to 30% in healthy people. While there is a decrease in the intake of fiber, iron, vitamin B1, and folic acid in the gluten-free nutrition model, the fat and calorie content of the products may increase. As a result of the consumption of gluten-free products, changes may occur in the colon, which may negatively affect the activity of bifidobacteria and cause problems in the immune response. Based on previous studies, this review evaluated the effects of using the gluten-free nutrition model in children by considering current sources.

The gluten-free diet [GFD] has been linked to an increased risk of weight gain and the development of metabolic disorders. Most of the studies have focused on the effect of GFD on the Body Mass Index [BMI]. We aimed to evaluate the nutritional status using specific nutritional parameters in patients with celiac disease [CeD] at diagnosis and on a GFD compared to healthy controls. We recruited subjects at our outpatient clinic at the University of Padua. We collected demographic and clinical data and values obtained with bioelectrical impedance analysis. A total of 24 CeD patients and 28 healthy controls were enrolled. CeD patients at diagnosis had a lower body cell mass index [BCMI, p = 0.006], fat-free mass index [FFMI, p = 0.02], appendicular skeletal muscle index [ASMI, p = 0.02], and phase angle [PA] [p < 0.001] compared to controls. Their percentage of extracellular water [ECW] was also higher [p < 0.001]. Considering CeD patients after GFD, nutritional status significantly improved after 6 months of GFD. We did not observe differences in BMI among groups [p = ns]. CeD patients at diagnosis were found to have a poorer nutritional status than healthy controls, with a positive effect of the GFD on their nutritional status, underlining the inefficacy of evaluating this aspect through only BMI evaluation.

Amaç: Çölyak hastalığının günümüzde bilinen tek tedavi şekli ömür boyu glutensiz diyet tedavisidir ve hastalığın yönetimindeki en önemli sorun diyete uyumsuzluktur. Bu çalışmada, çocukluk çağında tanı almış çölyak hastalarında diyet tedavisini etkileyen faktörlerin değerlendirilmesi amaçlanmıştır. Bireyler ve Yöntem: Bu çalışmada, çölyak hastalığı tanısı almış ve en az bir yıldır takipli olan 8-18 yaş arasındaki rastgele seçilmiş 92 hasta kesitsel olarak değerlendirilmiştir. Hastaların demografik ve klinik özellikleri, ailelerinin sosyal yapısı ve glutensiz diyet hakkındaki bilgileri incelenmiştir. Hastaların diyete uyumu güncel serum anti-tTG IgA düzeylerine bakılarak değerlendirilmiştir. Seroloji sonucuna göre hastalar, diyete uyumlu ve uyumsuz olarak 2 gruba ayrılmış ve veriler karşılaştırılmıştır. Bulgular: Çalışmaya dahil edilen 92 hastanın güncel yaş ortalaması 13.1±3.5 yıl’dır. Anti-tTG IgA düzeyi normal olan hasta oranı %55.4 olarak saptanmıştır. Diyete uymayan hastalarda yaş ortalamasının daha yüksek (13.8±3.4 yıl; p

The aim of this study is to assess Portuguese celiac patients’ quality of life (QoL) perception. A cross-sectional study was performed with a non-probability convenience sample of Portuguese celiac patients using an online self-administered celiac disease quality of life questionnaire (CDQ), previously validated for the Portuguese population. The final sample comprised 234 celiac patients, which included the following: primarily women (69.2%); aged between 18 and 49 years old (56.4%); with a partner (60.6%); with a high educational level (58.9%—graduated or post-graduated); following a gluten-free diet (GFD) (55.1%); and not using antidepressants (93.1%). The Portuguese CDQ presented good reliability and responsiveness in this sample of Portuguese celiac patients. In general, the CDQ in Portugal was affected by age at diagnosis (p = 0.017), educational level (p = 0.005), and compliance with GFD (p = 0.034). The emotion domain was affected only by using antidepressants (p = 0.036). The social domain was affected by gender (females had lower rates, p = 0.016), age at diagnosis (p = 0.009), educational level (p = 0.000), and compliance with a GFD (p = 0.002). The worries domain did not differ according to socioeconomic data. The symptoms domain was affected by compliance with GFD (p = 0.000), age at diagnosis (p = 0.000), and educational level (p = 0.014). Data on celiac QoL is essential to support the formulation and implementation of strategies to minimize the issues suffered by celiac patients, lowering their physical, emotional, and social burden. Additionally, data on Portuguese celiac disease patients using the CDQ will allow future comparative research among celiac populations from different countries.

The following are available online at https://www.mdpi.com/article/ 10.3390/nu15071761/s1, This research was funded by the FEDER/Junta de Andalucía-Consejería de Transformación Económica, Industria, Conocimiento y Universidades/ Project No B-AGR-658. It was also partially funded with the grant “Investigation grant program by the Association of Celiacs and Sensitive to Gluten of the Community of Madrid”. It also was partially funded by BIOMEDAL S.L., A gluten-free diet (GFD) is the only treatment available for celiac disease (CD); hence, it is important to ensure correct adherence to the diet and adequate monitoring of the diet. The present study aims to assess the importance of an early follow-up of celiac patients after diagnosis of the disease, identify the role of stool gluten immunogenic peptides (GIPs) in the assessment of GFD adherence, and analyze possible nutritional imbalances or deficiencies in the GFD. This is a cross-sectional study carried out in pediatric patients with newly diagnosed CD in a tertiary hospital in Spain. Of the 61 patients included, 14% had positive stool GIPS at 4 months after CD diagnosis, Among them, 88% had negative stool GIPS at 9 months after diagnosis, following dietary advice. We found nutritional deficiencies in the GFD, such as vitamin D (with only 27% of patients with adequate intakes), folate, calcium, magnesium, and fiber. Similarly, we found imbalances: excess protein and fat intakes and a high percentage of total daily energy intake came from ultra-processed foods (UPF). These findings emphasize the importance of early follow-up of children after diagnosis of CD. It is also crucial to identify patients with poor GFD compliance based on stool GIPS and analyze GFD nutritional imbalances and deficits. Our findings may contribute to the development of specific strategies for the early follow-up of patients with CD, including appropriate nutritional counselling., FEDER/Junta de Andalucía-Consejería de Transformación Económica, Industria, Conocimiento y Universidades/ B-AGR-658, "Investigation grant program by the Association of Celiacs and Sensitive to Gluten of the Community of Madrid", BIOMEDAL S.L.

A gluten-free diet (GFD) is currently the only treatment available for patients with celiac disease (CD). However, adherence to a GFD can be challenging because gluten is present in many foods. A lifelong follow-up of patients with CD must be performed to promote adherence to a GFD and to identify the appearance of symptoms and the associated diseases. Therefore, the development of tools to analyze gluten exposure in these patients is important. This study proposes the development of the first automatable ELISA to monitor adherence to a GFD through the quantification of urine gluten immunogenic peptides (u-GIP). Seven healthy volunteers without suspicion of CD and 23 patients with CD were monitored as part of this study to optimize, validate, and apply this assay. Non-interference was found in the urine matrix, and the recovery percentage for spiked samples was 81–101%. The u-GIP was stable for up to 16 days when the samples were stored at different temperatures. Overall, 100% of the patients had detectable u-GIP at diagnosis (range of 0.39–2.14 ng GIP/mL), which reduced to 27% after 12 months on a GFD. Therefore, this highly sensitive immunoassay would allow the analysis of u-GIP from a large battery of samples in clinical laboratories of specialized healthcare centers.

Background: The association of celiac disease (CD) with premature atherosclerosis, including increased carotid artery intima-media thickness and cardiovascular disease (CVD), is controversial. The aim of this study was to investigate this relationship. Methods: Clinical records of patients from Northern Sardinia referred to the Gastroenterology section of the Department of Medicine, University of Sassari, Italy, were analyzed. Unadjusted and adjusted odds ratios (ORs) for CVD with their 95% confidence intervals (CIs) were calculated according to established risk factors, including age, sex, diabetes, dyslipidemia, overweight/obesity, blood hypertension, and cigarette smoking, as well as a possible risk factor such as H. pylori infection. Results: In a total of 8495 patients (mean age 52.1 ± 17.3 years; 64.7% females), 2504 reported a diagnosis of CVD and 632 of CD. Logistic regression analysis showed a significantly reduced risk of CVD among patients with CD (OR 0.30, 95% CI 0.22–0.41). Moreover, the long duration of the gluten-free diet (GFD) was able to lower the risk of CVD in celiac patients. Finally, CD significantly decreased the frequency of carotid plaques (11.8% vs. 40.1%, p < 0.001). Conclusions. Our retrospective study demonstrated that CD reduces the risk of CVD in general and more specifically of carotid lesions after adjusting for potential confounders, especially in those on GFD for a long time.

