Special Issue "Nutrition, Diet and Celiac Disease"

A special issue of Nutrients (ISSN 2072-6643).

Deadline for manuscript submissions: closed (1 August 2019).

Special Issue Editors

Prof. Stefano Guandalini
E-Mail Website
Guest Editor
Section of Pediatric Gastroenterology, Hepatology and Nutrition, and Celiac Disease Center, University of Chicago, Chicago, IL, USA
Interests: celiac disease; pediatric diarrheal disorders; chronic diarrhea; food allergies; probiotics in pediatrics clinical practice
Special Issues and Collections in MDPI journals
Dr. Valentina Discepolo
E-Mail
Guest Editor
Department of Medicine, University of Chicago, Chicago, IL, USA
Interests: celiac disease; autoimmunity; type-1 diabetes; mucosal immunology

Special Issue Information

Dear Colleagues,

Currently affecting more than one percent of the general population, celiac disease represents an important public health burden, particularly in western countries. It is a systemic autoimmune disorder caused by a pro-inflammatory response arising in the small intestinal mucosa in response to the ingestion of dietary gluten and occurs only in genetically susceptible individuals, carrying the predisposing HLA-DQ2 and/or -DQ8 alleles.

As several other autoimmune disorders, a significant rise in the prevalence of celiac disease has been observed worldwide in the past few decades, due to a combination of improved diagnostic accuracy, increased awareness as well as a higher incidence of new disease cases. This relatively rapid breakout cannot be explained by genetic changes, that require longer times to take place, nor by a change in gluten consumption, that has been shown not to play a major role. On the contrary, environmental triggers have been advanced to contribute to disease onset in genetically susceptible individuals. Gluten is the most important and well-studied among environmental contributors of celiac disease, being required for its development and its removal from the diet representing the only currently accepted and efficient treatment. In addition to gluten, early feeding practices and other dietary factors have been investigated as potential contributors of celiac disease development. Finally, viral infections as well as the composition of small intestinal commensal microbiota have been shown to play a role in disease onset.

In this special issue we aim at clarifying, based on the evidences present in the literature as well as some of the most recent personal findings, what is the role of dietary as well as other environmental factors in celiac disease development.

On another hand, we aim at providing an overview of the pros and cons of the gluten-free diet for celiac disease patients with respect to both short and long-term clinical outcomes, disease complications and prevention of associated pathological conditions. Notably, we will try to approach the gluten-free diet associated issues from multiple prospective including those of physicians, scientists, dietitians and health care providers who daily deal with patients affected by celiac disease

We deeply believe that this multidisciplinary approach, together with the prestige of the selected authors will contribute to an interesting special issue that the reader of Nutrients will value and enjoy.

Prof. Stefano Guandalini
Dr. Valentina Discepolo
Guest Editors

Manuscript Submission Information

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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 2000 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-free diet
  • Autoimmunity
  • Potential Celiac Disease
  • Refractory Celiac disease
  • Non-celiac gluten-sensitivity
  • Breastfeeding
  • Viral infections
  • Microbiome

Published Papers (13 papers)

