Exposure to Different Amounts of Dietary Gluten in Patients with Non-Celiac Gluten Sensitivity (NCGS): An Exploratory Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Intervention
2.2. Diets
2.3. Gastrointestinal Symptoms and Quality of Life
2.4. Statistical Analysis
3. Results
3.1. Patients
3.2. Quality of Life
3.3. Gastrointestinal Symptoms
4. Discussion
Author Contributions
Funding
Conflicts of Interest
References
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Study (Reference) | Patients | Study Design | No. of Patients | Challenge Duration | Methods | Main Findings |
---|---|---|---|---|---|---|
Biesiekierski et al. [5] | NCGS w/IBS | DBRPCT | 34 patients | up to 6 weeks | Gluten or placebo (two bread slices plus one muffin per day) | 68% (13) of patients in the gluten group reported inadequate symptoms control compared with 40% (6) under placebo. |
Carroccio et al. [24] | NCGS | DBRPCT | 2 weeks | Capsules with wheat (20 g) vs. placebo | 30% (276) of patients diagnosed as non-celiac wheat sensitivity. Wheat challenge induced >30% increase in symptoms. | |
Peters et al. [25] | NCGS w/IBS symptoms | DBRPCT | 22 patients | 3 days | Dietary challenge: gluten-free food supplemented with gluten (16 g/day), whey (16 g/day) or not supplemented (placebo) | Higher overall Spielberger State Trait Personality Inventory state depression scores compared to placebo but not whey, after gluten. Similar gastrointestinal symptoms induced after all treatments |
Zanini et al. [26] | NCGS | DBRPCT | 35 non-CD patients | 10 days | Gluten-containing flour or gluten-free flour for 10 days, followed by a 2-week washout period | 34% of patients diagnosed as having NCGS |
Capannolo et al. [27] | NCGS | DBRPCT | 364 patients (27 with NCGS and 337 with no specific diagnosis) | 1 month | Challenge with dietary gluten vs. a GFD. | 85.96% did not experience a change in symptomatology after a GFD. Low value of a gluten-containing diet for an increase in symptoms. |
Rosinach et al. [28] | NCGS | DBRPCT | 18 non-CD patients | 6 months | 11 gluten (20 g/day) and 7 placeboes | 91% of patients with clinical relapse during gluten challenge (vs. 28.5% after placebo) |
Picarelli et al. [29] | NCGS | DBRPCT | 26 patients | 1 day | Food challenge (oral provocation test) with a gluten-containing croissant (10 g of gluten per croissant) to 13 patients and a gluten-free croissant to the other 13 patients. | No difference was found between the severity of symptoms with gluten-containing croissants compared to a group of patients with gluten-free croissants. |
Elli et al. [30] | NCGS w/functional gastrointestinal symptoms | DBRPCT | 98 patients | 7 days | Gluten intake (5.6 g/day) or placebo | 28 patients reported symptomatic relapse with deteriorated quality of life |
