RESUMEN

Celiac disease (CD) is an autoimmune disease triggered by the ingestion of gluten in genetically predisposed individuals, affecting 1.4% of the world population. CD induces an inflammatory reaction that compromises small intestine villi, leading to nutrient malabsorption, and gastro and extraintestinal manifestations. Although other treatment approaches are being studied, adherence to a gluten-free diet (GFD) is the only effective intervention to date. Despite this, about 50% of patients experience persistent inflammation, often associated with unintentional gluten ingestion through contaminated food. There are regulations for labeling gluten-free foods which specify a limit of 20 mg/kg (20 ppm). The risks of gluten cross-contamination above that level are present throughout the whole food production chain, emphasizing the need for caution. This review explores studies that tested different procedures regarding the shared production of gluten-containing and gluten-free food, including the use of shared equipment and utensils. A literature review covering PubMed, Scielo, Web of Science, VHL and Scopus identified five relevant studies. The results indicate that shared environments and equipment may not significantly increase gluten cross-contamination if appropriate protocols are followed. Simultaneous cooking of gluten-containing and gluten-free pizzas in shared ovens has demonstrated a low risk of contamination. In general, shared kitchen utensils and equipment (spoon, ladle, colander, knife, fryer, toaster) in controlled experiments did not lead to significant contamination of samples. On the other hand, cooking gluten-free and gluten-containing pasta in shared water resulted in gluten levels above the established limit of 20 ppm. However, rinsing the pasta under running water for a few seconds was enough to reduce the gluten content of the samples to less than 20 ppm.

Asunto(s)

RESUMEN

INTRODUCTION/OBJECTIVES: Coeliac disease (CD) and non-coeliac gluten sensitivity (NCGS) cause symptoms like those seen in patients with fibromyalgia (FM) and functional gastrointestinal disorders. There is no consistent data on frequency of these symptoms and no study performed duodenal biopsies to investigate CD/NCGS in Brazilian FM patients. Therefore, we sought to verify the prevalence of CD/NCGS in FM patients and the association between gastrointestinal manifestations and FM symptoms. MATERIAL AND METHODS: Sixty-two individuals with FM (ACR2010) were recruited from FM outpatient clinics of a tertiary hospital. Clinical evaluation included the Widespread Pain Index (WPI), Severity Symptom Scale (SS), Polysymptomatic Distress Scale (PDS), and Fibromyalgia Impact Questionnaire (FIQ). Subjects were screened for the presence of coeliac antibodies and upper gastrointestinal endoscopy (duodenal biopsies) was performed for diagnosis of CD/NCGS. RESULTS: 46 (74.2%) women reported at least one digestive symptom: constipation, abdominal distension, loss of weight/inappetence, and nausea/vomiting. Fourteen (31.8%) presented macroscopic duodenitis and 2(4.5%) had duodenal lymphocytic infiltrates, but none met CD criteria. In 1(1.6%) patient NCGS was confirmed. There was association between presence of any digestive symptom and WPI and SS (fatigue, waking up tired, cognition), but no difference on FIQ between patients with and without gastrointestinal symptoms. CONCLUSION: Gastrointestinal complaints were frequent and associated with increased degree of polysymptomatic distress in FM patients, but presence of these symptoms was not related to overall impact of FM over different dimensions of the patient's life. Moreover, the prevalence of CD/NCGS was very low. This suggests that screening for CD in Brazilian FM patients might not be cost-effective, since the frequency of CD/NCGS was very low.

Asunto(s)

RESUMEN

A gluten-free diet (GFD) is the treatment of choice for gluten-related disorders. It has been associated with macro- and micronutrient deficiencies. Recently, consumption of arsenic-contaminated rice has raised concern because of the potential greater risk that it may represent for people on GFDs, whose rice consumption is high, since it is a fundamental cereal in GFDs. We reviewed the data published over the last 20 years in Medline and Scielo, in English, French and Spanish, on four metals (As, Hg, Cd, and Pb), to assess whether the evidence suggests that celiac disease or consumption of a GFD is associated with increased levels of blood/urinary metal concentrations. The review revealed a few articles that were directly related to the four metals and their relationships with a GFD. The evidence supports that rice-based products are a relevant source of As and other metals. Clinical studies and evaluations based on NHANES have indicated that persons on GFDs have higher As and Hg blood/urinary levels, suggesting that the diet and not the disease is responsible for it. The levels described are statistically significant compared to those of persons on complete diets, but far from toxic levels. The question of whether higher exposure to heavy metals associated with a GFD is biologically relevant remains unanswered and deserves study.