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Research

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Open AccessArticle
Nutritional Status in Spanish Children and Adolescents with Celiac Disease on a Gluten Free Diet Compared to Non-Celiac Disease Controls
Nutrients 2019, 11(10), 2329; https://doi.org/10.3390/nu11102329 - 01 Oct 2019
Abstract
Patients who follow a gluten-free diet (GFD) may be prone to nutritional deficiencies, due to food restriction and consumption of gluten-free products. The aim was to assess nutritional status in celiac children and adolescents on a long-term GFD. A cross-sectional age and gender-matched [...] Read more.
Patients who follow a gluten-free diet (GFD) may be prone to nutritional deficiencies, due to food restriction and consumption of gluten-free products. The aim was to assess nutritional status in celiac children and adolescents on a long-term GFD. A cross-sectional age and gender-matched study in 70 celiac and 67 non-celiac volunteers was conducted, using dietary, anthropometric, biochemical parameters, and assessing bone mineral density and physical activity. Adequacy of vitamin D intake to recommendations was very low, in both groups, and intakes for calcium and magnesium were significantly lower in celiac volunteers. Celiac children and adolescents may have a higher risk of iron and folate deficiencies. Both groups followed a high-lipid, high-protein, low fiber diet. Median vitamin D plasma levels fell below reference values, in celiac and non-celiac participants, and were significantly lower in celiac girls. Other biochemical parameters were within normal ranges. Anthropometry and bone mineral density were similar within groups. With the exception of some slightly lower intakes, children and adolescents following a GFD appear to follow the same trends as healthy individuals on a normal diet. No effect of food restriction or gluten-free product consumption was observed. Full article
(This article belongs to the Special Issue Nutrition, Diet and Celiac Disease)
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Open AccessArticle
Measuring Quality of Life in Parents or Caregivers of Children and Adolescents with Celiac Disease: Development and Content Validation of the Questionnaire
Nutrients 2019, 11(10), 2302; https://doi.org/10.3390/nu11102302 - 27 Sep 2019
Abstract
Celiac disease (CD) is an autoimmune disorder triggered by the ingestion of gluten and affects approximately 1% of the global population. Currently, the only treatment available is lifelong strict adherence to a gluten-free diet (GFD). Chronic diseases such as CD affect patients and [...] Read more.
Celiac disease (CD) is an autoimmune disorder triggered by the ingestion of gluten and affects approximately 1% of the global population. Currently, the only treatment available is lifelong strict adherence to a gluten-free diet (GFD). Chronic diseases such as CD affect patients and their family members’ quality of life (QoL); particularly parents and caregivers who play an essential role in the child’s care and treatment. A higher level of psychological distress has been found in the parents of children with chronic ailments due to limited control over the child’s daily activities and the child’s illness. In this context, the validation of a specific questionnaire of QoL is a valuable tool to evaluate the difficulties faced by parents or caregivers of children with this chronic illness. A specific questionnaire for this population can elucidate the reasons for stress in their daily lives as well as the physical, mental, emotional, and social impact caused by CD. Therefore, this study aimed to develop and validate a specific questionnaire to evaluate the QoL of parents and caregivers of children and adolescents with CD. Overall results showed that a higher family income resulted in a higher score of the worries domain. In addition, having another illness besides CD decreased the QoL (except in the worries domain). The other variables studied did not present a statistically significant impact on the QoL, which was shown to be low in all aspects. Knowledge of the QoL is important to help implement effective strategies to improve celiac patients’ quality of life and reduce their physical, emotional, and social burden. Full article
(This article belongs to the Special Issue Nutrition, Diet and Celiac Disease)
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Open AccessArticle
Gluten-Free Products: From Dietary Necessity to Premium Price Extraction Tool
Nutrients 2019, 11(9), 1997; https://doi.org/10.3390/nu11091997 - 23 Aug 2019
Abstract
Every year, the Italian National Health Service (NHS) provides about 200,000 celiac people (based on 2017 data) living in Italy with financial support of about 250 million euro to cover the cost of their specific dietary constrains. The existence of gluten-free products of [...] Read more.