Introduction and aim: Usually, adherence to the gluten-free diet (GFD) in celiac patients is indirectly assessed through serological analysis, questionnaires, or invasive methods such as intestinal biopsy. The detection of gluten immunogenic peptides in urine (urinary gluten immunogenic peptides—uGIP) is a novel technique that directly evaluates the ingestion of gluten. The aim of this study was to evaluate the clinical efficacy of uGIP in the follow-up of celiac disease (CD). Methods: From April 2019 to February 2020, CD patients reporting complete adherence to the GFD were prospectively enrolled but were unaware of the reason for the tests. Urinary GIP, the celiac dietary adherence test (CDAT), symptomatic visual analog scales (VAS), and tissue transglutaminase antibodies (tTGA) titres were evaluated. Duodenal histology and capsule endoscopy (CE) were performed when indicated. Results: A total of 280 patients were enrolled. Thirty-two (11.4%) had a positive uGIP test (uGIP+). uGIP+ patients did not show significant differences in demographic parameters, CDAT, or VAS scores. The tTGA+ titre was not related to the positivity of uGIP (14.4% vs. 10.9% in patients with tTGA+ and tTGA−). Regarding histology, 66.7% of the GIP+ patients had atrophy compared to 32.7% of the GIP patients (p-value 0.01). However, the presence of atrophy did not correlate with tTGA. Mucosal atrophy was detected in 29 (47.5%) out of 61 patients by CE. With this method, no noticeable dependence on uGIP results (24 GIP− vs. 5 GIP+) was observed. Conclusions: The single uGIP test was positive in 11% of CD cases referring a correct GFD adherence. Furthermore, uGIP results significantly correlated with the duodenal biopsy, formerly considered the gold standard for assessing CD activity.

Data on factors governing long-term adherence to a gluten-free diet (GFD) in celiac disease (CD) are scarce. We aimed to determine trends and clinical predictors of long-term GFD adherence in adult CD.Initial and long-term (3 years) GFD adherence, clinical characteristics at baseline and follow-up were collected retrospectively from celiac patients followed-up over 20 years (2000-2020). Predictors of long-term GFD adherence at diagnosis, and follow-up were evaluated by multivariate logistic regression.248 patients (37 ± 12 years, 186F, median time on a GFD 90 months) were included. Twenty-five (10.1%) had only short-term follow-up (3 years) while 223 (89.9%) had initial and long-term dietary assessment. 187/223 (83.9%) patients were initially adherent and 36/223 (16.1%) were not. 17/36 (47.2%) patients initially not adherent become adherent, while only 4/187 (2.1%) initially adherent patients became not adherent. In the long-term, 200/223 (89.7%) were adherent and 21/223 (9.4%) patients were not. Adherence improved more frequently than worsened (OR, 39.5; 95% CI, 11.4-178.5; P.01). Classical symptoms (diarrhea, weight loss) at diagnosis of CD predicted stricter long-term GFD adherence (OR, 3.27; 95% CI, 1.21-8.81; P = .02), while anemia (OR, 0.31; 95% CI, 0.12-0.82; P = .02) and dermatitis herpetiformis (OR, 0.23; 95% CI, 0.06-0.91; P = .04) predicted poorer long-term adherence. At follow-up, initial GFD adherence (OR, 42.70; 95% CI, 10.70-171.00; P = .04) was the major determinant of long-term GFD adherence.GFD adherence changes over time in10% of patients, generally improving when it does. Major determinants of long-term GFD adherence are classical symptoms at diagnosis and initial adherence to a GFD. Patients with anemia or dermatitis herpetiformis at diagnosis require stricter dietetic input.

BACKGROUND Wheat and other gluten-containing grains are widely consumed, providing approximately 50% of the caloric intake in both industrialised and developing countries. The widespread diffusion of gluten-containing diets has rapidly led to a sharp increase in celiac disease prevalence. This condition was thought to be very rare outside Europe and relatively ignored by health professionals and the global media. However, in recent years, the discovery of important diagnostic and pathogenic milestones has led to the emergence of celiac disease (CD) from obscurity to global prominence. These modifications have prompted experts worldwide to identify effective strategies for the diagnosis and follow-up of CD. Different scientific societies, mainly from Europe and America, have proposed guidelines based on CD's most recent evidence. AIM To identify the most recent scientific guidelines on CD, aiming to find and critically analyse the main differences. METHODS We performed a database search on PubMed selecting papers published between January 2010 and January 2021 in the English language. PubMed was lastly accessed on 1 March 2021. RESULTS We distinguished guidelines from 7 different scientific societies whose reputation is worldwide recognized and representative of the clinical practice in different geographical regions. Differences were noted in the possibility of a no-biopsy diagnosis, HLA testing, follow-up protocols, and procedures. CONCLUSION We found a relatively high concordance between the guidelines for CD. Important modifications have occurred in the last years, especially about the possibility of a no-biopsy diagnosis in children. Other modifications are expected in the next future and will probably involve the extension of the non-invasive diagnosis to the adult population and the follow-up modalities.

Celiac disease (CD), a gluten-induced autoimmune disease, is associated with low bone mineral density (BMD) among children. Unfortunately, it is often diagnosed in adulthood, which may lead to an increased risk of fragile bones. The aim of this systematic review was to report on BMD status among young adults newly diagnosed with CD, and to examine the effect of a gluten-free diet (GFD), nutritional supplements, such as vitamin D, or antiresorptive medications on BMD recovery. Databases searched were Medline, Embase, and Cochrane Library up to July 2nd, 2020. Both observational studies and clinical trials were considered, if patients were newly diagnosed and between 20 and 35 years of age and reported on BMD. We critically appraised the identified studies using ROBINS-I and summarized the findings narratively. Out of 3991 references, we identified 3 eligible studies: one cross-sectional study and two longitudinal studies. In total, 188 patients were included, and the study population consisted primarily of women with an age range between 29 and 37 years old. Compared to healthy controls, our target population had lower BMD. Moreover, a strict GFD may increase BMD during a follow-up period of up to 5 years. Newly diagnosed CD patients aged 20–35 years are at risk of lower BMD. Therefore, it may be crucial to assess BMD at time of diagnosis in young women. Whether the results can be extrapolated to young men is unknown. While strict GFD may improve BMD over time, there is a lack of robust evidence to demonstrate that nutritional supplements or antiresorptive agents are beneficial in the prevention of fragile bones in this age group. Supplementary Information The online version contains supplementary material available at 10.1007/s00223-021-00938-w.

Evidence on the consumption of ultra-processed foods (UPF) in adults with celiac disease (CD) and its impact on Mediterranean Diet (MD) adherence is still limited. Our aim was to determine UPF consumption and its relationship with MD adherence in a group of adults, according to the presence of CD. This case-control study included 103 adults with CD and 312 without CD. UPF intake was assessed using the NOVA Food Frequency Questionnaire (NFFQ), while MD adherence was assessed using the Medi-Lite score. UPF represented 14.5% of the diet of participants with CD (246 g/day) and came mainly from cereals-based products (29%) and sweets (24.2%). UPF consumption did not differ with the presence of CD, but participants with CD had significantly (p < 0.05) higher consumption of precooked pasta and pre-packaged breads. Participants with CD also reported a significantly lower MD adherence than participants without CD (9.4 vs. 10.4), with higher intake of meat and dairy products, and lower consumption of vegetables and fish. An inverse trend was found between UPF consumption and MD adherence in adults with CD, although not statistically significant. These findings highlight the importance of improving nutrition education for subjects with CD, which should not only focus on gluten exclusion.