Asunto(s)

RESUMEN

Cerebellar manifestations have been described in patients with gluten sensitivity (GS)-related disorders. A better understanding of the neurological manifestations of GS requires the use of neuroimaging techniques. We performed a systematic review on neuroimaging findings in GS patients with cerebellar symptoms. We also included a specific search on neuroimaging findings in GS patients with cerebellar manifestations on a gluten-free diet (GFD). PubMed, Embase, and Bireme were systematically searched to identify studies assessing neuroimaging features of adults with cerebellar manifestations and GS with or without enteropathy on a GFD. Ten studies with a total of 222 adult-GS patients were included. Magnetic resonance imaging was used in 100% of the studies. Cerebellar atrophy was evaluated in 7 studies and observed in 63% of the patients. White matter abnormalities were described in 2 studies. Single-photon emission computed tomography was used in 2 studies, and decreased cerebellar perfusion was detected in 92% of the included patients. No study employed nuclear medicine after the start of GFD. Magnetic resonance spectroscopy (MRS) was performed in 2 studies before and after GFD. An increase in the Naa/Cr ratio in cerebellar vermis was seen in 98% of the cases on a strict GFD. Cerebellar atrophy was found to be a prevalent condition in GS patients. MRS demonstrated to be useful in the follow-up of GS patients with cerebellar manifestations on a GFD. Prospective studies using nuclear medicine imaging are needed to study brain changes in GS patients on a GFD.

Asunto(s)

RESUMEN

AIM: Gluten-free diets (GFDs) have gained popularity in the general population. Nonetheless, controlled studies are necessary before decisions can be made to promote GFDs. We aimed to evaluate the effects of gluten intake on body weight, body composition, and resting energy expenditure and observe the changes in nutrient intake caused by GFDs. METHODS: Twenty-three women were kept on a GFD for six weeks and received muffins with 20 g of gluten isolate (gluten period) or muffins without gluten (gluten-free period) in a crossover, single-blind, non-randomized trial. Gastrointestinal symptoms, food frequency questionnaires, body composition, and resting energy expenditure were assessed before the study (habitual or usual diet) and in the third and sixth weeks. Food intake was recorded daily for six weeks. RESULTS: Gastrointestinal symptoms, resting energy expenditure, and body weight and composition were similar during the gluten period and gluten-free period. When the diet of the gluten-free period was compared with the habitual diet, we found an increase in the intake of fat and sodium and a reduction in the intake of fiber and vitamins B1, B6, B12, and folate. The nutrient imbalance caused by a GFD led to an increase in the dietary inflammatory index, thus suggesting that this type of diet has high inflammatory potential. CONCLUSION: Gluten intake (20 g/day) did not alter body composition and resting energy expenditure in healthy women without caloric restriction in the diet for a short period (three weeks). However, a GFD led to changes in the composition of the diet, which worsened the quality of the diet and increased its inflammatory potential.

Asunto(s)

Asunto(s)

RESUMEN

Non-celiac gluten sensitivity (NCGS) is a clinical entity characterized by the absence of celiac disease and wheat allergy in patients that trigger reproducible symptomatic responses to gluten-containing foods consumption. Due to the lack of sensitive and reproducible biomarkers for NCGS diagnosis, placebo-controlled gluten challenges must be carried out for its diagnosis. The gluten challenges can be either double- or single-blind, for research or clinical practice purposes, respectively. For improving our understanding about the magnitude and relevance of NCGS in different populations, epidemiological studies based on self-report have been carried out. However, the gluten challenge-based prevalence of NCGS remains to be estimated. Since NCGS was recently recognized as a clinical entity, more studies are needed to delve into NCGS pathogenesis, for instance, the molecular interactions between the suspected cereal grain components that trigger NCGS, such as fermentable oligo-, di-, monosaccharides, and polyols (FODMAPs) and amylase and trypsin inhibitors, and the immune system remains to be elucidated. Although still under debate, NCGS patients can be susceptible to only one or more than one of the NCGS triggers. The treatment of NCGS involves the dietary restriction of the suspected triggers of the disease, but there is controversial data about the effectiveness of different dietary interventions such as the gluten-free diet and low-FODMAP diet. Certainly, our understanding of NCGS is improving quickly due to the constant availability of new scientific information on this topic. Thus, the aim of the present narrative review is to present an up-to-date overview on NCGS from epidemiology to current therapy.

