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Nutrients
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Recent Advances in Gluten-Free Diet and Celiac Disease
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Recent Advances in Gluten-Free Diet and Celiac Disease

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

Deadline for manuscript submissions: closed (15 July 2024) | Viewed by 18101

Special Issue Editors

Prof. Dr. Carlo Catassi

E-Mail Website
Guest Editor
Division of Pediatrics, DISCO Department, Polytechnic University of Marche, 60123 Ancona, Italy
Interests: celiac disease and other gluten-related disorders
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Fernando Chirdo

E-Mail Website1 Website2
Guest Editor
Departamento de Ciencias Biologicas, Facultad de Ciencias Exactas, Instituto de Estudios Inmunologicos y Fisiopatologicos—IIFP (UNLP-CONICET), Bv. 120 1489, La Plata 1900, Argentina
Interests: celiac disease; experimental enteropathy; inflammation

Special Issue Information

Dear Colleagues,

Thanks to the pioneering work of the Dutch pediatrician Willem Dicke in the 1950s, the gluten-free diet (GFD) has become the standard therapy for celiac disease (CeD), one of the most common life-long disorders. Through this simple and straightforward dietary treatment, thousands of lives have been saved and millions of patients have been able to live healthy lives. Recently, it has been discovered that the GFD can treat other gluten-related disorders (GRD), such as gluten ataxia and non-celiac gluten sensitivity. Nevertheless, the GFD has limitations, such as a less-than-optimal content of nutrients such as fiber and calcium, the risk of gluten contamination in many commercial foods, and a significant impact on the psycho-social aspects of daily life. As such, alternative/complementary dietary and non-dietary treatments are currently under scrutiny.

The aim of this Special Issue of Nutrients is to highlight recent advances in the gluten-free diet in CeD and other GRDs from a broad perspective, e.g., including new methods for gluten analysis, the clinical monitoring of adherence to the GFD, psycho-social quality of life in patients treated with the GFD, complementary/alternative treatments including gluten-free wheat flours, probiotics and drugs.

Prof. Dr. Carlo Catassi
Prof. Dr. Fernando Chirdo
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.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

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
  • gluten-related disorders
  • gluten-free diet
  • wheat-related disorders
  • gluten
  • dietary treatment
  • adherence to the gluten-free diet

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Published Papers (7 papers)

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Editorial

Jump to: Research, Review, Other

3 pages, 157 KiB  
Editorial
The Gluten-Free Diet: The Road Ahead
by Carlo Catassi and Fernando Gabriel Chirdo
Nutrients 2025, 17(7), 1226; https://doi.org/10.3390/nu17071226 - 31 Mar 2025
Viewed by 514
Abstract
The gluten-free diet (GFD) is the resolutive and safe treatment of celiac disease (CeD), i [...] Full article
(This article belongs to the Special Issue Recent Advances in Gluten-Free Diet and Celiac Disease)