Title: Myths in nutrition Objectives: The aim of this thesis is to define and analyse the most common myths about nutrition that are commonly encountered on websites, social networks or in popular science literature. I will then seek to confirm or refute these claims by reviewing the available scientific evidence. Methods: Research Keywords: sports nutrition, protein, anabolic window, evening meal, protein before bedtime, effects of creatine, gluten-free diet, fats

A gluten-free diet (GFD) is currently the only treatment available for patients with celiac disease (CD). However, adherence to a GFD can be challenging because gluten is present in many foods. A lifelong follow-up of patients with CD must be performed to promote adherence to a GFD and to identify the appearance of symptoms and the associated diseases. Therefore, the development of tools to analyze gluten exposure in these patients is important. This study proposes the development of the first automatable ELISA to monitor adherence to a GFD through the quantification of urine gluten immunogenic peptides (u-GIP). Seven healthy volunteers without suspicion of CD and 23 patients with CD were monitored as part of this study to optimize, validate, and apply this assay. Non-interference was found in the urine matrix, and the recovery percentage for spiked samples was 81–101%. The u-GIP was stable for up to 16 days when the samples were stored at different temperatures. Overall, 100% of the patients had detectable u-GIP at diagnosis (range of 0.39–2.14 ng GIP/mL), which reduced to 27% after 12 months on a GFD. Therefore, this highly sensitive immunoassay would allow the analysis of u-GIP from a large battery of samples in clinical laboratories of specialized healthcare centers. Ministerio de Ciencia e Innovación de España y (MCIN/AE)-IDI-17-09627 y RTC2019-006806-1 Ministerio de Ciencia e Innovación y Agencia Estatal de Investigación de España (MICIN/AEI)-IDI-17-09627 y RTC2019-006806-1 Consejería de Economía y Conocimiento de la Junta de Andalucía (PAIDI I+D+i)-P18-RT-3004 Consejería de Economía, Conocimiento, Empresas y Universidad de la Junta de Andalucía (Actividades de Transferencia 2017)-AT17_5489_USE PAIDI

Celiac disease (CD) is an autoimmune intestinal disease caused by the intake of gluten-containing cereals and their products by individuals with genetic susceptibility genes. Vitiligo is a commonly acquired depigmentation of the skin; its clinical manifestation are skin patches caused by localized or generalized melanin deficiency. Both diseases have similar global incidence rates (approximately 1%) and are associated to similar diseases, including autoimmune bullous disease, inflammatory bowel disease, autoimmune thyroiditis, autoimmune gastritis, and type 1 diabetes. The relationship between CD and vitiligo has been reported in several studies, but their conclusions are inconsistent. Further, it has also been reported that a gluten-free diet (GFD) can improve the symptoms of immune-related skin diseases such as vitiligo. In this mini-review, we summarize and review the literature on the relationship between CD and vitiligo, assess the therapeutic significance of GFD for patients with vitiligo, and explore their possible physiopathology. We are hopeful that the information summarized here will assist physicians who treat patients with CD or vitiligo, thereby improving the prognosis.

Aims Lockdown and restricted mobility due to the pandemic of corona virus disease 2019 (COVID-19) has severely affected the continuity of healthcare of patients with acute and chronic diseases. We evaluated the impact of COVID-19 on the adherence to gluten-free diet (GFD), symptom control, and quality of life (QOL) in patients with celiac disease (CeD). Methods A questionnaire, consisting of both ad-hoc and validated questions, was created after review of literature, group discussions, and expert meetings. Standardized questionnaires namely CeD adherence test (CDAT), celiac symptom index score, and CeD-related QOL were used. The web-based questionnaire was sent to 3130 patients via social media and 452 responses (14.4%) were received. Also, additional 68 patients (not available on any social media application) were interviewed telephonically by a trained dietitian. Results Overall, 505 patients (females: 318; mean age: 24.1±14.2 years) were included. While only 6.7% (n = 34) had poor compliance to GFD (CDAT > 17) before COVID-19 pandemic, it almost doubled to 12.6% (n = 64) during the COVID-19 pandemic times (p = 0.02). Furthermore, 4.9% (n = 25) of patients were diagnosed contacting COVID-19. Interestingly, 73.2% (n = 370) patients preferred online appointment than physical appointment. Most common difficulties faced during lockdown period were high delivery charges for getting gluten-free (GF) food at home (54.4%), increased prices of regular GF food (43.1%), and travelling long distance to arrange GF food (44.9%). Conclusions The COVID-19 pandemic has substantially affected the adherence, symptom control, and QOL in patients with CeD, attributable to unavailability, shortage of money, and heightened cost of GF food. The pandemic has offered an opportunity to practice teleconsultation approach for patients with CeD. Supplementary Information The online version contains supplementary material available at 10.1007/s12664-021-01213-4.

Coeliac disease (CD, gluten enteropathy, gluten sprue) is an autoimmune, genetic condition related to possesion of certain combination of genes HLA-DQ2 and HLA-DQ8. In persons suffering from CD eating gluten causes villus atrophy, which in turn effects with absorption disorders and other medical conditions (weight loss, anemy, lack of vitamins, osteoporosis). It is chronic and nontreatable condition and in most cases the sole treatment is restrictive gluten-free diet involving full elimination from meals certain proteins present in cereals – gliadin in wheat, secalin in rye, hordein in barley and avenin in oats.CD is commonly associated with childhood but its prevalence in adult life is more and more frequent. Gluten-free diet, which is the only known therapy requires from the sick person systematicity and consequence and is often related to change in the life style. The aim of the article is to present complexity of medical background of the disease and its implications regarding reactions toward a disease, the life and dealing with it as well as social and environmental determinants influencing improvement in the patients’ condition. It has been assumed that it is a condition still not enough recognized in the society as well as among doctors (which proves the average time of the proper diagnosis). The main thesis of the paper states that the coeliac disease is a complex condition and the lack of the classical medication makes it a disease, that the success of the therapy strongly depends on the patients, their knowledge and determination in the demanding diet. From the social point of view misunderstanding of the patient may frequently negatively influence their illness behavior, which in turn, can have a negative impact on their condition. Additionally, coeliac patients have to deal with limitations in everyday routines – job performance, travelling or meetings.The article is constructed in sociomedical frames. In the first part, the article presents medical image of the disease – its clinical description, types and variants as well as diagnostic path. Presentation of those issues in the first place is crucial to understand properly the essence of the disease and difficulties in dealing with it as well as with the co-existing conditions. The second part is devoted to sociomedical perspective – it describes the disease from the patient’s perspective taking into account their reactions toward the condition, undertaking the sick role, illness behavior, stigma management, relations with others and everyday problems resulting from the disease and diet. Presented reflections don’t exhaust the complexity of the topic and multidimensional problems of the coeliac patients. Subsequent parts of the article are aimed at showing that complexity and can be the starting point for deeper and more detailed analises. The article is based on the review of the Polish and foreign body of work in that field as well as obtainable research in that area. Celiakia (choroba trzewna, enteropatia glutenowa) to choroba genetyczna (związana z występowaniem u chorych specyficznego wariantu genów HLA-DQ2 oraz HLA-DQ8) o charakterze autoimmunologicznym. U chorych spożywanie glutenu prowadzi do zaniku kosmków znajdujących się w błonie śluzowej dwunastnicy i jelita cienkiego, co w konsekwencji prowadzi do zaburzeń wchłaniania i innych związanych z tym dolegliwości (utrata masy ciała, anemia, niedobory witamin, osteoporoza). Jest to choroba przewlekła, nieuleczalna i w większości wypadków jedynym lekarstwem jest restrykcyjna dieta polegająca na eliminacji z pożywienia frakcji białek zawartych w takich zbożach jak pszenica (gliadyna), żyto (sekalina), jęczmień (hordeina) i owies (awenina).Celiakia to choroba najczęściej kojarzona z okresem dzieciństwa, jednak coraz częściej rozpoznawana jest w życiu dorosłym. Dieta bezglutenowa, będąca jedynym lekarstwem, wymaga od chorego systematyczności oraz konsekwencji i często wiąże się ze zmianą stylu życia. Celem artykułu jest zaprezentowanie złożoności medycznego podłoża choroby i wynikających z niego implikacji dotyczących reakcji na chorobę, życia i radzenia sobie z nią oraz społecznych i środowiskowych czynników wpływających na poprawę stanu zdrowia chorych na celiakię. Przyjęto bowiem założenie, iż jest to schorzenie wciąż mało rozpoznane w społeczeństwie, a także mało uświadomione w środowisku medycznym (o czym świadczy średni czas diagnozy celiakii). Główna teza artykułu głosi, iż celiakia jest chorobą złożoną, zaś brak klasycznego lekarstwa czyni ją schorzeniem, w którym sukces terapii zależy w ogromnym stopniu od pacjenta, jego wiedzy oraz determinacji w stosowaniu wymagającej diety eliminacyjnej. Z punktu widzenia społeczeństwa niezrozumienie chorego często negatywnie wpływa na jego zachowania w chorobie, co może prowadzić do pogorszenia stanu zdrowia. Pacjenci z celiakią borykają się dodatkowo z ograniczeniami w codziennym funkcjonowaniu – pracy, podróżach czy spotkaniach towarzyskich.Artykuł wpisuje się w ramy rozważań socjomedycznych. W pierwszej części prezentuje perspektywę medyczną dotyczącą istoty choroby, jej typów i odmian oraz diagnostyki. Prezentacja tych aspektów w pierwszej kolejności jest kluczowa dla zrozumienia istoty choroby i trudności w radzeniu sobie z nią oraz schorzeniami współwystępującymi. W drugiej części zaprezentowano – na podstawie wybranych koncepcji socjologii medycyny – chorobę z perspektywy pacjenta – jego reakcji i przyjmowania roli chorego, zachowań w chorobie, zarządzania piętnem z nią związanym, relacji z otoczeniem, a także codziennych problemów wynikających z konieczności stosowania diety eliminacyjnej. Prezentowane rozważania nie wyczerpują złożoności tematu i wieloaspektowości problematyki związanej z życiem oraz funkcjonowaniem pacjentów z celiakią. Wyodrębnione podrozdziały mają na celu ukazanie złożoności poruszanej w artykule problematyki i mogą stać się przyczynkiem do dalszych pogłębionych i szczegółowych analiz. Artykuł opiera się na przeglądzie przedmiotowej literatury polskiej i zagranicznej oraz badań w tym obszarze.

