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Might gluten traces in wheat substitutes pose a risk in patients with celiac disease? A population-based probabilistic approach to risk estimation.
Am J Clin Nutr. 2013 Jan; 97(1):109-16.AJ

Abstract

BACKGROUND

In patients with treated celiac disease (CD), the ingestion of gluten traces contained in gluten-free (GF) wheat substitutes (eg, GF bread, flour, and pasta) could cause persisting intestinal mucosal damage.

OBJECTIVE

The objective was to evaluate the proportion of CD patients at risk of mucosal damage due to the consumption of GF products in 4 European countries (Italy, Spain, Germany, and Norway).

DESIGN

A probabilistic modeling approach was used to assess the risk of gluten intake at the population level. The input variables were 1) consumption of GF products, 2) concentration of gluten traces in GF products determined by the sandwich R5 ELISA method, and 3) the gluten threshold for mucosal damage of 10 to 50 mg/d. Different population and product availability scenarios were examined for risk assessment.

RESULTS

The gluten content of 205 commercially available GF products ranged between <5 and 27.8 mg/kg. Overall, 99.5% of the analyzed samples had a gluten concentration <20 mg/kg. Most (94%) had a gluten concentration below the limit of quantification (5 mg/kg). The mean percentage of the CD European population at risk of mucosal damage resulting from consumption of GF products ranged between 0.01 (Germany) and 0.15 (Italy) and remained very low, even in the worst-case scenario (<1%).

CONCLUSIONS

The adoption of a single gluten threshold (20 mg/kg) for gluten contamination is suggested. GF products in Europe constitute a very safe option for patients with CD. The dietary follow-up of CD patients should focus on other potential sources of gluten contamination.

Authors+Show Affiliations

Associació de Celíacs de Catalunya, Barcelona, Spain.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23193005

Citation

Gibert, Anna, et al. "Might Gluten Traces in Wheat Substitutes Pose a Risk in Patients With Celiac Disease? a Population-based Probabilistic Approach to Risk Estimation." The American Journal of Clinical Nutrition, vol. 97, no. 1, 2013, pp. 109-16.
Gibert A, Kruizinga AG, Neuhold S, et al. Might gluten traces in wheat substitutes pose a risk in patients with celiac disease? A population-based probabilistic approach to risk estimation. Am J Clin Nutr. 2013;97(1):109-16.
Gibert, A., Kruizinga, A. G., Neuhold, S., Houben, G. F., Canela, M. A., Fasano, A., & Catassi, C. (2013). Might gluten traces in wheat substitutes pose a risk in patients with celiac disease? A population-based probabilistic approach to risk estimation. The American Journal of Clinical Nutrition, 97(1), 109-16. https://doi.org/10.3945/ajcn.112.047985
Gibert A, et al. Might Gluten Traces in Wheat Substitutes Pose a Risk in Patients With Celiac Disease? a Population-based Probabilistic Approach to Risk Estimation. Am J Clin Nutr. 2013;97(1):109-16. PubMed PMID: 23193005.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Might gluten traces in wheat substitutes pose a risk in patients with celiac disease? A population-based probabilistic approach to risk estimation. AU - Gibert,Anna, AU - Kruizinga,Astrid G, AU - Neuhold,Susanna, AU - Houben,Geert F, AU - Canela,Miguel A, AU - Fasano,Alessio, AU - Catassi,Carlo, Y1 - 2012/11/28/ PY - 2012/11/30/entrez PY - 2012/11/30/pubmed PY - 2013/3/8/medline SP - 109 EP - 16 JF - The American journal of clinical nutrition JO - Am J Clin Nutr VL - 97 IS - 1 N2 - BACKGROUND: In patients with treated celiac disease (CD), the ingestion of gluten traces contained in gluten-free (GF) wheat substitutes (eg, GF bread, flour, and pasta) could cause persisting intestinal mucosal damage. OBJECTIVE: The objective was to evaluate the proportion of CD patients at risk of mucosal damage due to the consumption of GF products in 4 European countries (Italy, Spain, Germany, and Norway). DESIGN: A probabilistic modeling approach was used to assess the risk of gluten intake at the population level. The input variables were 1) consumption of GF products, 2) concentration of gluten traces in GF products determined by the sandwich R5 ELISA method, and 3) the gluten threshold for mucosal damage of 10 to 50 mg/d. Different population and product availability scenarios were examined for risk assessment. RESULTS: The gluten content of 205 commercially available GF products ranged between <5 and 27.8 mg/kg. Overall, 99.5% of the analyzed samples had a gluten concentration <20 mg/kg. Most (94%) had a gluten concentration below the limit of quantification (5 mg/kg). The mean percentage of the CD European population at risk of mucosal damage resulting from consumption of GF products ranged between 0.01 (Germany) and 0.15 (Italy) and remained very low, even in the worst-case scenario (<1%). CONCLUSIONS: The adoption of a single gluten threshold (20 mg/kg) for gluten contamination is suggested. GF products in Europe constitute a very safe option for patients with CD. The dietary follow-up of CD patients should focus on other potential sources of gluten contamination. SN - 1938-3207 UR - https://www.unboundmedicine.com/medline/citation/23193005/Might_gluten_traces_in_wheat_substitutes_pose_a_risk_in_patients_with_celiac_disease_A_population_based_probabilistic_approach_to_risk_estimation_ L2 - https://academic.oup.com/ajcn/article-lookup/doi/10.3945/ajcn.112.047985 DB - PRIME DP - Unbound Medicine ER -