Research

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10 pages, 843 KiB  
Article
Exploring Total Immunoglobulin A’s Impact on Non-Biopsy Diagnosis of Celiac Disease: Implications for Diagnostic Accuracy
by Alberto Raiteri, Alessandro Granito, Dante Pio Pallotta, Alice Giamperoli, Agnese Pratelli, Giovanni Monaco, Chiara Faggiano and Francesco Tovoli
Nutrients 2024, 16(18), 3195; https://doi.org/10.3390/nu16183195 - 21 Sep 2024
Viewed by 1673
Abstract
Objective: In the current debate surrounding the biopsy-free diagnosis of CeD, it is crucial to identify factors influencing the accuracy of results. This study investigated the impact of total IgA on the non-invasive diagnosis of celiac disease (CeD). Methods: We retrospectively assessed total [...] Read more.
Objective: In the current debate surrounding the biopsy-free diagnosis of CeD, it is crucial to identify factors influencing the accuracy of results. This study investigated the impact of total IgA on the non-invasive diagnosis of celiac disease (CeD). Methods: We retrospectively assessed total IgA titers’ influence on the diagnostic accuracy of different tTG-IgA thresholds compared to the upper reference value (UNL). Results: Of 165 included patients, tTG-IgA values at 10× UNL and 6× UNL showed specificity of 82.6% and 73.9% and sensitivity of 49.3% and 69.0%, respectively, in predicting intestinal villous atrophy (Marsh 3). In 130 patients, total IgA levels were known at baseline. These patients were divided into three tertiles according to total IgA, i.e., patients with lower, intermediate, or higher total IgA within the population. For patients with total IgA ≥ 245 mg/dL, using a tTG-IgA cutoff of 6× UNL instead of 10× UNL resulted in decreased specificity from 71.4% to 42.8% and increased sensitivity from 67.6% to 81.1%. For patients with total IgA < 174 mg/dL and between 174 mg/dL and 245 mg/dL, using a tTG-IgA cutoff of 6× UNL instead of 10× UNL maintained specificity (75.0% and 85.7%, respectively) with increased sensitivity (from 46.2% to 64.1% and from 36.1% to 52.8%, respectively). Conclusions: In conclusion, total IgA influences the diagnostic accuracy of a predetermined tTG-IgA cutoff. Greater consideration should be given to total IgA, beyond its deficiency, in evaluating the applicability and accuracy of non-invasive CeD diagnosis. Full article
(This article belongs to the Special Issue Recent Advances in Gluten-Free Diet and Celiac Disease)
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22 pages, 864 KiB  
Article
Dietary Adherence to Recommendations among a Cohort of Adults and Teens with Celiac Disease Maintaining a Gluten-Free Diet Compared to a Nationally Representative Sample: A Cross-Sectional Study
by Jennifer W. Cadenhead, Anne R. Lee, Thanh Thanh T. Nguyen, Benjamin Lebwohl, Peter H. R. Green and Randi L. Wolf
Nutrients 2024, 16(18), 3067; https://doi.org/10.3390/nu16183067 - 11 Sep 2024
Viewed by 1899
Abstract
Celiac disease (CeD) is a common autoimmune condition, with a prevalence of ~1%. Currently, a gluten-free diet (GFD) is the only treatment option. Due to fortification rules excluding gluten-free products in the United States of America (U.S.A.), understanding the nutritional adequacy of a [...] Read more.
Celiac disease (CeD) is a common autoimmune condition, with a prevalence of ~1%. Currently, a gluten-free diet (GFD) is the only treatment option. Due to fortification rules excluding gluten-free products in the United States of America (U.S.A.), understanding the nutritional adequacy of a GFD is important for promoting optimal health among those with CeD. Cross-sectional examination of multiple 24 h dietary recalls from a study sample of 50 adults and 30 teens with CeD was used to determine nutritional adequacy and excesses according to U.S.A. recommendations. The results were compared with those of 15,777 adults and 2296 teens from a nationally representative sample not reporting CeD, the National Health and Nutrition Examination Survey (NHANES) 2009–2014. Compared with NHANES, our study population was more at risk of low folate and carbohydrate (adults) consumption, and of excessive niacin and vitamin A (teens), as well as saturated and total fat consumption (adults). Overall, though, compared with NHANES, our study participants had similar nutrient concerns but fewer nutritional imbalances, with some notable exceptions. In addition to maintaining a GFD, individuals with CeD should be counseled to maintain a balanced diet and to pay attention to nutrient-dense foods. Special attention should be given to teens in providing dietary counseling to potentially mitigate the risk of future morbidity. Full article
(This article belongs to the Special Issue Recent Advances in Gluten-Free Diet and Celiac Disease)
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13 pages, 2104 KiB  
Article
Gluten Is Not Gluten
by Majlinda Xhaferaj and Katharina Anne Scherf
Nutrients 2024, 16(16), 2745; https://doi.org/10.3390/nu16162745 - 17 Aug 2024
Viewed by 2025
Abstract
Wheat gluten is responsible for the unique baking properties of wheat flour, but it also causes wheat-related disorders in predisposed individuals. Different commercially available gluten materials are commonly used for a variety of assays, but a detailed characterization of their composition is missing [...] Read more.
Wheat gluten is responsible for the unique baking properties of wheat flour, but it also causes wheat-related disorders in predisposed individuals. Different commercially available gluten materials are commonly used for a variety of assays, but a detailed characterization of their composition is missing in many cases. This is why we aimed to provide an in-depth analysis of three commonly used gliadin and gluten materials from two different batches using gel electrophoretic and chromatographic techniques. The gliadin material did not show the typical qualitative and quantitative protein composition and does not appear to be representative of wheat gliadin. The two gluten materials had the expected protein composition, but both showed large batch-to-batch variability regarding total protein content. Since these variations result in different biochemical, immunological, and functional behaviors, it is important to analyze at least the total protein content of each material and each batch. Full article
(This article belongs to the Special Issue Recent Advances in Gluten-Free Diet and Celiac Disease)
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14 pages, 280 KiB  
Article
Division of Responsibility in Child Feeding and Eating Competence: A Cross-Sectional Study in a Sample of Caregivers of Brazilian Children with Celiac Disease
by Larissa Caetano Silva, Eduardo Yoshio Nakano and Renata Puppin Zandonadi
Nutrients 2024, 16(7), 1052; https://doi.org/10.3390/nu16071052 - 4 Apr 2024
Viewed by 1468
Abstract
The objective of this cross-sectional study was to assess eating competence (EC) and the adherence to the division of responsibility in child feeding (sDOR) of Brazilian caregivers of children with celiac disease (CD). It also examined the association between EC and sDOR, children’s [...] Read more.
The objective of this cross-sectional study was to assess eating competence (EC) and the adherence to the division of responsibility in child feeding (sDOR) of Brazilian caregivers of children with celiac disease (CD). It also examined the association between EC and sDOR, children’s adherence to a gluten-free diet, and sociodemographic data. This study administered a survey set that included sociodemographic data, health-related data, eating habits, and the instruments ecSI2.0TMBR and sDOR.2-6yTM BR, validated for a Brazilian population. The sample comprised 50 caregivers of children with CD (between 24 and 72 months of age). The participants following a gluten-free diet (GFD) presented higher scores for all EC domains and the total EC. The total EC scores were higher for the participants over 40 y/o, frequently having meals as a family, with their children consuming more than three servings of fruit and at least one serving of vegetables daily and complying with a GFD. Different from the EC, the sDOR.2-6yTM scores did not differ between the participants complying with a GFD. The sDOR.2-6yTM mealtime structure domain scores were significantly associated with the EC eating attitude, food acceptance, contextual skills, and total. These findings support the need for greater attention to exploring the division of responsibility in feeding and EC in pediatric celiac disease, potentially enhancing intervention strategies for patients and their families. Full article
(This article belongs to the Special Issue Recent Advances in Gluten-Free Diet and Celiac Disease)