Background Both undiagnosed celiac disease and some chronic childhood diseases are associated with lower academic achievement. However, there is little knowledge of achievements in those diagnosed with celiac disease. Our aim was to investigate school achievements in upper secondary school among Swedish adolescents with celiac disease. Methods We performed a retrospective cohort study using register data. We analyzed choice of upper secondary school program, completion of upper secondary school including achievements of basic eligibility for college/university, and final grade in individuals with celiac disease diagnosed before 15 years of age, born 1991–97. We compared with the Swedish population of the same birth years. Analyses were adjusted for sex, year of birth, living region at 17 years of age, and parental education as well as income. Results The cohort included 734 074 individuals, whereof 3 257 (62% females) with celiac disease. There was no significant difference in choice of upper secondary school program. No significant difference was found in completion or achieving basic eligibility for college/university in adjusted analyses. The mean final grade in the celiac disease group was 13.34 (standard deviation 4.85) compared to 12.78 (standard deviation 5.01) in the reference population (p p = 0.012). Conclusions We found that diagnosed celiac disease does not negatively affect school achievements in upper secondary school. This finding suggests the diagnosis, treatment and follow-up programs of celiac disease could reverse potential deleterious academic processes.

This paper proposes a first monetary measure of the private costs of celiac disease, including intangible costs (physical symptoms, logistical constraints, etc.) in Switzerland. This auto-immune disease damages the intestine when patients ingest gluten. The only treatment currently available is a gluten-free diet, which implies great nutritional constraints. To get a monetary equivalent of the costs borne by celiac patients, we used a contingent valuation. The scenario suggested to celiac patients a treatment in form of a daily pill, which would allow them to eat normally and avoid any physical pain from celiac disease. Mean Willingness To Pay (WTP) for the treatment is found to be around CHF 87 (approx. USD 87) per month. WTP is positively influenced by direct and indirect costs of the disease. Oppositely, individuals, who find the gluten-free diet healthier are willing to pay less. Finally, unlike symptoms before diagnostic, the current presence or intensity of physical symptoms are found to be insignificant. The latter result can be explained by the fact that, individuals facing stronger symptoms are more likely to adhere strictly to the GFD and hence to reduce their frequency.

This research aimed to investigated the short- and long-term effects of gluten free diet (GFD) on nutritional intake, glycaemic and insulin response. In a cross-sectional study, participants who consumed a gluten-containing diet (GCD; n=11) and a GFD (n=11) completed a food diary, blood glucose and insulin measurements. In a pre-postn intervention study (n=, 11), glycaemic and insulin responsed were tested individuals completed a food diary, blood glucose and insulin measurements before and after four weeks of a GFD. Food intake was recorded before and after two weeks. No significant differences in nutrient intake, glycaemic or insulin responses were found in the cross-sectional study (p>0.05). In the intervention study, there was a significant reduction in body weight (p=0.007) and, body mass index (BMI) (p=0.004) after four weeks and and lower thiamine intake (p=0.021) after two weeks of GFD. Glycaemic response was significantly higher (p

Celiac disease (CD) is a chronic immune-mediated intestinal disease with genetic susceptibility. It is characterized by inflammatory damage to the small intestine after ingestion of cereals and products containing gluten protein. In recent years, the global prevalence rate of CD has been approximately 1%, and is gradually increasing. CD patients adhere to a gluten-free diet (GFD) throughout their entire life. However, it is difficult to adhere strictly to a GFD. Untreated CD may be accompanied by gastrointestinal symptoms, such as diarrhea, abdominal pain, and extraintestinal symptoms caused by secondary malnutrition. Many studies have suggested that CD is associated with intestinal tumors such as enteropathy-associated T-cell lymphoma (EATL), small bowel cancer (SBC), and colorectal cancer. In this study, we reviewed related studies published in the literature to provide a reference for the prevention and treatment of intestinal tumors in patients with CD. Compared with the general population, CD patients had a high total risk of SBC and EATL, but not colorectal cancer. The protective effect of GFD on CD-related malignancies is controversial. Further studies are needed to confirm whether GFD treatment can reduce the risk of intestinal neoplasms in CD.