Asunto(s)

RESUMEN

Gluten-related disorders affect 1% to 6% of the population, with complications and high risk of short and long-term morbidity and mortality. Since 2009, Brazil has a Clinical Protocol of Therapeutic Guidelines for Celiac Disease, but there are frequent complaints by persons with gluten-related disorders concerning the lack of healthcare professionals' knowledge of this topic and the difficulties related to healthcare, for both diagnosis and treatment. This study aimed to understand the weaknesses in healthcare perceived by persons with gluten-related disorders. An online qualitative survey was conducted in the Living Without Gluten group on Facebook, consulting the records saved by the group for 65 months, which totaled 510 posts and the respective comments. The data were grouped in categories, and thematic content analysis was performed, adopting the theoretical references on healthcare. The analysis revealed that the searches for diagnosis and adequate treatment were often described as a forced pilgrimage, resulting from shortcomings in healthcare, including lack of up-to-date knowledge on gluten-related disorders among the healthcare professionals and problems in the physician-patient relationship. Weaknesses in patient care and late diagnoses contribute to increasing the risk of complications and deaths. In this context, the Living Without Gluten group plays a leading role as a support group and network of solidarity, favoring increased awareness and empowerment of numerous Brazilians with gluten-related disorders.

As desordens relacionadas ao glúten (DRG) afetam de 1% a 6% da população, com complicações e alto risco de morbimortalidade em curto e longo prazos. Desde 2009, o Brasil possui um Protocolo Clínico de Diretrizes Terapêuticas para a Doença Celíaca, entretanto, são comuns as queixas das pessoas com DRG a respeito da falta de conhecimento dos profissionais de saúde nessa temática e das dificuldades relacionadas ao cuidado em saúde em relação tanto ao diagnóstico quanto ao tratamento. Este estudo objetivou compreender as fragilidades no cuidado em saúde percebidas por pessoas com DRG. Foi realizada uma pesquisa qualitativa virtual no grupo Viva Sem Glúten (VSG), da rede social Facebook, na qual foram consultados os registros armazenados no grupo por 65 meses, que totalizaram 510 postagens e seus respectivos comentários. Os dados foram agrupados em categorias, e foi realizada análise temática de conteúdo, adotando-se os referenciais teóricos sobre o cuidado em saúde. A análise revelou que as buscas por um diagnóstico e por tratamento adequado frequentemente são descritas como uma peregrinação, sendo decorrentes das fragilidades no cuidado em saúde, traduzidas pela falta de conhecimento atualizado dos profissionais sobre as DRG e por problemas na relação profissional-paciente. As fragilidades no cuidado em saúde e os diagnósticos tardios contribuem para aumentar o risco de complicações e óbitos. Nesse contexto, o grupo VSG se destaca em seu papel de grupo de apoio e rede de solidariedade, favorecendo o esclarecimento e o empoderamento de inúmeras pessoas com DRG.

Los desórdenes relacionados al gluten afectan de 1% a 6% de la población, con complicaciones y alto riesgo de morbimortalidad en corto y largo plazos. Desde 2009, Brasil posee un Protocolo Clínico de Directrices Terapéuticas para la Enfermedad Celíaca, sin embargo, son comunes las quejas de las personas con desórdenes relacionados al gluten, respecto a la falta de conocimiento de los profesionales de salud en esa temática y las dificultades relacionadas con el cuidado en salud, en relación tanto con el diagnóstico como con el tratamiento. Este estudio se marcó como objetivo comprender las fragilidades en el cuidado en salud percibidas por personas con desórdenes relacionados al gluten. Se realizó una investigación cualitativa virtual en el grupo Vivir Sin Gluten (VSG) de la red social Facebook, en la que se consultaron los registros almacenados en el grupo durante 65 meses, que totalizaron 510 posts y sus respectivos comentarios. Los datos se agruparon en categorías y se realizó un análisis temático de contenido, adoptándose los referenciales teóricos sobre el cuidado en salud. El análisis reveló que las búsquedas de un diagnóstico y tratamiento adecuado frecuentemente se describen como una peregrinación, siendo derivados de las fragilidades en el cuidado en salud, traducidas por la falta de conocimiento actualizado de los profesionales sobre las desórdenes relacionados al gluten y por problemas en la relación profesional-paciente. Las fragilidades en el cuidado en salud y los diagnósticos tardíos contribuyen a aumentar el riesgo de complicaciones y óbitos. En este contexto el grupo VSG se destaca en su papel de grupo de apoyo y red de solidaridad, favoreciendo la información y el empoderamiento de innumerables personas con desórdenes relacionados al gluten.

