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DIETA LIBRE DE GLUTEN Y DISMINUCIóN DEL RIESGO DE ASOCIACIóN DE ENFERMEDADES AUTOINMUNES EN EL PACIENTE CELIACO GLUTEN FREE DIET AND DECREASE IN THE RISK OF ASSOCIATION OF AUTOIMMUNE DISEASE IN CELIAC PATIENT  [cached]
Sylvia Cruchet M.,Sandra Verbeke P.
Revista Chilena de Nutricíon , 2003,
Abstract: Estudios publicados concluyen que el desarrollo de enfermedades autoinmunes en pacientes celiacos se incrementa al aumentar el tiempo de exposición al gluten y cuanto mayor sea la edad al diagnóstico. La adolescencia constituye un periodo de la vida en el cual una dieta libre de gluten frecuentemente se abandona. Por esto es de suma importancia investigar marcadores inmunológicos endocrinos en pacientes celiacos que cumplen o no la dieta libre de gluten Results of studies published recently have shown that autoimmune phenomena in celiac patients increases with a delayed diagnosis and a more prolonged exposure to gluten. Adolescence is a stage of life in which the gluten-free diet is frequently discontinue. For this reason it is of interest to investigate in this age group the immunological markers of endocrine disturbances in celiac patients depending on whether they have a good compliance to the gluten-free diet
Adherencia e impacto de la dieta sin gluten en ni?os con enfermedad celíaca
BRAVO M,FRANCISCA; MU?OZ F,MARíA PAZ;
Revista chilena de pediatría , 2011, DOI: 10.4067/S0370-41062011000300003
Abstract: the treatment of celiac disease (cd) is a strict and permanent gluten-free diet (gfd). factors exist that influence adherence: motivation, information, costs, correct labeling and food availability. objectives: describe adherence and impact of gfd in children with cd. patients and methods: prospective descriptive study, through application of a 28 question survey to children 12-18 y.o. with the disorder, and parents of children 3-18 with the disease. results: median age: 10.5 years, 1.8 years at diagnosis. 62.5% women. adherence to treatment was seen in 42,5% of patients according to parents, 15% according to children > 12 yrs. vs 35% parents of children > 12 y.o. 80% of children state feeling no different on a diet, 70% find the diet hard to follow. 55% have difficulty following the diet, among them, 42,8% are not sure what they can eat, 51.5% state it creates financial distress in the family. about 55% believe it affects family life due to the following: 55% food limitation, 50% food preparation, 75% affect eating out, 35% affect traveling. 50% of parents have fed children a forbidden food, mainly at home (44%). information regarding gfd is obtained at the hospital (85%). there is 32.5% adherence to cd foundations. conclusions: gfd impacts children's lifestyle with difficulty in adherence and management.
Adherencia a la dieta mediterránea en la población universitaria Adherence to a Mediterranean diet in a college population  [cached]
T. Durá Travé,A. Castroviejo Gandarias
Nutrición Hospitalaria , 2011,
Abstract: Objetivo: Determinar la adherencia a la dieta mediterránea de una población universitaria y analizar diversos factores que pudieran condicionar su calidad nutricional. Material y métodos: Distribución del test kidmed a una muestra aleatoria de 570 universitarios. El índice kidmed (de 0 a 12) indicaba si la adherencia a la dieta mediterránea era baja (de 0 a 3), media (de 4 a 7) o alta (de 8 a 12). De cada encuestado se registraba sexo, edad, peso, talla e índice de masa corporal, tipo de residencia y provincia de procedencia. Resultados: La muestra era de 217 varones y 353 mujeres con edades entre 18 y 25 a os. El 9,5% de los universitarios tenían un índice kidmed bajo, el 62,1% intermedio y el 28,4% alto. Aquellos universitarios que vivían en residencia familiar tenían un porcentaje de alta adherencia (35,6%) significativamente superior (p < 0,05) a los que vivían en colegio mayor (11,1%) o piso de estudiantes (11,2%). Los universitarios con sobrepeso tenían un porcentaje de baja adherencia (15,5%) significativamente superior (p < 0,05) a los que tenían una situación nutricional normal (8,5%). Conclusiones: El 71,6% de los universitarios necesitaban mejorar su patrón alimentario (adherencia media-baja a la dieta mediterránea), apreciándose un cierto factor familiar conservador de las costumbres dietéticas tradicionales. Los universitarios con baja adherencia tenían mayor riesgo de sobrepeso. Seria conveniente desarrollar programas de educación nutricional en los curriculum universitarios. Objective: To determine the adherence to the Mediterranean diet of a university population and to analyze several factors that may condition its nutritional quality. Material and methods: Distribution of the Kidmed test to a random sample of 570 university students. The Kidmed index (0-12) indicated whether the adherence to the Mediterranean diet was low (0-3), intermediate (4-7) or high (8-12). The gender, age, weight, height, and body mass index were gathered from each participant, as well as the type of residence and the province of origin. Results: The sample comprised 217 men and 353 women aged 18-25 years. 9.5% of the university students had a low Kidmed index, 62.1% intermediate, and 28.4% high. Those students living at their parental home had a high percentage of adherence (35.6%), significantly higher (p < 0.05) to that of those living at a student's residence (11.1%) or at a student's apartment (11.2%). Overweighed students had a low percentage of adherence (15.5%), significantly higher (p < 0.05) to those with a normal nutritional situation (8.5%). Conclusi