Background. Celiac disease (CD) is a chronic immune-mediated disorder characterized by growth retardation and malabsorbtion related to mucosal damage and inflammation of small intestine in genetically predisposed people as a result of gluten exposure. In CD treatment, clinical, histological and serological improvement is possible with gluten-free diet. Thus, we aimed to assess the vitamin and trace element levels of CD patients in regard to their compliance with gluten-free diet. Materials and methods. In our study, 77 patients diagnosed with CD were evaluated retrospectively. All individuals were assessed with Marsh classification histopathologically and surveyed when they follow a gluten-free diet. Demographic features, age of disease onset, physical examination findings, anthropometric measurements and laboratory findings along with clinical and laboratory outcomes of patients after a gluten-free diet were compared between compliant to diet and non-compliant to diet groups. Results. A total of 77 individuals, 48 females and 29 males with a diagnosis of CD and mean age of 9.81 ± 4.73 years on admission, were reqruited in our study. Patients were mostly found to have Marsh type 3a (n = 22) and Marsh type 3b (n = 20) histopathologically. The results of serological screening revealed that 40.3 % of people (n = 31) were compliant with diet whereas 59.7 % (n = 46) — non-compliant. Non-compliant group had significantly lower mean vitamin B12, vitamin D, folate, zinc and selenium levels compared to compliant group (p = 0.000; 0.000; 0.000; 0.000 and 0.031, respectively). In addition, a significantly higher mean serum total IgA level was detected in non-compliant group in comparison to compliant group (p = 0.027). Conclusions. High efficacy of gluten-free diet in correcting nutritional insufficiencies and deficiencies was shown. Thus, there is no doubt that informing patients and their families about lifelong gluten-free diet in detail is beneficial although this treatment contains many social and practical difficulties., Актуальность. Целиакия — хроническое заболевание иммунного генеза, характеризующееся задержкой роста и мальабсорбцией, связанной с повреждением слизистой оболочки и воспалением тонкой кишки у генетически предрасположенных людей в результате воздействия глютена. При лечении целиакии достигается клиническое, гистологическое и серологическое улучшение состояния путем соблюдения безглютеновой диеты. Цель исследования: оценить уровень витаминов и микроэлементов у больных целиакией при соблюдении безглютеновой диеты. Материалы и методы. Под наблюдением находились 77 пациентов с диагнозом «целиакия», выявленным ретроспективно. Все случаи были подтверждены гистологически по классификации Marsh, все пациенты обследованы на фоне соблюдения безглютеновой диеты. Демографические особенности, возраст начала заболевания, результаты клинического обследования, антропометрические показатели и лабораторные результаты сравнивали в группах больных, которые придерживались диеты, и при ее отсутствии. Результаты. В исследование были включены 77 больных (48 женщин и 29 мужчин) с целиакией, средний возраст которых составил 9,81 ± 4,73 года. В основном у пациентов обнаружены гистологически по классификации Marsh типы 3a (n = 22) и 3b (n = 20). Результаты серологического скрининга показали, что в 40,3 % случаев (n = 31) больные соблюдали безглютеновую диету, тогда как в 59,7 % (n = 46) — не соблюдали. У больных этой группы отмечались достоверно более низкие показатели содержания витамина В12, витамина D, фолатов, цинка и селена по сравнению с группой больных, которые соблюдали соответствующую диету (p = 0,000; 0,000; 0,000; 0,000 и 0,031 соответственно). Кроме того, был обнаружен достоверно более высокий средний уровень общего IgA в сыворотке крови в группе больных без соблюдения диеты по сравнению с группой больных, которые соблюдали безглютеновую диету (p = 0,027). Выводы. Установлена высокая эффективность безглютеновой диеты для коррекции недостаточности и дефицита витаминов и микроэлементов. Необходимо детально информировать пациентов с целиакией и их семьи о неуклонном пожизненном соблюдении безглютеновой диеты, хотя соблюдение такого питания создает немало социальных и практических трудностей., Актуальність. Целіакія — хронічне захворювання імунного генезу, що характеризується затримкою росту та маль­абсорбцією, пов’язаною з пошкодженням слизової оболонки і запаленням тонкої кишки у генетично схильних людей внаслідок впливу глютену. При лікуванні целіакії досягається клінічне, гістологічне та серологічне поліпшення стану шляхом дотримання безглютенової дієти. Мета дослідження: оцінити рівень вітамінів та мікроелементів у хворих на целіакію за умов дотримання безглютенової дієти. Матеріали та методи. Під спостереженням перебували 77 пацієнтів з діагнозом «целіакія», виявленим ретроспективно. Усі випадки були підтверджені гістологічно за класифікацією Marsh, усі па­цієнти обстежені на тлі дотримання безглютенової дієти. Демографічні особливості, вік початку захворювання, результати клінічного обстеження, антропометричні показники та лабораторні результати порівнювали у групах хворих, які дотримувалися дієти, та за її відсутності. Результати. До дослідження були включені 77 хворих (48 жінок і 29 чоловіків) із целіакією, середній вік яких становив 9,81 ± 4,73 року. Переважно у пацієнтів виявлені гістологічно за класифікацією Marsh типи 3a (n = 22) і 3b (n = 20). Результати серологічного скринінгу показали, що у 40,3 % випадків (n = 31) хворі дотримувалися безглютенової дієти, тоді як у 59,7 % (n = 46) — не дотримувалися. У хворих цієї групи відзначалися вірогідно нижчі показники вмісту вітаміну В12, вітаміну D, фолатів, цинку та селену порівняно з групою хворих, які дотримувалися відповідної дієти (p = 0,000; 0,000; 0,000; 0,000 та 0,031 відповідно). Крім того, був виявлений вірогідно вищий середній рівень загального IgA в сироватці крові у групі хворих без дотримання дієти порівняно з групою хворих, які дотримувалися безглютенової дієти (p = 0,027). Висновки. Встановлена висока ефективність безглютенової дієти для корекції недостатності та дефіциту вітамінів і мікроелементів. Необхідно детально інформувати пацієнтів з целіакією та їх родини про неухильне пожиттєве дотримання безглютенової дієти, хоча дотримання такого харчування створює чимало соціальних і практичних труднощів.

Complete food composition databases (FCDBs) on gluten-free (GF) foods are needed to assess the nutrient intakes of celiac disease patients. The aim of the present work was to update the previously developed version of the Italian GF-FCDB and to apply it to a theoretical GF diet. The updated GF-FCDB includes the composition of 108 GF cereal-based foods, as sold, in terms of energy and macro- and micro-nutrients, imputed using food label information combined with the standard recipe approach. Three scenarios (i.e., refined, mixed, and wholegrain cereals) of the weekly guideline menu for the general Italian population were analyzed for energy and nutrient content in a theoretical dietary assessment using traditional gluten-containing (GC) foods and the corresponding GF substitutes. All GF menus were higher than the corresponding GC menus in polyunsaturated fatty acids, linoleic acid, and vitamin E. Zinc was lower in GF than in GC menus only in the wholegrain-cereal scenario. Thanks to the application of the updated GF-FCDB including a comprehensive list of micronutrients, we observed that it is possible for celiac disease patients to meet nutrient requirements by simply substituting GC with GF cereal-based products following recommendations for the general population.

BackgroundCeliac disease (CeD) is often accompanied by other autoimmune diseases (AID). However, the association of co-existing autoimmunity with the presentation and treatment success in CeD is unclear. We investigated these issues with a large and well-defined cohort of Finnish patients.MethodsAdult CeD patients (n = 806) were collected from multiple heath care sites via nationwide recruitment. They were interviewed, underwent measurement of CeD autoantibodies, and filled out questionnaires to ascertain quality of life (PGWB) and gastrointestinal symptoms (GSRS) after a median of 9.7 years on a gluten-free diet. Data were supplemented retrospectively from patient records. The results were compared between CeD patients with and without a coexisting AID.ResultsAltogether 185 patients had CeD+AID and 621 had CeD only. At CeD diagnosis, patients with CeD+AID were older (median 42 vs. 36 years, p = 0.010) and had more joint symptoms (9.1 vs. 4.2%, p = 0.011), whereas the groups were comparable in sex, family history of CeD, other presenting symptoms, proportion of screen-detected subjects, and severity of duodenal lesion. During follow-up on gluten-free diet, CeD+AID patients experienced poorer general health (median score 12 vs. 14, p < 0.001) in PGWB, more overall gastrointestinal symptoms (2.1 vs. 1.9, p = 0.001), and constipation (2.0 vs. 1.7, p < 0.001) in GSRS, whereas there was no difference in histological and serological recovery, dietary adherence, use of gluten-free oats, smoking, and presence of regular follow-up.ConclusionsCo-existing AID was not significantly associated with the baseline features or with most long-term outcomes in CeD. However, the increased prevalence of gastrointestinal symptoms and reduced poorer self-perceived health during treatment indicates these patients' need for special support.

Anemia is considered to be the most frequent extra-intestinal manifestation of Celiac Disease (CD). We assessed frequency, severity, morphologic features, and pathogenic factors of anemia in patients of the Sicilian Regional Network of Celiac Disease and attempted to identify putative pre-diet factors influencing anemia persistence. We retrospectively analyzed CD patients admitted to three centers between 2016–2020. 159 patients entered the study (129 females). More than half (54.7%) had mild-moderate, hypochromic and microcytic anemia, associated with below normal total serum iron and ferritin, indicative of iron deficiency anemia (IDA). One year after diagnosis, 134 patients were following ‘strict’ GFD. Hypochromic and microcytic anemia persisted in 46% of subjects who were anemic at diagnosis. Patients with persistent anemia had at diagnosis a higher prevalence of female gender (p = 0.02), lower body mass index (BMI, p = 0.01), higher prevalence of poly/hypermenorrhea (p = 0.02) and atopy (p = 0.04), and lower ferritin levels (p = 0.05) than the whole group of non-anemic ones. IDA is found in more than 50% of CD patients at diagnosis; nevertheless, in a lot of women IDA is not corrected by ‘strict’ GFD. Low BMI and poly/hypermenorrhea at diagnosis characterize this subgroup, suggesting that IDA might be due to iron loss rather than malabsorption, or to their coexistence/overlap.