Every year, the Italian National Health Service (NHS) provides about 200,000 celiac people (based on 2017 data) living in Italy with financial support of about 250 million euro to cover the cost of their specific dietary constrains. The existence of gluten-free products of high quality and affordable price is very important for the quality of life of celiac people and the sustainability of public support. Over the last decade, the market for gluten-free products has experienced a dramatic surge, with an increasing shelf space dedicated to these products in supermarkets, and a large variety of products both in terms of kind of agricultural inputs and processing and packaging methods. This study aimed at assessing the offer of gluten-free (GF) pasta in Italian supermarkets, with respect to its ability to meet the needs of celiac people in terms of variety, prices and safety. A hedonic price analysis was performed. Results indicated that GF pasta is sold only in 44% of the 212 stores of the sample, with a price equal to more than twice that of conventional pasta. A premium price was found for the following attributes: small packages, brands specialized in GF products, content in fiber and the presence of quinoa as ingredient. Full article
(This article belongs to the Special Issue Nutrition, Diet and Celiac Disease)
Open AccessCommunication
Accidental Gluten Contamination in Traditional Lunch Meals from Food Services in Brasilia, Brazil
Nutrients 2019, 11(8), 1924; https://doi.org/10.3390/nu11081924 - 16 Aug 2019
Abstract
This study aimed to evaluate the occurrence of gluten contamination in naturally gluten-free meals from food services in the Federal District, Brazil. This is an exploratory cross-sectional quantitative study in which a total of 180 samples of naturally gluten-free dishes were collected from [...] Read more.
This study aimed to evaluate the occurrence of gluten contamination in naturally gluten-free meals from food services in the Federal District, Brazil. This is an exploratory cross-sectional quantitative study in which a total of 180 samples of naturally gluten-free dishes were collected from 60 food services in Brazil. The enzyme-linked immunosorbent assay was used for the quantification of gluten. As established by the Codex Alimentarius, the threshold of 20 ppm of gluten was considered as the accepted upper gluten level for gluten-free food. A total of 2.8% (95% CI: 0.3–5.2%) gluten contamination was found in the samples. Among the 60 food services, 6.7% (95% CI: 2.7–10.6%) displayed at least one contaminated food in our sample. The occurrence of gluten contamination in naturally gluten-free preparations was uncommon and low on a quantitative basis. Full article
(This article belongs to the Special Issue Nutrition, Diet and Celiac Disease)
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Open AccessArticle
Food Neophobia in Celiac Disease and Other Gluten-Free Diet Individuals
Nutrients 2019, 11(8), 1762; https://doi.org/10.3390/nu11081762 - 31 Jul 2019
Abstract
The only treatment currently available to combat celiac disease (CD) is strict adherence to a gluten-free diet (GFD), but there may be various determinants of its adherence, including food neophobia (FN), that is associated with sensory aversions, or fears of negative consequences of [...] Read more.
The only treatment currently available to combat celiac disease (CD) is strict adherence to a gluten-free diet (GFD), but there may be various determinants of its adherence, including food neophobia (FN), that is associated with sensory aversions, or fears of negative consequences of eating specific food products, that may be crucial for CD patients following a GFD. The aim of the present study was to analyze food neophobia levels and its determinants in CD patients in comparison with other individuals who follow a GFD based on their own decision. The study was conducted in two independent groups of individuals following a GFD: those diagnosed with CD (n = 101) and those following a GFD based on their own decision (n = 124). Each group was recruited with cooperation from the local CD and GFD societies located in Poland. The FN was assessed using the Food Neophobia Scale (FNS) and compared between groups, as well as the influence of gender, age, body mass index, educational level, place of residence and employment status was assessed. It was stated, that for the individuals following a GFD, CD was the major determinant of FN. The FNS score values were higher (indicating higher food neophobia) for CD individuals (39.4 ± 9.2), than for those following a GFD based on their own decision (33.6 ± 8.7; p < 0.0001) and it was observed both for general group and for sub-groups stratified by assessed variables. Moreover, the indicated variables did not influence the FNS in any of the analyzed groups. The influence of CD with no influence of other variables was confirmed in the regression analysis. It may be concluded that CD is a major contributor to FN, which can be attributed to fear of developing adverse reactions to gluten-contaminated food products, which is more pronounced in CD patients compared to non-CD patients following a GFD based on their own decision. Full article
(This article belongs to the Special Issue Nutrition, Diet and Celiac Disease)
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Open AccessArticle
Daily Life Restrictions are Common and Associated with Health Concerns and Dietary Challenges in Adult Celiac Disease Patients Diagnosed in Childhood
Nutrients 2019, 11(8), 1718; https://doi.org/10.3390/nu11081718 - 25 Jul 2019
Abstract
The prevalence and associated factors of daily life restrictions due to a gluten-free diet in adult celiac disease patients diagnosed in childhood are poorly known. We investigated these issues by collecting the medical data of 955 pediatric patients and sending questionnaires evaluating various [...] Read more.