Perceived health status in celiac disease Percepción del estado de salud en la enfermedad celiaca  [cached]
F. Casellas,J. López Vivancos,J. R. Malagelada
Revista Espa?ola de Enfermedades Digestivas , 2005,
Abstract: Introduction: chronic conditions modify perceived health in affected individuals. For this reason celiac disease, being a chronic condition, may impair health-related quality of life (HRQOL). Objective: to analyze the impact of celiac disease in affected individuals. Method: observational, cross-sectional, prospective study in patients with celiac disease by administering two HRQOL questionnaires: EuroQol-5D and GastroIntestinal Quality of Life (GIQLI). Results: 54 stable patients on a gluten-free diet for a median 60 months, and 9 newly diagnosed individuals still on their usual diet were included. Overall GIQLI score was significantly higher, meaning a better HRQOL, in treated celiac patients versus pre-treated celiac patients (3.1 [2.7-3.5] vs. 2.4 [2.1-2.6], p < 0.01). Similarly, EuroQol's health status preference value was also significantly better in treated patients (0.87[0.8-1.0] vs. 0.7 [0.5-0.8], p < 0.01). EuroQol's visual analogic scale had also better scores, representing a better perceived health, among treated patients (80.0 [70.0-90.0] vs. 65.0 [40.0-71.0], p < 0.05). In comparison to EuroQol-5D scores among the healthy Spanish population, values obtained for celiac patients under treatment are similar to those seen in the general population. Conclusions: celiac disease impairs perceived health in affected individuals, which improves and reaches results similar to those in the general population when on a gluten-free diet. Introducción: las enfermedades crónicas modifican la percepción de salud de los individuos que las padecen. Por este motivo, al ser la enfermedad celiaca una enfermedad crónica, podría causar un deterioro de la calidad de vida relacionada con la salud (CVRS). Objetivo: analizar el impacto de la enfermedad celiaca en las personas que la padecen. Método: estudio observacional transversal prospectivo en pacientes con enfermedad celiaca administrando dos cuestionarios genéricos de medida de la CVRS: el EuroQol-5D y el GastroIntestinal Quality of Life (GIQLI). Resultados: se han incluido 54 pacientes controlados con dieta sin gluten durante una mediana de 60 meses y 9 recién diagnosticados y que aún no habían iniciado la dieta sin gluten. La puntuación global del GIQLI fue significativamente más alta, representativa de una mejor CVRS, en los celiacos tratados que en los que aún no habían iniciado la dieta (3,1 [2,7-3,5] vs. 2,4 [2,1-2,6], p < 0,01). Del mismo modo, el valor de preferencia del estado de salud del EuroQol fue también significativamente mejor en los celiacos tratados (0,87[0,8-1,0] vs. 0,7 [0,5-0,8], p < 0,01)
Enfermedad celíaca del adulto: aspectos endocrinológicos y nutricionales Adult celiac disease: endocrinological and nutritional issues  [cached]
D. Peteiro-González,M. A. Martínez-Olmos,R. Peinó,A. M.a Prieto-Tenreiro
Nutrición Hospitalaria , 2010,
Abstract: La enfermedad celíaca es una enteropatía autoinmune que aparece como respuesta a la ingesta de gluten en sujetos genéticamente predispuestos. Aunque históricamente se la ha considerado una patología pediátrica e infrecuente su prevalencia está próxima al 1% de la población general, siendo todavía más elevada en pacientes con determinadas patologías endocrinológicas y déficits nutricionales. El empleo de los anticuerpos antitransglutaminasa y antiendomisio y la endoscopia digestiva con toma de biopsia serán elementos clave para su diagnóstico. La instauración de una dieta sin gluten logrará la recuperación del trofismo intestinal y evitará el riesgo de complicaciones a largo plazo a la vez que mejora la calidad de vida del paciente. El seguimiento médico y nutricional será clave para lograr una buena adherencia terapéutica. Celiac disease is an autoinmune enterophaty induced by the ingestion of gluten in genetically susceptible individuals. Although historically it was thought that it was an infrequent pediatric disease, now it is know that its prevalence is close to 1% in the general population. It is even higher between patients with some endocrine disorders and nutritional deficits. The use of antitransglutaminase and antiendomisium antibodies and the endoscopical duodenal biopsy are the cornerstones for its diagnosis. The introduction of a gluten-free diet will achieve the normalization of the intestinal mucosa. It will avoid the risk of long term complications and an it will achieve an improvement in quality of life. Medical and dietitian long term follow-up will be important to improve the compliance to the treatment.
