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Nowadays, the gluten-free diet (GFD) has become much more than the dietary treatment for celiac disease. Due to its presumed beneficial effects even in non-celiac subjects, it has become a new fashion statement and it is promoted by some healthcare professionals, social media and marketing strategists. On the other hand, regardless of a proper medical indication, a GFD may present side effects, such as poor palatability, high costs and socio-psychological adversities. Moreover, it can be an obstacle to correct clinical practice and may induce nutritional deficiency due to a low-quality diet. In addition, a GFD can trigger or exacerbate many irritable bowel syndrome (IBS)-like disorders in predisposed subjects: reactivity to dietary nickel, the increased consumption of FODMAP-rich foods and histamine intolerance seem to frequently play a relevant role. The possible intersections between high-risk foods in these categories of patients, as well as the possible overlaps among IBS-like disorders during GFD, are described. In conclusion, it is advisable to undergo a careful clinical evaluation by a gastroenterologist and a nutritionist (in some cases, also a psychotherapist) before starting and during a GFD, because both benefits and risks are possible. It is also important to take into account IBS-like disorders that can be exacerbated by a GFD and that are still underestimated today. [ABSTRACT FROM AUTHOR]

Background: Chemotherapy-induced neutropenia (CIN) has been demonstrated to be a prognostic factor in several cancer conditions. We previously found a significant prognostic value of CIN on overall survival (OS), in a pooled dataset of patients with advanced non-small-cell lung cancer (NSCLC) receiving first line chemotherapy from 1996 to 2001. However, the prognostic role of CIN in NSCLC is still debated. Methods: We performed a post hoc analysis pooling data prospectively collected in six randomized phase 3 trials in NSCLC conducted from 2002 to 2016. Patients who never started chemotherapy and those for whom toxicity data were missing were excluded. Neutropenia was categorized on the basis of worst grade during chemotherapy: absent (grade 0), mild (grade 1-2), or severe (grade 3-4). The primary endpoint was OS. Multivariable Cox model was applied for statistical analyses. In the primary analysis, a minimum time (landmark) at 180 days from randomization was applied in order to minimize the time-dependent bias. Results: Overall, 1529 patients, who received chemotherapy, were eligible; 572 of them (who received 6 cycles of treatment) represented the landmark population. Severe CIN was reported in 143 (25.0%) patients and mild CIN in 135 (23.6%). At multivariable OS analysis, CIN was significantly predictive of prognosis although its prognostic value was entirely driven by severe CIN (hazard ratio [HR] of death 0.71; 95%CI: 0.53-0.95) while it was not evident with mild CIN (HR 1.21; 95%CI: 0.92-1.58). Consistent results were observed in the out-of-landmark group (including 957 patients), where both severe and mild CIN were significantly associated with a reduced risk of death. Conclusion: The pooled analysis of six large trials of NSCLC treatment shows that CIN occurrence is significantly associated with a longer overall survival, particularly in patients developing severe CIN, confirming our previous findings. [ABSTRACT FROM AUTHOR]