There is a need for consensus on the recommendations for follow-up of children and adolescents with celiac disease. Objectives: To gather the current evidence and to offer recommendations for follow-up and management. Methods: The Special Interest Group on Celiac Diseases of the European Society of Paediatric Gastroenterology Hepatology and Nutrition formulated ten questions considered to be essential for follow-up care. A literature search (January 2010-March 2020) was performed in PubMed or Medline. Relevant publications were identified and potentially eligible studies were assessed. Statements and recommendations were developed and discussed by all coauthors. Recommendations were voted upon: joint agreement was set as at least 85%. Results: Publications (n = 2775) were identified and 164 were included. Using evidence or expert opinion, 37 recommendations were formulated on: The need to perform follow-up, its frequency and what should be assessed, how to assess adherence to the gluten-free diet, when to expect catch-up growth, how to treat anemia, how to approach persistent high serum levels of antibodies against tissue-transglutaminase, the indication to perform biopsies, assessment of quality of life, management of children with unclear diagnosis for which a gluten-challenge is indicated, children with associated type 1 diabetes or IgA deficiency, cases of potential celiac disease, which professionals should perform follow-up, how to improve the communication to patients and their parents/caregivers and transition from pediatric to adult health care. Conclusions: We offer recommendations to improve follow-up of children and adolescents with celiac disease and highlight gaps that should be investigated to further improve management.

Recent guidelines suggest non-biopsy serology-based approach for the diagnosis of celiac disease; however, there is no evidence-based data regarding noninvasive follow-up of mucosal healing. The aim of this study is to investigate the efficacy of serology in reflecting mucosal status in the follow-up of pediatric patients with celiac disease. This is a validation study conducted at a university hospital. Patients who had biopsy proven celiac disease (Marsh III) at diagnosis, and had been followed-up for at least 12 months, were prospectively evaluated with duodenal biopsies. tTG-IgA and EMA tests were performed on the day of endoscopy. One hundred four patients with a mean age of 7.4 ± 4.02 years were included in the study. The sensitivity and specificity of tTG-IgA were 85.2% and 61% respectively, with a high negative predictive value (NPV) of 92.2% but a very low positive predictive value (PPV) of 43.4%. We found that a cutoff value of 68.5 U/mL for tTG-IgA had a sensitivity, specificity of 85.2% and 85.7% respectively. The AUC was 0.891. The sensitivity and specificity of EMA was 77.8% and 87% respectively, with a high NPV of 91.8% but low PPV of 67.7%.This study suggests that negative tTG-IgA and/or EMA can be used as an indicator of mucosal improvement in the follow-up of pediatric patients with celiac disease. However, positive serology (i.e., 10 × ULN) may be misleading in reflecting mucosal status in the follow-up of pediatric patients with celiac disease.• The tissue transglutaminase IgA (tTG-IgA) and endomysium IgA (EMA) tests are widely used, sensitive and reliable diagnostic tests, but their role in monitoring adherence to dietary treatment in celiac patients has not yet been demonstrated. • There is still no reliable and non-invasive marker of persistent villous atrophy or mucosal recovery.• Negative celiac serology detected in the follow-up of pediatric patients with celiac disease was successful in demonstrating histopathological mucosal healing. • Positive celiac serology, which is highly reliable in the diagnosis of celiac disease, has not been successful in reflecting mucosal status when used in the follow-up of pediatric patients with celiac disease.

on. Celiac disease is treated by following a lifelong strict gluten-free diet. It is practically difficult to follow this diet and patient requires appropriate management. Objective. The aim of the study was to assess adherence to the gluten-free diet and the management of celiac disease in patients of Batna city. Population and methods. A descriptive cross-sectional survey was carried out with 110 patients from Batna city. A questionnaire was established to collect socio-demographic and clinical data, and information on gluten-free diet adherence, and on celiac disease management. Results. Good adherence to gluten-free diet was found in most patients (78%). Patients age, socio-professional level, as well as disease duration had a significant positive effect on gluten-free diet adherence. More than half of patients carried out dietetic and medical consultations. All patients inquired about the disease and its diet, even though they were not members of a celiac association. Education about the disease and treatment of complications were the main components of celiac disease management. Conclusion. Despite the good adherence to the gluten-free diet, noted in most patients, awareness and education of patients and their families about the celiac disease and its management is very important.

Introduction Celiac disease (CD) is an autoimmune enteropathy triggered by gluten ingestion in genetically susceptible individuals. In CD, activation of the immune response causes damage of the intestinal mucosa, and a gluten-free diet (GFD) is the only available therapy. Intestinal damage can lead to an increase in the circulation of components of bacteria from the intestinal lumen, such as lipopolysaccharide (LPS). Soluble CD14 (sCD14) and lipopolysaccharide-binding protein (LBP) participate in the recognition of LPS, and their levels are altered in different pathologies. In the present study, the circulating levels of sCD14 and LBP from untreated CD patients were evaluated and compared to CD patients on a GFD and controls. Material and methods In total seventy-two adult patients with CD, twenty-three untreated CD patients and forty-nine on a GFD were included. In addition, fifty-five healthy individuals were included as controls. Additionally, the effect of LPS on sCD14 production by both normal and inflamed intestinal tissue culture was explored. Results Serum levels of sCD14 were found to be significantly increased in untreated CD patients compared to patients on a GFD and controls. In addition, we found that LPS induced the production of sCD14 by biopsies of intestinal tissue from untreated CD patients. Conclusions The data from this study show that circulating levels of sCD14 are increased in the untreated CD patients compared to patients on a GFD. Our data show that LPS induces the production of sCD14 by the intestinal tissue from untreated CD patients.

Introduction Celiac disease typically presents with symptoms of malabsorption, but extraintestinal manifestations are increasingly reported. Aplastic anemia as the mode of celiac disease presentation is extremely rare in children. Case presentation We report a 2‐year‐old boy who presented with loose stools, loss of appetite, and bicytopenia with severe aregenerative normocytic anemia. Investigations, including bone marrow aspirate and biopsy, revealed aplastic anemia. Screening for malabsorption showed increased plasma concentrations of anti‐transglutaminase and anti‐gliadin antibodies. A duodenal biopsy confirmed the histologic features of celiac disease. The child received a packed red cell transfusion and was started on a gluten‐free diet, with a very good prognosis and normalization of both his blood and histological parameters. To the best of our knowledge, our report is the sixth pediatric case in the literature. Conclusion Screening for celiac disease should be performed in children with unexplained hematological abnormalities such as aplastic anemia with or without gastrointestinal symptoms.

Currently, the only treatment for coeliac disease (CD) is a strict, lifelong gluten-free diet (GFD); however, their completeness with regard to energy and macro- and micronutrients remains poorly understood. Paediatric studies are often limited by a low quality and a lack of controls, and their findings should be interpreted with caution. The aim of the present study was to evaluate nutritional imbalances in children with CD on a strict GFD. Methods: A single-centre prospective cohort study was conducted. A total of 48 children with CD (33 girls, mean age 11.8 ± 3.68 years) on a strict GFD (mean duration 5.02 ± 3.87 years) were compared with 50 non-coeliac subjects (26 girls, mean age 10.2 ± 3.97 years). In both groups, anthropometric measurements (body height, weight and BMI) and laboratory tests (haemoglobin level, calcium and magnesium serum concentration, folic acid, vitamin B1, B2, B6 and B12 level) were checked. Additionally, in coeliac subjects, a 3-day food record for energy and macro- and micronutrient intake assessment were determined, and the values were compared to those in non-CD participants and the dietary reference intake (DRI) standards. Results: The CD children were more likely to demonstrate significantly lower serum vitamin B1 and folic acid levels compared to controls (p = 0.01 and p = 0.002, respectively). Although mean serum calcium values were within normal ranges, they were significantly lower in CD subjects than controls (p = 0.01). Mean calcium, folic acid and vitamin D intake was below the dietary recommendations in the CD group (69.9%, 71.2% and 68.9% DRI, respectively) but did not differ significantly between CD and non-coeliac subjects. In turn, the mean supply of proteins and carbohydrates in the CD group substantially exceeded the recommended levels (190.3% and 189.4% DRI, respectively) but was similar to controls. A significantly higher number of CD children were classified as underweight, and a significantly lower number as overweight or obese, compared with controls (p < 0.001). Conclusion: Although children with CD receive nutritional education at diagnosis, a GFD often does not provide a balanced set of macro- and micronutrients. This is mainly due to unhealthy dietary habits, as commonly observed in the general population. Children with CD should be informed that while their diet should be free of gluten, it should nevertheless cover all their nutrition requirements in the long term.