Value of Gluten Patch Test in Diagnosis of Celiac Disease
Hosein Saneian,Fariborz Zandieh,Paria Akhavan,Rouzbeh Taherian
Iranian Journal of Pediatrics , 2011,
Abstract: Objective: Celiac disease is an intestinal disorder identified by mucus inflammation, villous atrophy and crypt hyperplasia. This disorder can be controlled by elimination of gluten from daily diet. Patients with celiac disease are at greater risk of gastrointestinal malignancy and non-Hodgkin lymphoma than are the general population. This study tries to present the value of gluten patch test for diagnosis of celiac disease.Methods: In this investigation, the study population was divided into case and control groups. The case group consisted of patients with celiac disease. The control group were patients involved in celiac disease but suffering from other gastrointestinal disorders. Both gluten patch and placebo patch were attached to the skin between the scapulas. The results were read twice: 48 hours and 96 hours after the patch was applied. Patients who showed irritation reactions were withdrawn from this study. The results were analysed by SPSS software, Spearman's test, chi square, and Mann-Whitney tests. Findings: The value obtained from the gluten patch test after 96 hours are as follows: specification at 95%, sensitivity at 8%, positive prediction value at 67%, and negative prediction value at 43%. Conclusion: It can be concluded that the gluten patch test is not an efficient test for screening of celiac disease, however, it can be useful for diagnosis of celiac disease if employed and studied with clinical symptoms and serologic and biopsy tests. Furthermore, we should doubt our judgment if the result of gluten patch test for the patient with celiac disease is positive.
Effect of the timing of gluten introduction on the development of celiac disease  [cached]
Marco Silano, Carlo Agostoni, Stefano Guandalini
World Journal of Gastroenterology , 2010,
Abstract: Celiac disease (CD) is a permanent auto-immune enteropathy, triggered in genetically predisposed individuals by the ingestion of dietary gluten. Gluten is the alcohol-soluble protein component of the cereals wheat, rye and barley. CD is a multifactorial condition, originating from the interplay of genetic and environmental factors. The necessary environmental trigger is gluten, while the genetic predisposition has been identified in the major histocompatibility complex region on chromosome 6p21, with over 90% of CD patients expressing HLA DQ2 and the remaining celiac patients express DQ8. The fact that only about 4% of DQ2/8-positive individuals exposed to gluten develop CD, has led to the recognition that other genetic and environmental factors are also necessary. In the last few years, several epidemiological studies have suggested that the timing of the introduction of gluten, as well as the pattern of breastfeeding, may play an important role in the subsequent development of CD. Here, we present and review the most recent evidences regarding the effect of timing of gluten introduction during weaning, the amount of gluten introduced and simultaneous breastfeeding, on the development of CD.