Asunto(s)

RESUMEN

BACKGROUND: Concomitance of celiac disease (CD) and IgE-mediated wheat allergy is described in some case reports. The objective was to evaluate the frequency of sensitization to wheat, rye, barley, and malt in children and adolescents with CD. METHODS: Measurement of serum levels of specific IgE to wheat, rye, barley, and malt (ImmunoCAP; sensitization IgE ≥0.35 kUA/L) in CD patients followed in specialized clinics to verify allergy history, general characteristics, small bowel biopsy characteristics, compliance with gluten-free diet (GFD), and occurrence of symptoms in case of noncompliance. RESULTS: We evaluated 74 patients; the median of age and age at diagnosis of CD were 8.6 years (5.0-12.8) and 3.6 years (1.6-7.0), respectively. Median time of GFD was 3.5 years (1.4-5.8). History of asthma occurred in 17.3% of subjects, allergic rhinitis in 13.5%, and AD in 5.4%. Frequency of sensitization was 4% for wheat, 10.8% for rye, 5.4% for barley, and 2.7% for malt. There was no association between wheat sensitization and age at diagnosis, time of GFD, small bowel biopsy characteristics, allergy history, and gluten consumption. There was no relationship between sensitization to wheat and occurrence of immediate symptoms when not complying with GFD. CONCLUSION: In conclusion, the frequency of sensitization to wheat, rye, barley, and malt in CD patients was 4, 10.8, 5.4, and 2.7%, respectively. Therefore, to ensure that cutaneous and respiratory contact with wheat is safe, we advise patients with CD to investigate their sensitivity to wheat, rye, and barley because not all patients with CD are allergic to these cereals.

Asunto(s)

RESUMEN

As desordens relacionadas ao glúten (DRG) afetam de 1% a 6% da população, com complicações e alto risco de morbimortalidade em curto e longo prazos. Desde 2009, o Brasil possui um Protocolo Clínico de Diretrizes Terapêuticas para a Doença Celíaca, entretanto, são comuns as queixas das pessoas com DRG a respeito da falta de conhecimento dos profissionais de saúde nessa temática e das dificuldades relacionadas ao cuidado em saúde em relação tanto ao diagnóstico quanto ao tratamento. Este estudo objetivou compreender as fragilidades no cuidado em saúde percebidas por pessoas com DRG. Foi realizada uma pesquisa qualitativa virtual no grupo Viva Sem Glúten (VSG), da rede social Facebook, na qual foram consultados os registros armazenados no grupo por 65 meses, que totalizaram 510 postagens e seus respectivos comentários. Os dados foram agrupados em categorias, e foi realizada análise temática de conteúdo, adotando-se os referenciais teóricos sobre o cuidado em saúde. A análise revelou que as buscas por um diagnóstico e por tratamento adequado frequentemente são descritas como uma peregrinação, sendo decorrentes das fragilidades no cuidado em saúde, traduzidas pela falta de conhecimento atualizado dos profissionais sobre as DRG e por problemas na relação profissional-paciente. As fragilidades no cuidado em saúde e os diagnósticos tardios contribuem para aumentar o risco de complicações e óbitos. Nesse contexto, o grupo VSG se destaca em seu papel de grupo de apoio e rede de solidariedade, favorecendo o esclarecimento e o empoderamento de inúmeras pessoas com DRG.

Gluten-related disorders affect 1% to 6% of the population, with complications and high risk of short and long-term morbidity and mortality. Since 2009, Brazil has a Clinical Protocol of Therapeutic Guidelines for Celiac Disease, but there are frequent complaints by persons with gluten-related disorders concerning the lack of healthcare professionals' knowledge of this topic and the difficulties related to healthcare, for both diagnosis and treatment. This study aimed to understand the weaknesses in healthcare perceived by persons with gluten-related disorders. An online qualitative survey was conducted in the Living Without Gluten group on Facebook, consulting the records saved by the group for 65 months, which totaled 510 posts and the respective comments. The data were grouped in categories, and thematic content analysis was performed, adopting the theoretical references on healthcare. The analysis revealed that the searches for diagnosis and adequate treatment were often described as a forced pilgrimage, resulting from shortcomings in healthcare, including lack of up-to-date knowledge on gluten-related disorders among the healthcare professionals and problems in the physician-patient relationship. Weaknesses in patient care and late diagnoses contribute to increasing the risk of complications and deaths. In this context, the Living Without Gluten group plays a leading role as a support group and network of solidarity, favoring increased awareness and empowerment of numerous Brazilians with gluten-related disorders.