The prevalence and associated factors of daily life restrictions due to a gluten-free diet in adult celiac disease patients diagnosed in childhood are poorly known. We investigated these issues by collecting the medical data of 955 pediatric patients and sending questionnaires evaluating various health outcomes to the 559 patients who had reached adulthood. Of the 231 respondents, 46% reported everyday life restrictions caused by dietary treatment. Compared with those without restrictions, they more often had anemia at diagnosis (37% vs. 22%, p = 0.014), but the groups were comparable in other diagnostic features. In adulthood, patients with restrictions reported more overall symptoms (32% vs. 17%, p = 0.006), although the symptoms measured with the Gastrointestinal Symptom Rating Scale questionnaire were comparable. Despite strict dietary adherence in both groups, the experience of restrictions was associated with dietary challenges (34% vs. 9%, p < 0.001), health concerns (22% vs. 13%, p = 0.050), and lower vitality scores in the Psychological General Well-Being questionnaire. The groups did not differ in their current age, socioeconomic status, family history of celiac disease, general health or health-related lifestyle, the presence of co-morbidities, or regular follow up. Our results encourage healthcare professionals to discuss the possible health concerns and dietary challenges with patients to avoid unnecessary daily life restrictions, especially when young patients start to take responsibility for their treatment. Full article
(This article belongs to the Special Issue Nutrition, Diet and Celiac Disease)
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Open AccessCommunication
Nutritional Deficiencies in Children with Celiac Disease Resulting from a Gluten-Free Diet: A Systematic Review
Nutrients 2019, 11(7), 1588; https://doi.org/10.3390/nu11071588 - 13 Jul 2019
Abstract
Background: A strictly gluten-free diet (GFD) is the basis for managing celiac disease (CD). Numerous studies have reported nutritional deficiencies/imbalances ascribable to a GFD. The aim of this review is to describe nutritional deficiencies observed in children with celiac disease on a GFD, [...] Read more.
Background: A strictly gluten-free diet (GFD) is the basis for managing celiac disease (CD). Numerous studies have reported nutritional deficiencies/imbalances ascribable to a GFD. The aim of this review is to describe nutritional deficiencies observed in children with celiac disease on a GFD, to discuss the clinical consequences related to these nutritional imbalances, and to identify strategies that may be adopted to treat them. Methods: We reviewed the MEDLINE and EMBASE databases between January 1998 and January 2019. Results: Children are, regardless of whether they are on a gluten-free diet or not, at risk of consuming too much fat and insufficient fiber, iron, vitamin D, and calcium. These imbalances may be exacerbated when children are on a gluten-free diet. In particular, the intake of folate, magnesium, zinc, and foods with a high glycemic index in children with CD who are on a GFD is significantly altered. Conclusions: Therapeutic protocols should include nutritional education to help teach subjects affected by disorders such as CD the importance of labels, the choice of foods, and the combination of macro- and micronutrients. Children with CD on a GFD should be encouraged to rotate pseudo-cereals, consume gluten-free commercial products that have been fortified or enriched, and use foods that are local and naturally gluten-free. Full article
(This article belongs to the Special Issue Nutrition, Diet and Celiac Disease)
Open AccessArticle
Self-Reported Non-Celiac Gluten Sensitivity in Brazil: Translation, Cultural Adaptation, and Validation of Italian Questionnaire
Nutrients 2019, 11(4), 781; https://doi.org/10.3390/nu11040781 - 04 Apr 2019
Cited by 1
Abstract
This study aimed to translate, culturally adapt, validate, and apply a questionnaire to the Brazilian non-celiac gluten sensitive (NCGS) population. We also aimed to estimate the prevalence of symptoms which affect Brazilian NCGS. The Brazilian Portuguese version of the NCGS questionnaire was developed [...] Read more.
This study aimed to translate, culturally adapt, validate, and apply a questionnaire to the Brazilian non-celiac gluten sensitive (NCGS) population. We also aimed to estimate the prevalence of symptoms which affect Brazilian NCGS. The Brazilian Portuguese version of the NCGS questionnaire was developed according to revised international guidelines. Five-hundred-and-fourty-three participants responded the NCGS questionnaire. We evaluated the reproducibility and validity of the questionnaire which presents valid measures of reproducibility. This is the first specific self-reported validated questionnaire for NCGS patients in Brazilian Portuguese, and the first nationwide characterization of self-reported NCGS in Brazilian adults. Most respondents were female (92.3%), and the main intestinal symptoms reported were bloating and abdominal pain. The most frequent extraintestinal symptoms were lack of wellbeing, tiredness, and depression. We expect that the present study will provide a picture of Brazilian individuals with suspected NCGS, which could help health professionals and governmental institutions in developing effective strategies to improve the treatment and diagnosis of Brazilian NCGS. Full article
(This article belongs to the Special Issue Nutrition, Diet and Celiac Disease)
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Review