Refractory iron-deficiency anemia and gluten intolerance: Response to gluten-free diet Anemia ferropénica refractaria e intolerancia al gluten: respuesta a la dieta sin gluten  [cached]
Luis Rodrigo-Sáez,Dolores Fuentes-álvarez,Isabel Pérez-Martínez,Noemí álvarez-Mieres
Revista Espa?ola de Enfermedades Digestivas , 2011,
Abstract: Introduction: refractory iron-deficiency anemia has a multifactorial origin related to various gastrointestinal conditions, with celiac disease plus malabsorption and IBD together with isolated gluten intolerance being most common. Objectives: to determine the prevalence of serum, genetic, and histological markers for gluten intolerance, and to analyze the response to gluten withdrawal from the diet in these patients. Methods: a number of patients with refractory anemia were prospectively and consecutively enrolled. A protocol to measure serum (TGt-2), genetic (HLA-DQ2/DQ8), and histological markers for celiac disease was applied. All followed a gluten-free diet for a median 3.6 years. Sustained remission of anemia during follow-up was interpreted as positive response. Results: ninety-eight patients (84% females) with a mean age of 54 years were studied. Anti-TGt2 antibodies were positive in 5% of cases. A total of 67 cases (68%) were haplotype HLA-DQ2 or -DQ8 (+). We found villous atrophy (Marsh III) in 13% of patients, and an inflammatory pattern (Marsh I or II) in 13%. All remaining 72 patients (74%) had no histological duodenal changes. Age, anemia duration, number of transfusions, number of parenteral iron doses, and time on a gluten-free diet were all compared according to the presence or absence of villous atrophy and HLA-DQ2/8 positivity, and no significant differences were found for any of the analyzed variables. Response was positive in 92% of subjects. Conclusions: celiac disease with villous atrophy is rarely a cause of refractory anemia. Gluten intolerance with no histological lesions is seen in almost 75% of patients, and therefore plays a relevant role in its development. Introducción: la anemia ferropénica refractaria presenta un origen multifactorial, relacionado con diversas enfermedades digestivas, siendo las más frecuentes la enfermedad celiaca con malabsorción y la EII junto con la intolerancia al gluten aislada. Objetivos: determinar la prevalencia de marcadores serológicos, genéticos e histológicos de intolerancia al gluten y analizar la respuesta a la retirada del gluten de la dieta en estos pacientes. Métodos: se incluyeron de forma prospectiva y consecutiva una serie de pacientes con anemia refractaria. Se les aplicó un protocolo consistente en determinación marcadores serológicos (TGt-2), genéticos (HLA-DQ2/DQ8) e histológicos de enfermedad celíaca. Todos siguieron una dieta sin gluten durante una mediana de 3,6 a os. Se interpretó como respuesta positiva la desaparición mantenida de la anemia durante el seguimiento. Resultados
Celiac disease: Alternatives to a gluten free diet  [cached]
Fabiana Zingone,Pietro Capone,Carolina Ciacci
World Journal of Gastrointestinal Pharmacology and Therapeutics , 2010,
Abstract: Celiac disease is a chronic inflammatory disorder of the small intestine caused by the ingestion of gluten or related rye and barley proteins. At present, the only available treatment is a strict gluten-exclusion diet. However, recent understanding of the molecular basis for this disorder has improved and enabled the identification of targets for new therapies. This article aims to critically summarize these recent studies.
Parallels between Pathogens and Gluten Peptides in Celiac Sprue  [PDF]
Michael T Bethune,Chaitan Khosla
PLOS Pathogens , 2008, DOI: 10.1371/journal.ppat.0040034
Abstract: Pathogens are exogenous agents capable of causing disease in susceptible organisms. In celiac sprue, a disease triggered by partially hydrolyzed gluten peptides in the small intestine, the offending immunotoxins cannot replicate, but otherwise have many hallmarks of classical pathogens. First, dietary gluten and its peptide metabolites are ubiquitous components of the modern diet, yet only a small, genetically susceptible fraction of the human population contracts celiac sprue. Second, immunotoxic gluten peptides have certain unusual structural features that allow them to survive the harsh proteolytic conditions of the gastrointestinal tract and thereby interact extensively with the mucosal lining of the small intestine. Third, they invade across epithelial barriers intact to access the underlying gut-associated lymphoid tissue. Fourth, they possess recognition sequences for selective modification by an endogenous enzyme, transglutaminase 2, allowing for in situ activation to a more immunotoxic form via host subversion. Fifth, they precipitate a T cell–mediated immune reaction comprising both innate and adaptive responses that causes chronic inflammation of the small intestine. Sixth, complete elimination of immunotoxic gluten peptides from the celiac diet results in remission, whereas reintroduction of gluten in the diet causes relapse. Therefore, in analogy with antibiotics, orally administered proteases that reduce the host's exposure to the immunotoxin by accelerating gluten peptide destruction have considerable therapeutic potential. Last but not least, notwithstanding the power of in vitro methods to reconstitute the essence of the immune response to gluten in a celiac patient, animal models for the disease, while elusive, are likely to yield fundamentally new systems-level insights.
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