Los desórdenes relacionados al gluten afectan de 1% a 6% de la población, con complicaciones y alto riesgo de morbimortalidad en corto y largo plazos. Desde 2009, Brasil posee un Protocolo Clínico de Directrices Terapéuticas para la Enfermedad Celíaca, sin embargo, son comunes las quejas de las personas con desórdenes relacionados al gluten, respecto a la falta de conocimiento de los profesionales de salud en esa temática y las dificultades relacionadas con el cuidado en salud, en relación tanto con el diagnóstico como con el tratamiento. Este estudio se marcó como objetivo comprender las fragilidades en el cuidado en salud percibidas por personas con desórdenes relacionados al gluten. Se realizó una investigación cualitativa virtual en el grupo Vivir Sin Gluten (VSG) de la red social Facebook, en la que se consultaron los registros almacenados en el grupo durante 65 meses, que totalizaron 510 posts y sus respectivos comentarios. Los datos se agruparon en categorías y se realizó un análisis temático de contenido, adoptándose los referenciales teóricos sobre el cuidado en salud. El análisis reveló que las búsquedas de un diagnóstico y tratamiento adecuado frecuentemente se describen como una peregrinación, siendo derivados de las fragilidades en el cuidado en salud, traducidas por la falta de conocimiento actualizado de los profesionales sobre las desórdenes relacionados al gluten y por problemas en la relación profesional-paciente. Las fragilidades en el cuidado en salud y los diagnósticos tardíos contribuyen a aumentar el riesgo de complicaciones y óbitos. En este contexto el grupo VSG se destaca en su papel de grupo de apoyo y red de solidaridad, favoreciendo la información y el empoderamiento de innumerables personas con desórdenes relacionados al gluten.

Asunto(s)

RESUMEN

People suffering from a food intolerance (FI) tend to initiate restrictive diets such as a gluten-free diet (GFD), to alleviate their symptoms. To learn about how people live with these problems in daily life (independent of their medical diagnoses), 1203 participants answered a previously validated questionnaire and were divided into: G1 (those self-reporting symptoms after gluten consumption) and G2 (those informing no discomfort after gluten consumption). Self-reported clinical characteristics, diagnoses and diets followed were registered. Twenty nine percent referred some FI (8.5% in G1). In G1, self-reported diagnoses were more frequent (p < 0.0001), including a high proportion of eating and mood disorders. Diagnoses were reported to be given by a physician, but GFD was indicated by professional and nonprofessional persons. In G2, despite declaring no symptoms after gluten consumption, 11.1% followed a GFD. The most frequent answer in both groups was that GFD was followed "to care for my health", suggesting that some celiac patients do not acknowledge it as treatment. Conclusion: close to one third of the population report suffering from some FI. Those perceiving themselves as gluten intolerant report more diseases (p < 0.0001). A GFD is followed by ~11% of those declaring no symptoms after gluten ingestion. This diet is perceived as a healthy eating option.

Asunto(s)

RESUMEN

OBJECTIVE: To evaluate the nutritional status and gastrointestinal changes in children with autism spectrum disorder (ASD). METHODS: Cross-sectional, descriptive analysis of 39 children with ASD aged between three and ten years old, registered in the participating association. Nutritional status was evaluated by body mass index/age and weight/age, according to the guidelines from the World Health Organization. In order to investigate whether gastrointestinal alterations occurred, the interviewees answered a questionnaire about the presence of these symptoms within the last 30 days. In order to evaluate food consumption, a 24-hour recall questionnaire was applied and the food reported were grouped as: gluten sources, casein and ultra-processed sources. For the statistical analysis, Epi-Info software version 7.2 was used. Multivariate logistic regression analysis was performed to evaluate the variables associated with gastrointestinal alterations. RESULTS: There was a high prevalence of overweight children with autism spectrum disorder (64.1%). No child was underweight. Thirty-four children (84.2%) had gastrointestinal symptoms. Consumption of gluten was associated with gastrointestinal symptoms (ß=0.38; 95%CI 0.07-0.75; p=0.02). CONCLUSIONS: The high prevalence of being overweight should be considered during the follow-up visits of children with ASD. The influence of gluten consumption on the presence of gastrointestinal symptoms was observed in this study, and the causes involved in these alterations need to be further investigated.

