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Nutrients
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Advances in Prevention and Management of Celiac Disease
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Advances in Prevention and Management of Celiac Disease

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: closed (5 September 2024) | Viewed by 14505

Special Issue Editors

Dr. Maria Teresa Nestares Pleguezuelo

E-Mail Website
Guest Editor
Biomedical Research Centre (CIBM), Institute of Nutrition and Food Technology “José MataixVerdú” (INYTA), Dept Physiology, University of Granada, Granada, Spain
Interests: nutrition; celiac disease; anemia; gluten free diet
Dr. Rafael Martín-Masot

E-Mail Website
Co-Guest Editor
Pediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Malaga, 29010 Málaga, Spain
Interests: gastroenterology; pediatrics; nutrition; celiac disease; inflammatory bowel disease

Special Issue Information

Dear Colleagues,

Celiac disease (CD) is an autoimmune condition characterized by a heterogeneous clinical presentation, affecting any organ or tissue with gastrointestinal and extraintestinal manifestations. CD remains a challenging condition because of a steady increase in its prevalence and comorbidities and the recognition that diagnosis is suboptimal.

We have witnessed an epidemic of CD, questioning the previous paradigm that gluten is the only key element dictating the onset of the CD. A genetic background is a mandatory determinant of the development of the CD, but it is modulated by a diverse range of environmental factors. These include quantity and type of gluten consumption, gut microbiota, diet and lifestyle, exposure to pathogens, loss of intestinal barrier function, inappropriate adaptive immune response, among others. It is of pivotal importance to improve the understanding of factors involving pathophysiology, diagnosis, management, and possible therapeutic options.

In this Special Issue, we would like to introduce readers to the state of the art in the field by presenting papers covering different aspects of environmental factors to identify possible targets for the prevention and management of CD. Both original research articles and reviews spanning clinical and preclinical work are welcome.

Dr. Maria Teresa Nestares Pleguezuelo
Dr. Rafael Martín-Masot
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • celiac disease
  • genetics
  • gluten-free diet
  • gluten
  • dietary habits
  • food
  • microbiome
  • physical activity
  • autoimmune disease
  • epigenome
  • environmental factors
  • lifestyle

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Published Papers (7 papers)