A lifelong strict gluten-free diet is the only available treatment for patients with coeliac disease (CD). As with any restrictive diet, it may potentially lead to nutritional deficits. Seventy-six patients with CD (mean age 9.0 ± 4.3 years, 57% female) and 590 healthy controls (HC) (mean age 9.9 ± 0.1 years, 54% female) were recruited and requested to keep a 3-day food record (3DFR). In HC patients, anthropometric data were determined at the time when 3DFRs were collected. In CD patients, anthropometric data were determined at two time points: at diagnosis and at the time of 3DFRs collection. Intake of energy, macronutrients, and micronutrients was determined using PRODI expert 6.9 software and expressed as a percentage of recommended daily intake. In CD patients, all measured anthropometric measures (body weight (BW), body height (BH), and body mass index (BMI) z-scores) increased significantly after the mean duration of 34.1 months of a GFD. Overall, CD patients had significantly lower BW and BH z-scores compared to healthy controls. Patients with CD were generally more compliant with the recommended dietary intakes of macronutrients and some micronutrients, as compared to HC. Three participants were not compliant with the GFD; 42.1% of participants took oral nutritional supplements at the start of their GFD. Our study showed that patients with CD have better compliance with dietary recommendations compared to healthy controls, showing that a well-balanced GFD diet can provide necessary macro- and micronutrients.

Background: Children diagnosed with type 1 diabetes mellitus (T1DM) are more prone to having celiac disease (CD) than the normal population. Moreover, patients with this dual diagnosis who are also on a diabetic and gluten-free diet (GFD) risk faltering growth and uncontrolled blood glucose levels. This review aims to assess the efficacy and effectiveness of managing patients with T1DM screened for CD with GFD to prevent complications associated with these chronic pathologies in childhood and adulthood. Materials and Methods: We abided by the PRISMA guidelines in this meta-analysis and used multiple databases and search engines. We included case–control studies. The primary outcomes were changes in the standard deviation score, body mass index (SDS BMI), and glycosylated hemoglobin (HA1C) after being on a GFD for at least twelve months. Results: The pooled data from the six studies included showed that there was neither a statistically significant difference in the mean SDS BMI (−0.28 (95% CI −0.75, 0.42)) (p = 0.24) nor in the mean of HA1C (mean −0.07 (95% CI −0.44, 0.30)) (p = 0.36) for the same group. HDL cholesterol improved significantly in patients on a strict GFD (p < 0.01). Conclusions: In children with T1DM and asymptomatic CD, being on a GFD had no significant effect on BMI or HA1C. However, it can have a protective effect on the other complications found in both chronic pathologies.

Iako su žitarice neophodan dio prehrane, pojedine žitarice mogu negativno utjecati na probavni sustav kod nekih osoba. Razlog tome jest postojanje glutena u pojedinim žitaricama. Za osobe kojima je dijagnosticirana celijakija, gluten može biti izrazito štetan. Obilnije stolice, bljedoća, osip, gubitak apetita i tjelesne težine te nezainteresiranost samo su neki od simptoma celijakije koji se mogu pojaviti u dječjoj ili odrasloj dobi. Kako bi se navedeni simptomi izbjegli, nužno je konzumirati isključivo hranu bez glutena. Ukoliko osobe oboljele od celijakije unesu gluten u svoj organizam, uništavaju se crijevne resice te se smanjuje apsorpcija hranjivih tvari što rezultira pothranjenošću. Dakle, za osobe koje boluju od celijakije, bezglutenska prehrana jedini je lijek. Cilj ovog diplomskog rada jest upoznati učenike s celijakijom (glutenskom enteropatijom) i glutenom kao glavnim uzročnikom ove bolesti. Također, ovim se radom nastoji osvijestiti učenike o posebnim prehrambenim potrebama djeteta s celijakijom i bezglutenskom dijetom kao oblikom prehrane oboljelih. Although cereals are an essential part of the diet, some cereals can negatively affect on digestive system in some people. The reason for this is the existence of gluten in certain cereals. For people who have coeliac disease, gluten can be extremely harmful. Excessive stools, paleness, rash, loss of appetite and weight, and lack of interest are just some of the symptoms of coeliac disease that can occur in childhood or adulthood. To avoid these symptoms, it is necessary to consume only gluten-free foods. If people with celiac disease take gluten into their body, the intestinal villi are destroyed and the absorption of nutrients is reduced, which results in malnutrition. So, for people suffering from celiac disease, a gluten-free diet is the only cure. The aim of this graduate thesis is to introduce students to celiac disease (gluten enteropathy) and gluten as the main cause of this disease. Also, this thesis seeks to make students aware of the special nutritional needs of children with celiac disease and gluten-free diet as a form of nutrition for patients.

ObjectiveTo investigate the prevalence and associated factors of persistent symptoms despite a strict gluten-free diet in adult patients with coeliac disease diagnosed in childhood.DesignMedical data on 239 currently adult patients with paediatric diagnosis were collected from patient records. Also, patients completed structured study questionnaire. All variables were compared between those with and without persistent symptoms.ResultsAltogether 180 patients reported adhering to a strict gluten-free diet. Of these, 18% experienced persistent symptoms, including various gastrointestinal symptoms (73%), arthralgia (39%), fatigue (39%), skin symptoms (12%) and depression (6%). Those reporting persistent symptoms had more often gastrointestinal comorbidities (19% vs 6%, p=0.023), health concerns (30% vs 12%, p=0.006) and experiences of restrictions on daily life (64% vs 43%, p=0.028) than the asymptomatic subjects. The patients with symptoms had poorer general health (median score 13 vs 14, p=0.040) and vitality (15 vs 18, p=0.015) based on a validated Psychological General Well-Being Questionnaire and more severe symptoms on a Gastrointestinal Symptom Rating Scale scale (total score 2.1 vs 1.7, pConclusionAlmost one-fifth of adult patients diagnosed in childhood reported persistent symptoms despite a strict gluten-free diet. The ongoing symptoms were associated with health concerns and impaired quality of life.

Prehrana u dječjoj dobi specifična je zbog povećanih energijskih i nutritivnih potreba, a kad je tome pridružena i celijakija, važnost uravnotežene prehrane koja će isključivo iz bezglutenskih namirnica osigurati sve hranjive tvari još je veća. Prekomjerni unos natrija, koji je trenutno prisutan među djecom u Republici Hrvatskoj i šire, izravno utječe na kvalitetu cjelokupne prehrane i zdravstveno stanje djeteta. Cilj ovog rada bio je odrediti prehrambeni unos natrija, odnosno soli, u uzorcima cjelodnevnih obroka djece na strogoj bezglutenskoj dijeti primjenom atomske apsorpcijske spektrometrije. Cjelodnevni obroci (n = 16) prikupljeni su u sklopu ranije provedenog istraživanja metodom duplikat dijete. Prosječan sadržaj natrija u svim uzorcima iznosio je 2389 ± 933 mg, odnosno 6,0 ± 2,33 g soli. Većina ispitanika premašila je dnevnu preporuku za unos soli (EFSA). Prekomjeran unos soli pokazatelj je niže kvalitete prehrane i može ostaviti negativne posljedice na zdravlje, osobito u kasnijoj životnoj dobi. Nutrition during childhood years is unique because of increased energy and nutrient requirements, even more so when accompanied by celiac disease. Maintaining a balanced gluten-free diet that meets all the requirements is of great importance. Excessive dietary sodium intake that is currently present among children in many countries including Croatia directly impacts their diet quality and health status. The aim of this thesis was to determine dietary sodium (salt) intake using atomic absorption spectrometry in 16 samples of children’s whole-day gluten-free meals. The samples were collected for the purpose of an earlier research using the duplicate diet method and represent two days of the participant’s usual diet. Average sodium intake was 2389 ± 933 mg which equals 6,0 ± 2,33 g of salt intake. Most of the participants exceeded the sodium intake recommendation. Excess sodium intake is linked to lower overall quality of children's diet with negative health implications, especially later in life.