Asunto(s)

RESUMEN

INTRODUCTION AND OBJECTIVES: It is essential for patients with celiac disease (CD) to be on a gluten-free diet (GFD) but said diet has also been reported to increase the risk for metabolic syndrome. There is no evidence on the metabolic effects of a GFD in patients with nonceliac gluten sensitivity (NCGS) or in asymptomatic subjects. Therefore, the aim of the present study was to evaluate the metabolic effects of a GFD over a 6-month period in patients with CD, patients with NCGS, and in asymptomatic controls (ACs). MATERIALS AND METHODS: A prospective study was conducted that evaluated metabolic syndrome and its components of obesity, high blood pressure, hepatic steatosis, and hyperglycemia at the baseline and at 6 months. RESULTS: A total of 66 subjects (22 CD, 22 NCGS, and 22 AC) were included in the study. At the baseline, 10% of the patients with CD presented with obesity, high blood pressure, hepatic steatosis, and metabolic syndrome. After 6 months, obesity and metabolic syndrome increased by 20% (p=0.125). In the patients with NCGS, obesity increased by 5% after the GFD and 20% of those patients presented with de novo hepatic steatosis. The prevalence of obesity decreased by 10% in the controls after the GFD (30 vs 20%, p=0.5) and none of the other components of metabolic syndrome were affected. CONCLUSIONS: The metabolic benefits and risks of a GFD should be considered when prescribing said diet in the different populations that opt for that type of intervention.

Asunto(s)

RESUMEN

ABSTRACT Objective: To evaluate the nutritional status and gastrointestinal changes in children with autism spectrum disorder (ASD). Methods: Cross-sectional, descriptive analysis of 39 children with ASD aged between three and ten years old, registered in the participating association. Nutritional status was evaluated by body mass index/age and weight/age, according to the guidelines from the World Health Organization. In order to investigate whether gastrointestinal alterations occurred, the interviewees answered a questionnaire about the presence of these symptoms within the last 30 days. In order to evaluate food consumption, a 24-hour recall questionnaire was applied and the food reported were grouped as: gluten sources, casein and ultra-processed sources. For the statistical analysis, Epi-Info software version 7.2 was used. Multivariate logistic regression analysis was performed to evaluate the variables associated with gastrointestinal alterations. Results: There was a high prevalence of overweight children with autism spectrum disorder (64.1%). No child was underweight. Thirty-four children (84.2%) had gastrointestinal symptoms. Consumption of gluten was associated with gastrointestinal symptoms (β=0.38; 95%CI 0.07-0.75; p=0.02). Conclusions: The high prevalence of being overweight should be considered during the follow-up visits of children with ASD. The influence of gluten consumption on the presence of gastrointestinal symptoms was observed in this study, and the causes involved in these alterations need to be further investigated.

RESUMO Objetivo: Avaliar o estado nutricional e a presença de alterações gastrintestinais em crianças com transtorno do espectro autista. Métodos: Estudo transversal, descritivo, composto por 39 crianças autistas com idades entre três e dez anos, cadastradas na associação participante. O estado nutricional foi analisado a partir do índice de massa corporal/idade e do peso/idade, tendo como referências as curvas da Organização Mundial da Saúde. Para investigação das alterações gastrintestinais, o entrevistado respondeu sobre a presença de alterações nos últimos 30 dias. Na avaliação do consumo alimentar foi aplicado um recordatório de 24 horas e os alimentos listados foram categorizados em: fontes de glúten, fontes de caseína e ultraprocessados. A análise estatística utilizou o software Epi-Info, versão 7.2. Foi realizada a análise de regressão logística multivariada para avaliar os fatores associados às alterações gastrintestinais. Resultados: Observou-se alta prevalência de excesso de peso nas crianças com transtorno do espectro autista (64,1%), não sendo registrada nenhuma criança com déficit de peso. Um total de 34 crianças (84,2%) apresentava alterações gastrintestinais. O consumo de glúten esteve associado às manifestações gastrintestinais (β=0,38; IC95% 0,07-0,75; p=0,02). Conclusões: A elevada prevalência do excesso de peso deve ser tratada com maior atenção em crianças com transtorno do espectro autista. Foi observada a influência do consumo de glúten no aparecimento das alterações gastrintestinais, sendo necessário que as causas envolvidas nessas alterações sejam mais bem investigadas.