Skodje et al. [31] | Subjects with self-reported NCGS | DBRPCT | 59 subjects | 7 days | Diets containing gluten (5.7 g), fructans (2.1 g), or placebo | Overall Gastrointestinal Symptom Rating Scale for Irritable Bowel Syndrome scores increased after fructans rather than gluten. |
Dale et al. [32] | Patients w/suspected NCGS | DBRPCT | 20 patients | 4 days | Two muffins a day (11/0 g gluten). (4 periods w/double-blinded provocation, 2 w/gluten, 2 w/placebo) | Most severe symptoms found after placebo. Only 4/20 patients correctly identified periods w/gluten. |
Meal | Low-Gluten (3.5–4 g Gluten) | Mid-Gluten (6.7–8 g Gluten) | High-Gluten (10–13 g Gluten) |
---|---|---|---|
Breakfast | 1 small cup of coffee, 300 mL partly skimmed milk, 1 gluten-free croissant | 1 small cup of coffee, 300 mL partly skimmed milk, 4 gluten-free biscuits | 1 small cup of coffee, 300 mL partly skimmed milk, 4 gluten-free rusks |
Morning snack | 1 kiwifruit | 1 apple | 1 banana |
Lunch | 100 g gluten-free pasta, 90 g mixed vegetables, 1 portion of chard, 4 mandarins | 100 g gluten-free pasta, 40 g cow ricotta cheese, 100 g potatoes, 2 bananas | 60 g wheat pasta with broccoli, 2 teaspoonfuls grated Parmesan cheese, 1 portion of mixed salad, 2.5 glasses of fruit salad |
Afternoon snack | 1 bowl of strawberries | 1 bowl of strawberries | 1 pear |
Dinner | 50 g wheat pasta with zucchini, 100 g turkey thigh 200 g potatoes, 5 slices of pineapple | 50 g wheat pasta with tomato sauce, 1 spoon of fresh peas 120 g pork, 1 portion of chard 5 mandarins | 60 g wheat pasta with tomato sauce, 100 g halibut, 200 g potatoes, 2 glasses of fruit salad |
During the day | 40 g gluten-free bread, 6.5 teaspoonfuls virgin olive oil | 50 g of white wheat bread, 3.5 teaspoonfuls virgin olive oil | 30 g white wheat bread, 8 teaspoonfuls virgin olive oil |
Low-Gluten (3.5–4 g/day, n = 8) | Mid-Gluten (6.7–8 g/day, n = 6) | High-Gluten (10–13 g/day, n = 8) | p-Value † | |
---|---|---|---|---|
Age, years | 44.6 ± 4.5 | 45.5 ± 3.1 | 44.6 ± 5.2 | 0.98 |
Gender, F/M | 7/1 | 6/0 | 7/1 | 0.99 |
BMI, kg/m2 | 23.0 ± 1.7 | 23.8 ± 1.8 | 21.8 ± 0.7 | 0.65 |
Diarrhea, n (%) | 1 (12.5) | 0 (0) | 1 (12.5) | 0.99 |
Bloating, n (%) | 0 (0) | 2 (33.3) | 1 (12.5) | 0.24 |
Constipation, n (%) | 3 (37.5) | 5 (83.3) | 3 (37.5) | 0.21 |
Abdominal pain, n (%) | 5 (62.5) | 4 (66.6) | 3 (37.5) | 0.64 |
Dyspepsia, n (%) | 6 (75) | 1 (16.6) | 2 (25) | 0.08 |
Low-Gluten (3.5–4 g/day, n = 8) | Mid-Gluten (6.7–8 g/day, n = 6) | High-Gluten (10–13 g/day, n = 8) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Baseline | 7-Day | p-Value † | Baseline | 14-Day | p-Value † | Baseline | 21-Day | p-Value † | p-Value ‡ | |
Physical functioning | 100.0 (5.0) | 95.0 (10.0) | 0.10 | 100.0 (20.0) | 82.5 (45.0) | 0.17 | 100.0 (2.5) | 100.0 (2.5) | 0.94 | 0.13 |
Role physical | 100.0 (25.0) | 50.0 (37.5) | 0.03 | 87.5 (25.0) | 100.0 (50.0) | 0.72 | 87.5 (37.5) | 87.5 (62.5) | 0.65 | 0.19 |