This cross-sectional study aims to assess eating competence (EC—an intra-individual approach to food, behaviors, and attitudes related to food) and aspects related to a gluten-free diet (GFD) in Brazilian adults with gluten-related disorders (GRDs). The research was conducted using an online survey with a self-reported instrument consisting of 40 items, organized into three parts: (I) Socioeconomic and demographic data; (II) the Brazilian version of the Eating Competence Satter Inventory (ec-SI2.0™BR); and (III) questions about adherence and difficulties in following the gluten-free diet. EC was measured by the ecSI2.0™BR instrument, with scores ≥32 were considered competent eaters. The instrument was applied nationwide through the GoogleForms® platform from 14 February 2022 to 30 March 2022. The publicity for the recruitment was supported by Brazilian celiac local and national associations (Acelbras and Fenacelbra), pages of food services or personal pages of tips and posts about gluten-related disorders, and specialized stores that offer gluten-free foods. The recruitment occurred through social networks (emails, Facebook groups, WhatsApp, and Instagram). A total of 1030 Brazilians with GRDs answered the questionnaire. Most participants were female, aged 40 years or older, with an income >R$3000, and a high education level. The main difficulty regarding adherence to GFD was the high cost of gluten-free foods. Individuals younger than 40 years old had lower EC scores, with no differences between men and women. Increasing socioeconomic status, schooling, and culinary practices increased the total score. Participants who “never/almost never” felt socially judged because their diet had higher scores for total EC. Competent eaters GRD individuals (EC ≥ 32) were mostly individuals aged ≥40 y/o; with income > R$3000; following a GFD; satisfied with purchased gluten-free products; consuming gluten-free products prepared at home, mainly by themselves; who do not feel judged because of the GRD and who feel that they can live a normal life with GRD. Our study showed that individuals who strictly adhere to the GFD have higher scores on eating competence than those who sometimes follow the treatment.

We report on the case of a 61-year-old male who initially presented with a progressive myoclonus and an intention tremor and was subsequently diagnosed with celiac disease. His neurological symptoms improved with anti-epileptic therapy and a gluten-free diet. Possible explanations include a milder disease phenotype or an epileptic component to his myoclonic movement disorder. This case highlights findings of a progressive myoclonic movement disorder, likely linked to celiac disease, and stresses the importance of a gluten-free diet in the management of the neurological manifestations of celiac disease.

One of the most challenging aspects of celiac disease management is lack of awareness in public. Aim of the study was to evaluate public awareness and sensitivity on celiac disease and gluten-free diet. 501 individuals in Manisa, Turkey were subjected to a survey to obtain information on demographics, awareness of celiac disease, celiac and gluten-free diet relationship, effect on social life quality and social awareness and sensitivity. Results were analyzed by chi-square test. 43.9% of the public had never heard of celiac disease before. Females were more aware of the disease and gluten-free diet dependency. Majority of the postgraduates (79.6%) recognized the disease. 44.9% of the respondents remarked that celiac patients had hesitations on dining out, while 32.3% found those people restricted for travel and holiday activities. Above one-third of subjects indicated that gluten-free product variety in the market was inadequate. However, more than half had no idea on these. Over 50% felt that, social awareness and sensitivity towards disease was unsatisfactory. This study was conducted to mirror the society’s approach towards celiac patients. It was demonstrated that public’s awareness and sensitivity about celiac disease was scarce. Knowledge of ‘celiac’ needs to be raised.

Lifelong adherence to a gluten-free diet (GFD) is the cornerstone of management of celiac disease (CD), but adhering to a GFD can be hard. Although several factors are positively associated with adherence of pediatric CD patients to a GFD, it is unknown whether these are influenced by variability caused by the specific tool used to assess adherence to a GFD. Here, we aimed to evaluate how individual patient characteristics and dietary counselling by a trained dietitian influence adherence to a GFD in children with CD, as assessed by two validated questionnaires: the Biagi questionnaire and the Leffler short questionnaire adapted for pediatric patients. Some 139 children and adolescents were recruited in a cross-sectional, multicenter study. Concordance between the two questionnaires in defining adherence was fair (weighted Cohen’s kappa coefficient 0.39, 95%CI 0.19–0.60). Upon regression analysis, having a cohabiting family member with CD, being of Italian origin, and receiving specialized dietary counselling during follow-up were found to positively influence stricter adherence to a GFD for children with CD. Neither questionnaire detected a significant relationship between adherence to a GFD and the presence of symptoms after gluten ingestion. This study provides important new data on the factors influencing GFD adherence in the pediatric population, and highlights the importance of dietician input and overcoming language and cultural barriers when educating patients.

In adults, celiac disease (CD) diagnosis is based on specific serology (anti-transglutaminase IgA-anti-tTG) and duodenal histology. Evidence is raising the possibility of perform CD diagnosis based only on high anti-tTG titer in children. We aimed to evaluate clinical, histological and biochemical differences between adult patients with high tTG IgA titer (HT) and those with low titer (LT) at CD diagnosis and follow-up. This retrospective study included consecutive adult CD patients divided into two groups: HT (anti-tTG > 10 × ULN) and LT (anti-tTG < 10 × ULN). Clinical, biochemical and histological features were compared between groups at CD diagnosis and at follow-up. A total of 291 patients were included (HT: 47.1%; LT: 52.9%). At CD diagnosis, HT patients showed a non ‘classical’ presentation (p = 0.04), Marsh 3C (p = 0.005), hypoferritinaemia (p = 0.006) and osteopenia/osteoporosis (p = 0.04) more frequently than LT patients. A total of 216 patients (HT: 48.6%; LT: 51.4%) performed a follow-up after a median Gluten-free diet of 14 months; HT patients had persistent antibodies positivity (p = 0.001) more frequently and GI symptoms (p = 0.04) less frequently than LT patients. In conclusion, HT patients presented severe histological damage more frequently at diagnosis, recovering similarly to LT patients after the start of the Gluten-free diet. At follow-up, anti-tTG persisted positive in HT more frequently compared to LT patients, without differences regarding histological recovery and clinical improvement.

Background & Aims: Gluten challenge studies are instrumental in understanding the pathophysiology of celiac disease. Our aims in this study were to reveal early gluten-induced transcriptomic changes in duodenal biopsies and to find tools for clinics. Methods: Duodenal biopsies were collected from 15 celiac disease patients on a strict long-term gluten-free diet (GFD) prior to and post a gluten challenge (PGC) and from 6 healthy control individuals (DC). Biopsy RNA was subjected to genome-wide 3’ RNA-Seq. Sequencing data was used to determine the differences between the three groups and was compared to sequencing data from the public repositories. The biopsies underwent morphometric analyses. Results: In DC vs. GFD group comparisons, 167 differentially expressed genes were identified with 117 genes downregulated and 50 genes upregulated. In PGC vs. GFD group comparisons, 417 differentially expressed genes were identified with 195 genes downregulated and 222 genes upregulated. Celiac disease patients on a GFD were not “healthy”. In particular, genes encoding proteins for transporting small molecules were expressed less. In addition to the activation of immune response genes, a gluten challenge induced hyperactive intestinal wnt-signaling and consequent immature crypt gene expression resulting in less differentiated epithelium. Biopsy gene expression in response to a gluten challenge correlated with the extent of the histological damage. Regression models using only four gene transcripts described 97.2% of the mucosal morphology and 98.0% of the inflammatory changes observed. Conclusions: Our gluten challenge trial design provided an opportunity to study the transition from health to disease. The results show that even on a strict GFD, despite being deemed healthy, patients reveal patterns of ongoing disease. Here, a transcriptomic regression model estimating the extent of gluten-induced duodenal mucosal injury is presented.

Aim: Herein, we present five children and adolescents with a final diagnosis of non-celiac gluten sensitivity (NCGS). Background: Non-celiac gluten sensitivity (NCGS) is a condition characterized by gastrointestinal and extra-intestinal symptoms triggered by ingestion of gluten-containing compounds, e.g., wheat, rye, and barley, in subjects without celiac disease or wheat allergy. Methods: Demographic characteristics, clinical manifestations, serum biomarkers and skin prick test were evaluated. Patient data was also recorded after they followed a gluten-free diet (GFD). Height and weight were measured, and all patients were examined 6 months after following the suggested GFD. Results: All patients had failure to thrive and abdominal pain. Clinical symptoms were reduced, and significant weight and height gains were detected after 1 month of following a gluten-free diet. Conclusion: The relationship between failure to thrive (FTT) and NCGS is still unknown; hence, NCGS may be one of the main causes of FTT which can be prevented by gluten-free diets.