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Open AccessReview
Celiac Disease and the Microbiome
Nutrients 2019, 11(10), 2403; https://doi.org/10.3390/nu11102403 - 08 Oct 2019
Abstract
Growing evidence supports the hypothesis that changes in both the composition and function of the intestinal microbiome are associated with a number of chronic inflammatory diseases including celiac disease (CD). One of the major advances in the field of microbiome studies over the [...] Read more.
Growing evidence supports the hypothesis that changes in both the composition and function of the intestinal microbiome are associated with a number of chronic inflammatory diseases including celiac disease (CD). One of the major advances in the field of microbiome studies over the last few decades has been the development of culture-independent approaches to identify and quantify the components of the human microbiota. The study of nucleic acids DNA and RNA found in feces or other biological samples bypasses the need for tissue cultures and also allows the characterization of non-cultivable microbes. Current evidence on the composition of the intestinal microbiome and its role as a causative trigger for CD is highly heterogeneous and sometimes contradictory. This review is aimed at summarizing both pre-clinical (basic science data) and clinical (cross-sectional and prospective studies) evidence addressing the relationship between the intestinal microbiome and CD. Full article
(This article belongs to the Special Issue Nutrition, Diet and Celiac Disease)
Open AccessReview
The Gut Microbiota in Celiac Disease and probiotics
Nutrients 2019, 11(10), 2375; https://doi.org/10.3390/nu11102375 - 05 Oct 2019
Abstract
Celiac disease (CeD) is an immune-mediated enteropathy, and unique in that the specific trigger is known: gluten. The current mainstay of therapy is a gluten-free diet (GFD). As novel therapies are being developed, complementary strategies are also being studied, such as modulation of [...] Read more.
Celiac disease (CeD) is an immune-mediated enteropathy, and unique in that the specific trigger is known: gluten. The current mainstay of therapy is a gluten-free diet (GFD). As novel therapies are being developed, complementary strategies are also being studied, such as modulation of the gut microbiome. The gut microbiota is involved in the initiation and perpetuation of intestinal inflammation in several chronic diseases. Intestinal dysbiosis has been reported in CeD patients, untreated or treated with GFD, compared to healthy subjects. Several studies have identified differential bacterial populations associated with CeD patients and healthy subjects. However, it is still not clear if intestinal dysbiosis is the cause or effect of CeD. Probiotics have also been considered as a strategy to modulate the gut microbiome to an anti-inflammatory state. However, there is a paucity of data to support their use in treating CeD. Further studies are needed with therapeutic microbial formulations combined with human trials on the use of probiotics to treat CeD by restoring the gut microbiome to an anti-inflammatory state. Full article
(This article belongs to the Special Issue Nutrition, Diet and Celiac Disease)
Open AccessReview
Systematic Review and Meta-Analysis of Prevalence of Coeliac Disease in Women with Infertility
Nutrients 2019, 11(8), 1950; https://doi.org/10.3390/nu11081950 - 20 Aug 2019
Abstract
We aimed to estimate the seroprevalence and the prevalence of coeliac disease (CD) in women with reproductive problems. A systematic review of English published articles until June 2019 was performed in PubMed and Scopus using the terms: (infertility and (coeliac disease OR gluten) [...] Read more.
We aimed to estimate the seroprevalence and the prevalence of coeliac disease (CD) in women with reproductive problems. A systematic review of English published articles until June 2019 was performed in PubMed and Scopus using the terms: (infertility and (coeliac disease OR gluten) OR (miscarriage and (coeliac disease OR gluten) OR (abortion and (coeliac disease OR gluten). All articles showing numerical data of anti-transglutaminase type 2 or anti-endomisium antibodies, or intestinal biopsy information were included. The study group comprised women with overall infertility, unexplained infertility, or recurrent spontaneous abortions. Two authors independently performed data extraction using a predefined data sheet. The initial search yielded 310 articles, and 23 were selected for data extraction. After meta-analysis, the pooled seroprevalence was very similar for overall and unexplained infertility, with a pooled proportion of around 1.3%–1.6%. This implies three times higher odds of having CD in infertility when compared to controls. The pooled prevalence could not be accurately calculated due to the small sample sizes. Further studies with increased sample sizes are necessary before giving specific recommendations for CD screening in women with reproductive problems, but current data seem to support a higher risk of CD in these women. Full article
(This article belongs to the Special Issue Nutrition, Diet and Celiac Disease)
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Open AccessReview
Gluten Free Wheat: Are We There?
Nutrients 2019, 11(3), 487; https://doi.org/10.3390/nu11030487 - 26 Feb 2019
Cited by 1
Abstract
Gluten proteins, major determinants of the bread-making quality of wheat, are related to several digestive disorders. Advances in plant genetic breeding have allowed the production of wheat lines with very low gliadin content through the use of RNAi and gene editing technologies. In [...] Read more.
Gluten proteins, major determinants of the bread-making quality of wheat, are related to several digestive disorders. Advances in plant genetic breeding have allowed the production of wheat lines with very low gliadin content through the use of RNAi and gene editing technologies. In this review, we carried out a comprehensive study of the application of these cutting-edge technologies towards the development of wheat lines devoid of immunogenic gluten, and their genetic, nutritional and clinical characterization. One line, named E82, showed outstanding nutritional properties, with very low immunogenic gluten and a low stimulation capacity of T-cells from celiac patients. Moreover, a clinical trial with non-celiac wheat sensitivity (NCWS) patients showed that the consumption of bread made with this E82 low gliadin line induced positive changes in the gut microbiota composition. Full article
(This article belongs to the Special Issue Nutrition, Diet and Celiac Disease)
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Other