Role emotional | 79.0 (26.0) | 41.0 (31.0) | 0.004 | 79.0 (26.0) | 62.5 (32.0) | 0.92 | 84.0 (27.5) | 67.5 (40.5) | 0.83 | 0.01 |
Bodily pain | 76.0 (22.5) | 53.5 (47.5) | 0.008 | 76.0 (22.5) | 64.0 (11.0) | 0.87 | 66.5 (50.0) | 69.5 (44.0) | 0.30 | 0.15 |
Mental health | 65.0 (20) | 47.5 (17.5) | 0.12 | 65.0 (20.0) | 55.0 (20.0) | 0.74 | 72.5 (15.0) | 57.5 (37.5) | 0.79 | 0.48 |
Vitality | 87.0 (12.5) | 56.0 (18.5) | 0.02 | 87.0 (12.5) | 62.5 (38.0) | 0.50 | 100.0 (31.5) | 68.5 (44.0) | 0.34 | 0.67 |
Social interaction | 100.0 (17.0) | 33.0 (33.0) | 0.007 | 100.0 (67.0) | 100.0 (34.0) | 0.10 | 100.0 (33.5) | 100.0 (17.0) | 0.39 | 0.30 |
General health | 82.0 (18.0) | 62.0 (34.0) | 0.15 | 76.0 (20.0) | 72.0 (16.0) | 0.46 | 78.0 (10.0) | 72.0 (24.0) | 0.99 | 0.49 |
Low-Gluten (3.5–4 g/day, n = 8) | Mid-Gluten (6.7–8 g/day, n = 6) | High-Gluten (10–13 g/day, n = 8) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Baseline | 7-Day | p-Value † | Baseline | 14-Day | p-Value † | Baseline | 21-Day | p-Value † | p-Value ‡ | |
Abdominal pain | 0 (1.3) | 2.6 (6.1) | 0.16 | 5.3 (4.5) | 4.9 (3.6) | 0.87 | 0 (0.4) | 0.5 (7.8) | 0.22 | 0.66 |
Stool satisfaction | 3.8 (9.1) | 0 (3.4) | 0.16 | 7.0 (9.8) | 3.2 (5.4) | 0.25 | 7.6 (8.8) | 4.1 (8.8) | 0.99 | 0.21 |
Abdominal bloating | 0 (3.9) | 3.0 (8.4) | 0.19 | 5.4 (5.5) | 5.2 (6.0) | 0.87 | 0 (2.2) | 3.5 (8.8) | 0.19 | 0.68 |
Postprandial fullness | 0 (4.4) | 4.3 (7.4) | 0.12 | 0 (6.7) | 0 (2.9) | 0.84 | 0 (0.0) | 2.5 (6.6) | 0.29 | 0.37 |
Early satiety feeling | 0.2 (1.8) | 3.5 (5.2) | 0.13 | 0 (1.0) | 0 (1.4) | 0.84 | 0 (0.0) | 1.3 (6.4) | 0.09 | 0.36 |
Epigastric burn | 0 (0.9) | 2.0 (8.2) | 0.07 | 0 (2.0) | 0 (4.4) | 0.85 | 0 (1.9) | 0.7 (5.8) | 0.41 | 0.42 |
General well-being | 9.1 (2.9) | 2.1 (2.9) | 0.01 | 7.9 (3.1) | 5.9 (4.5) | 0.14 | 8.5 (1.9) | 5.1 (4.3) | 0.21 | 0.05 |
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Roncoroni, L.; Bascuñán, K.A.; Vecchi, M.; Doneda, L.; Bardella, M.T.; Lombardo, V.; Scricciolo, A.; Branchi, F.; Elli, L. Exposure to Different Amounts of Dietary Gluten in Patients with Non-Celiac Gluten Sensitivity (NCGS): An Exploratory Study. Nutrients 2019, 11, 136. https://doi.org/10.3390/nu11010136
Roncoroni L, Bascuñán KA, Vecchi M, Doneda L, Bardella MT, Lombardo V, Scricciolo A, Branchi F, Elli L. Exposure to Different Amounts of Dietary Gluten in Patients with Non-Celiac Gluten Sensitivity (NCGS): An Exploratory Study. Nutrients. 2019; 11(1):136. https://doi.org/10.3390/nu11010136
Chicago/Turabian StyleRoncoroni, Leda, Karla A. Bascuñán, Maurizio Vecchi, Luisa Doneda, Maria T. Bardella, Vincenza Lombardo, Alice Scricciolo, Federica Branchi, and Luca Elli. 2019. "Exposure to Different Amounts of Dietary Gluten in Patients with Non-Celiac Gluten Sensitivity (NCGS): An Exploratory Study" Nutrients 11, no. 1: 136. https://doi.org/10.3390/nu11010136