Review

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15 pages, 290 KiB  
Review
Gluten and Wheat in Women’s Health: Beyond the Gut
by Francesca Manza, Lisa Lungaro, Anna Costanzini, Fabio Caputo, Umberto Volta, Roberto De Giorgio and Giacomo Caio
Nutrients 2024, 16(2), 322; https://doi.org/10.3390/nu16020322 - 22 Jan 2024
Cited by 3 | Viewed by 6779
Abstract
Since the rise of awareness of gluten/wheat-related disorders in the academic and clinical field in the last few decades, misinformation regarding the gluten-free diet (GFD) and its impact on health has been spreading among the general population. Despite the established link between gluten [...] Read more.
Since the rise of awareness of gluten/wheat-related disorders in the academic and clinical field in the last few decades, misinformation regarding the gluten-free diet (GFD) and its impact on health has been spreading among the general population. Despite the established link between gluten and celiac disease (CD), where a GFD is mandatory to reach clinical and histological remission, things are more complicated when it comes to non-celiac gluten/wheat sensitivity (NCGWS) and other autoimmune/dysimmune disorders. In the last conditions, a beneficial effect of gluten withdrawal has not been properly assessed, but still is often suggested without strong supporting evidence. In this context, women have always been exposed, more than men, to higher social pressure related to nutritional behaviors and greater engagement in controlling body weight. With this narrative review, we aim to summarize current evidence on the adherence to a GFD, with particular attention to the impact on women’s health. Full article
(This article belongs to the Special Issue Recent Advances in Gluten-Free Diet and Celiac Disease)

Other

8 pages, 1028 KiB  
Brief Report
Dynamics of Serologic Change to Gluten in Celiac Disease Patients
by Jack Syage, Ana Ramos, Vasiliy Loskutov, Anna Norum, Adam Bledsoe, Rok Seon Choung, Matthew Dickason, Jennifer Sealey-Voyksner and Joseph Murray
Nutrients 2023, 15(24), 5083; https://doi.org/10.3390/nu15245083 - 12 Dec 2023
Cited by 1 | Viewed by 2464
Abstract
Serologic measures of tissue transglutaminase (tTG) immunoglobulin A (IgA) and deamidated gliadin peptide (DGP) IgA and immunoglobulin G (IgG) are hallmark tests utilized when diagnosing individuals for celiac disease (CeD) and for monitoring adherence to a gluten-free diet (GFD), currently the only available [...] Read more.
Serologic measures of tissue transglutaminase (tTG) immunoglobulin A (IgA) and deamidated gliadin peptide (DGP) IgA and immunoglobulin G (IgG) are hallmark tests utilized when diagnosing individuals for celiac disease (CeD) and for monitoring adherence to a gluten-free diet (GFD), currently the only available treatment for CeD. We address two issues in this study: (i) the relapse to seropositivity for CeD patients who resume a gluten containing diet and (ii) the correlation between two different tTG-IgA assays near the upper limit of normal (ULN) designated thresholds. Regarding the first issue, often a suspected CeD individual is put back on a gluten diet to return to their serologic levels. However, we show it requires a substantial amount of gluten for serology to return to a positive level. For example, in one study of 22 patients treated with placebo and taking 84 g of gluten over 6 weeks, only two converted from seronegative to seropositive for tTG-IgA. Regarding the second topic, we compare the relationship for different serologic assays, namely tTG-IgA AB (recombinant, ULN = 4 units/mL) vs. tTG-IgA (non-recombinant, ULN = 20 units). There is a strong correlation between both measurements as evidenced by a Pearson coefficient of R = 0.8584; however, we observed that the cross-correlation in terms of sensitivity and specificity improved substantially by using an ULN value of three instead of four for the tTG-IgA AB (recombinant) assay. This result suggests that assay thresholds used for initial diagnosis in patients who have not yet started a GFD may need to be adjusted for monitoring and in the setting of a diagnostic gluten challenge. Full article
(This article belongs to the Special Issue Recent Advances in Gluten-Free Diet and Celiac Disease)
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