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Open AccessDiscussion
The Pros and Cons of Using Oat in a Gluten-Free Diet for Celiac Patients
Nutrients 2019, 11(10), 2345; https://doi.org/10.3390/nu11102345 - 02 Oct 2019
Abstract
A therapeutic gluten-free diet often has nutritional limitations. Nutritional qualities such as high protein content, the presence of biologically active and beneficial substances (fiber, beta-glucans, polyunsaturated fatty acids, essential amino acids, antioxidants, vitamins, and minerals), and tolerance by the majority of celiac patients [...] Read more.
A therapeutic gluten-free diet often has nutritional limitations. Nutritional qualities such as high protein content, the presence of biologically active and beneficial substances (fiber, beta-glucans, polyunsaturated fatty acids, essential amino acids, antioxidants, vitamins, and minerals), and tolerance by the majority of celiac patients make oat popular for use in gluten-free diet. The health risk of long-time consumption of oat by celiac patients is a matter of debate. The introduction of oat into the diet is only recommended for celiac patients in remission. Furthermore, not every variety of oat is also appropriate for a gluten-free diet. The risk of sensitization and an adverse immunologically mediated reaction is a real threat in some celiac patients. Several unsolved issues still exist which include the following: (1) determination of the susceptibility markers for the subgroup of celiac patients who are at risk because they do not tolerate dietary oat, (2) identification of suitable varieties of oat and estimating the safe dose of oat for the diet, and (3) optimization of methods for detecting the gliadin contamination in raw oat used in a gluten-free diet. Full article
(This article belongs to the Special Issue Nutrition, Diet and Celiac Disease)
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