Asunto(s)

RESUMEN

Gluten is only partially digested by intestinal enzymes and can generate peptides that can alter intestinal permeability, facilitating bacterial translocation, thus affecting the immune system. Few studies addressed the role of diet with gluten in the development of colitis. Therefore, we investigate the effects of wheat gluten-containing diet on the evolution of sodium dextran sulphate (DSS)-induced colitis. Mice were fed a standard diet without (colitis group) or with 4·5 % wheat gluten (colitis + gluten) for 15 d and received DSS solution (1·5 %, w/v) instead of water during the last 7 d. Compared with the colitis group, colitis + gluten mice presented a worse clinical score, a larger extension of colonic injury area, and increased mucosal inflammation. Both intestinal permeability and bacterial translocation were increased, propitiating bacteria migration for peripheral organs. The mechanism by which diet with gluten exacerbates colitis appears to be related to changes in protein production and organisation in adhesion junctions and desmosomes. The protein α-E-catenin was especially reduced in mice fed gluten, which compromised the localisation of E-cadherin and ß-catenin proteins, weakening the structure of desmosomes. The epithelial damage caused by gluten included shortening of microvilli, a high number of digestive vacuoles, and changes in the endosome/lysosome system. In conclusion, our results show that wheat gluten-containing diet exacerbates the mucosal damage caused by colitis, reducing intestinal barrier function and increasing bacterial translocation. These effects are related to the induction of weakness and disorganisation of adhesion junctions and desmosomes as well as shortening of microvilli and modification of the endocytic vesicle route.

Asunto(s)

RESUMEN

Recomenda ao Ministério da Saúde encomendar estudos, a serem amplamente publicizados, acerca dos tópicos que seguem: Perfil epidemiológico dos portadores de doença celíaca; Avaliação de incidência e prevalência da doença celíaca; Pesquisa sobre novos tratamentos para a doença celíaca; Avaliação do risco da contaminação cruzada no controle da doença celíaca; Avaliação dos impactos na saúde mental dos portadores da doença celíaca; Pesquisa de biomarcadores de sensibilidade ao glúten não celíaca; e Pesquisa para detectar e quantificar o glúten nos alimentos e possível revisão sistemática.

Asunto(s)

RESUMEN

As the celiac disease (CD), the non-celiac gluten sensitivity (NCGS) has also been associated with several autoimmune manifestations. It is rarely associated with myasthenia gravis (MG). This paper shall introduce the case of a young female patient, initially presenting a peripheral neuropathy framework. During clinical and neurological follow-up, she began to present symptoms of various immune-mediated morbidities. Diseases related to gluten represent a clinical spectrum of manifestations with a trigger in common, the ingestion of gluten. CD is the most well-known and serious disease of the spectrum, also called gluten-sensitive enteropathy. The NCGS is diagnosed from clinical evidence of improvement in symptoms followed by a Gluten Free Diet (GFD) in patients without signs of enteropathy in duodenal biopsy. There are indications that, although rare, with a prevalence of 1 in 5000, myasthenia gravis (MG) may occur more often when CD is also present. Between 13 to 22% of the patients with MG have a second autoimmune disorder. However, it is often associated with dermatomyositis or polymyositis, lupus erythematosussystemic lupus erythematosus, Addison's disease, Guillain-Barré syndrome and juvenile rheumatoid arthritis. Thus, the symptoms of neuromuscular junction involvement may give a diagnostic evidence of this rare association.

Asunto(s)

RESUMEN

SUMMARY As the celiac disease (CD), the non-celiac gluten sensitivity (NCGS) has also been associated with several autoimmune manifestations. It is rarely associated with myasthenia gravis (MG). This paper shall introduce the case of a young female patient, initially presenting a peripheral neuropathy framework. During clinical and neurological follow-up, she began to present symptoms of various immune-mediated morbidities. Diseases related to gluten represent a clinical spectrum of manifestations with a trigger in common, the ingestion of gluten. CD is the most well-known and serious disease of the spectrum, also called gluten-sensitive enteropathy. The NCGS is diagnosed from clinical evidence of improvement in symptoms followed by a Gluten Free Diet (GFD) in patients without signs of enteropathy in duodenal biopsy. There are indications that, although rare, with a prevalence of 1 in 5000, myasthenia gravis (MG) may occur more often when CD is also present. Between 13 to 22% of the patients with MG have a second autoimmune disorder. However, it is often associated with dermatomyositis or polymyositis, lupus erythematosussystemic lupus erythematosus, Addison's disease, Guillain-Barré syndrome and juvenile rheumatoid arthritis. Thus, the symptoms of neuromuscular junction involvement may give a diagnostic evidence of this rare association.