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Research

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14 pages, 1983 KiB  
Article
From Struggle to Strength: A Multicentric Study on How Public Policies for Celiac Disease Transform Lives
by Ana Luísa Falcomer, Claudia B. Pratesi, Eduardo Yoshio Nakano, Cláudia Chaves, Mohammad Rostami-Nejad, Morad Guennouni, Ayşegül Aksan, Jacques Pouchot, Winfried Häuser and Renata Puppin Zandonadi
Nutrients 2024, 16(17), 2855; https://doi.org/10.3390/nu16172855 - 26 Aug 2024
Viewed by 1103
Abstract
This multicenter study aims to assess the impact of public policies (PPs) on the health-related quality of life (HRQoL) of individuals with celiac disease (CD) using the Celiac Disease Questionnaire (CDQ) and PPs for Celiac Disease Score (PPCDS). This cross-sectional exploratory study was [...] Read more.
This multicenter study aims to assess the impact of public policies (PPs) on the health-related quality of life (HRQoL) of individuals with celiac disease (CD) using the Celiac Disease Questionnaire (CDQ) and PPs for Celiac Disease Score (PPCDS). This cross-sectional exploratory study was conducted in four stages: first, standardizing data from countries using the CDQ; second, analyzing PPs aimed at CD patients; third, statistically examining these data; and fourth, associating HRQoL indicators with corresponding PPs. This study analyzed 15 CDQ assessments from 12 countries from 2007 to 2023. It found that comprehensive PPs positively correlated with HRQoL outcomes (Spearman correlation of 0.358). However, policies specifically targeting gluten-free meals and certification did not significantly improve HRQoL individually, suggesting they may be more effective when implemented together. Additionally, specialized health services did not notably reduce gastrointestinal symptoms, underscoring the necessity for improved patient education to enhance the effectiveness of these services. This study concludes that implementing and rigorously monitoring regulations to support CD patients is crucial for enhancing their HRQoL. Full article
(This article belongs to the Special Issue Advances in Prevention and Management of Celiac Disease)
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14 pages, 938 KiB  
Article
Eating Attitudes of Patients with Celiac Disease in Brazil: A Nationwide Assessment with the EAT-26 Instrument
by Luiza Franco, Eduardo Yoshio Nakano, António Raposo, Hmidan A. Alturki, Sehad N. Alarifi, Cláudia Chaves, Edite Teixeira-Lemos and Bernardo Romão
Nutrients 2023, 15(22), 4796; https://doi.org/10.3390/nu15224796 - 16 Nov 2023
Viewed by 1720
Abstract
Celiac disease (CD) is an immune-mediated enteropathy triggered by the ingestion of gluten in genetically predisposed individuals. In this sense, a gluten-free diet is the only safe treatment available. Due to the restrictions resulting from this eating pattern, this treatment may impair the [...] Read more.
Celiac disease (CD) is an immune-mediated enteropathy triggered by the ingestion of gluten in genetically predisposed individuals. In this sense, a gluten-free diet is the only safe treatment available. Due to the restrictions resulting from this eating pattern, this treatment may impair the relationship of the people with CD with food, increasing the risk of a disordered eating attitude, which is associated with eating disorders. The EAT-26 is a validated instrument already applied worldwide in different populations, and higher scores are suggestive of eating attitudes prone to evolve into eating disorders. Studies carried out in other countries have already shown that people with CD are prone to developing eating disorders; however, no study has been carried out with this theme in the population with CD in Brazil. We carried out a nationwide cross-sectional study in three steps: (i) study design and instrument; (ii) recruitment of participants and ethics; (iii) statistical analysis. A total of 385 participants were included in our sample, 96.36% of them being women. The internal consistency of the applied self-administered Brazilian version of the EAT-26 online questionnaire presented a satisfactory Cronbach’s alpha of 0.812, and in total, 36.1% of the respondents were classified with a disordered eating attitude. No differences were found among the scores of participants when divided by categories regarding gender, average monthly income, age, and educational level. However, scores classified as a disordered eating attitude were found in respondents with a body mass index classified as overweight and obese. Our study highlights that disordered eating attitudes are present in overweight and obese women with celiac disease; thus, public health politics are needed to prevent and treat these attitudes. Full article
(This article belongs to the Special Issue Advances in Prevention and Management of Celiac Disease)
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18 pages, 356 KiB  
Article
Nutritional Composition of Breakfast in Children and Adolescents with and without Celiac Disease in Spain—Role of Gluten-Free Commercial Products
by Natalia Úbeda, María Purificación González, María Achón, Ángela García-González, Catalina Ballestero-Fernández, Violeta Fajardo and Elena Alonso-Aperte
Nutrients 2023, 15(10), 2368; https://doi.org/10.3390/nu15102368 - 18 May 2023
Cited by 1 | Viewed by 2501
Abstract
Eating a nutritionally balanced breakfast can be a challenge when following a gluten-free diet (GFD). We assessed the ingredients and nutrient composition of 364 gluten-free breakfast products (GFPs) and 348 gluten-containing counterparts (GCCs), and we analysed the nutritional quality of breakfast in a [...] Read more.
Eating a nutritionally balanced breakfast can be a challenge when following a gluten-free diet (GFD). We assessed the ingredients and nutrient composition of 364 gluten-free breakfast products (GFPs) and 348 gluten-containing counterparts (GCCs), and we analysed the nutritional quality of breakfast in a group of Spanish children and adolescents with celiac disease (CD) (n = 70), as compared to controls (n = 67). Food intakes were estimated using three 24 h dietary records. The composition of GFPs and GCCs was retrieved from the package labels of commercially available products. Most participants (98.5%) ate breakfast daily, and only one person in each group skipped breakfast once. The breakfast contribution of the total daily energy was 19% in participants with CD and 20% in controls. CD patients managed a balanced breakfast in terms of energy (54% from carbohydrates; 12% from proteins; 34% from lipids) and key food groups (cereals, dairy, fruits), but their intake of fruits needs improvement. Compared to controls, breakfast in the CD group provided less protein and saturated fat, a similar amount of carbohydrates and fibre, and more salt. Fibre is frequently added to GFPs, but these contain less protein because of the flours used in formulation. Gluten-free bread contains more fat and is more saturated than is GCC. Sugars, sweets, and confectionery contribute more to energy and nutrient intakes in participants with CD, while grain products do so in controls. Overall, breakfast on a GFD can be adequate, but can be improved by GFPs reformulation and a lower consumption of processed foods. Full article
(This article belongs to the Special Issue Advances in Prevention and Management of Celiac Disease)
12 pages, 1956 KiB  
Article
The Importance of an Early Evaluation after Establishing a Gluten-Free Diet in Children with Celiac Disease
by Rafael Martín-Masot, María Jiménez-Muñoz, Marta Herrador-López, Marta Flor-Alemany, Víctor Manuel Navas-López and Teresa Nestares
Nutrients 2023, 15(7), 1761; https://doi.org/10.3390/nu15071761 - 4 Apr 2023
Cited by 3 | Viewed by 2101
Abstract
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 [...] Read more.
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. Full article
(This article belongs to the Special Issue Advances in Prevention and Management of Celiac Disease)
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12 pages, 1402 KiB  
Article
Evaluation of the Usefulness of an Automatable Immunoassay for Monitoring Celiac Disease by Quantification of Immunogenic Gluten Peptides in Urine
by Verónica Segura, Ángela Ruiz-Carnicer, Irati Mendía, Marta Garzón-Benavides, Ángeles E. Pizarro, Isabel Comino and Carolina Sousa
Nutrients 2023, 15(7), 1730; https://doi.org/10.3390/nu15071730 - 31 Mar 2023
Cited by 1 | Viewed by 1627
Abstract
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 [...] Read more.
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. Full article
(This article belongs to the Special Issue Advances in Prevention and Management of Celiac Disease)
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11 pages, 951 KiB  
Article
Coeliac Disease Case–Control Study: Has the Time Come to Explore beyond Patients at Risk?
by Gemma Castillejo, Carlos Ochoa-Sangrador, David Pérez-Solís, Maria Luz Cilleruelo, Ester Donat, Jose Ignacio García-Burriel, Félix Sánchez-Valverde, Salvador Garcia-Calatayud, Francisco Javier Eizaguirre, Eva Martinez-Ojinaga, Patricia Barros, Rosaura Leis, Jose Carlos Salazar, Josefa Barrio, Luis Peña-Quintana, Verónica Luque, Isabel Polanco, Carmen Ribes and Enriqueta Roman
Nutrients 2023, 15(5), 1267; https://doi.org/10.3390/nu15051267 - 3 Mar 2023
Cited by 3 | Viewed by 2093
Abstract
The worldwide prevalence of asymptomatic coeliac disease (CD) is increasing, which is in part due to the routine screening of children with risk factors. Both symptomatic and asymptomatic patients with CD are at risk of long-term complications. The objective of this study was [...] Read more.
The worldwide prevalence of asymptomatic coeliac disease (CD) is increasing, which is in part due to the routine screening of children with risk factors. Both symptomatic and asymptomatic patients with CD are at risk of long-term complications. The objective of this study was to compare the clinical characteristics of asymptomatic and symptomatic children at the time of CD diagnosis. A case–control study was conducted using data from a cohort of 4838 CD patients recruited from 73 centers across Spain between 2011 and 2017. A total of 468 asymptomatic patients (cases) were selected and matched by age and sex with 468 symptomatic patients (controls). Clinical data, including any reported symptoms, as well as serologic, genetic, and histopathologic data were collected. No significant differences were found between the two groups in most clinical variables, nor in the degree of intestinal lesion. However, the asymptomatic patients were taller (height z-score −0.12 (1.06) vs. −0.45 (1.19), p < 0.001) and were less likely to have anti transglutaminase IgA antibodies ≥ 10 times the upper normal limit (66.2% vs. 758.4%, p = 0.002). Among the 37.1% of asymptomatic patients who were not screened for CD due to the absence of risk factors, only 34% were truly asymptomatic, while the remaining 66% reported non-specific CD-related symptoms. Therefore, expanding CD screening to any child who undergoes a blood test could reduce the burden of care for some children, as many of those considered asymptomatic reported non-specific CD-related symptoms. Full article
(This article belongs to the Special Issue Advances in Prevention and Management of Celiac Disease)
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Review

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16 pages, 716 KiB  
Review
Metabolomic Profiling in Children with Celiac Disease: Beyond the Gluten-Free Diet
by Rafael Martín-Masot, María Jiménez-Muñoz, Marta Herrador-López, Víctor Manuel Navas-López, Elia Obis, Mariona Jové, Reinald Pamplona and Teresa Nestares
Nutrients 2023, 15(13), 2871; https://doi.org/10.3390/nu15132871 - 25 Jun 2023
Cited by 2 | Viewed by 2247
Abstract
Celiac disease (CD) is included in the group of complex or multifactorial diseases, i.e., those caused by the interaction of genetic and environmental factors. Despite a growing understanding of the pathophysiological mechanisms of the disease, diagnosis is still often delayed and there are [...] Read more.
Celiac disease (CD) is included in the group of complex or multifactorial diseases, i.e., those caused by the interaction of genetic and environmental factors. Despite a growing understanding of the pathophysiological mechanisms of the disease, diagnosis is still often delayed and there are no effective biomarkers for early diagnosis. The only current treatment, a gluten-free diet (GFD), can alleviate symptoms and restore intestinal villi, but its cellular effects remain poorly understood. To gain a comprehensive understanding of CD’s progression, it is crucial to advance knowledge across various scientific disciplines and explore what transpires after disease onset. Metabolomics studies hold particular significance in unravelling the complexities of multifactorial and multisystemic disorders, where environmental factors play a significant role in disease manifestation and progression. By analyzing metabolites, we can gain insights into the reasons behind CD’s occurrence, as well as better comprehend the impact of treatment initiation on patients. In this review, we present a collection of articles that showcase the latest breakthroughs in the field of metabolomics in pediatric CD, with the aim of trying to identify CD biomarkers for both early diagnosis and treatment monitoring. These advancements shed light on the potential of metabolomic analysis in enhancing our understanding of the disease and improving diagnostic and therapeutic strategies. More studies need to be designed to cover metabolic profiles in subjects at risk of developing the disease, as well as those analyzing biomarkers for follow-up treatment with a GFD. Full article
(This article belongs to the Special Issue Advances in Prevention and Management of Celiac Disease)
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