Asunto(s)

RESUMEN

Gluten-related disorders (GRDs) are gradually emerging as epidemiologically relevant diseases, with a global prevalence estimated to be approximately 5% in the population. Conditions related to gluten ingestion include celiac disease (CD), wheat allergy (WA), and nonceliac gluten sensitivity (NCGS). Although mediated by different pathogenic pathways, these 3 conditions share similar clinical manifestations and can present a difficult differential diagnosis. The gluten challenge (GC) is an important diagnostic tool for GRDs, but there is great variability in regards to deciding which patients should be challenged, what amount of gluten should be used, what the GC duration should be, when and where the GC should occur, and, sometimes, why to conduct a GC. This review summarizes the current knowledge about the desirable characteristics of GCs in the 3 main GRDs following a 5 Ws approach-that is, the 5 main journalistic questions: who, what, when, where, why. The answers will help to determine the correct use of the GC in diagnosing GRDs.

Asunto(s)

RESUMEN

No Brasil, chocolate branco é o produto obtido a partir da mistura de manteiga de cacau com outros ingredientes, alguns dos quais podem desencadear reações, sendo denominadas alergênicos. Entre os alergênicos alimentares mais comuns estão a proteína do leite, proteína do ovo, essências, traços de frutas oleaginosas, soja e aditivos alimentares, como corantes e conservantes. O objetivo deste trabalho foi avaliar a presença de componentes potencialmente alergênicos em diferentes marcas de chocolate branco comercializadas na cidade de Caxias do Sul. Foram adquiridas 12 marcas de chocolate branco no comércio de Caxias do Sul. Os critérios para aquisição das marcas foram: ser chocolate branco puro, em embalagens com peso de 40g a 150g, estando dentro do período de validade. Foram analisados os ingredientes de cada marca com o intuito de identificar os aditivos alimentares e os alérgenos potenciais. O estudo mostrou que, das 12 marcas de chocolate branco, 58,33% apresentaram soja, 66,66% glúten e 75% apresentaram algum traço alergênico de contaminantes da produção. Nenhuma marca apresentou ingrediente transgênico ou glutamato monossódico. Os principais elementos traços encontrados foram amendoim, nozes, amêndoas, avelã, castanhas de caju e do Brasil, macadâmia, coco, ovos, pistache, cevada, trigo, derivados de soja e de leite. Percebe-se a importância da observação e leitura atenta dos rótulo de chocolates antes do consumo, especialmente por indivíduos que apresentam sensibilidade a componentes alimentares, pois mesmo os chocolates puros apresentam substâncias capazes de desencadear complicações graves ao sistema imunológico.(AU)

In Brazil, white chocolate is the product obtained from the mixture of cocoa butter with other ingredients, which can trigger reactions called allergens. Among the most common alimentary allergens are milk protein, egg protein, essences, traces of oleaginous fruits, soy and food additives such as dyes and preservatives. The objective of this work was to evaluate the presence of potentially allergenic components in different brands of white chocolate commercialized in the city of Caxias do Sul. Twelve brands of white chocolate were purchased in Caxias do Sul market. The criteria for acquiring the brands were: being chocolate pure white, in packages weighing 40 g to 150 g, being within the validity period. The ingredients of each brand were analyzed in order to identify food additives and potential allergens. The study showed that of the 12 white chocolate brands, 58.33% presented soy and 66.66% gluten, and 75% presented some allergenic traces of production contaminants. No brand presented transgenic ingredient or monosodium glutamate. The major trace elements found were peanuts, walnuts, almonds, hazelnuts, cashew nuts and Brazil nuts, macadamia nuts, coconut, eggs, pistachio, barley, wheat, soy and milk derivatives. lt is noticed the importance of careful observation and chocolates label reading before consumption, especially by individuaIs who are sensitive to food components, because even pure chocolates present substances capable of triggering serious complications to the immune system.(AU)

Asunto(s)