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

Deadline for manuscript submissions: closed (31 August 2020) | Viewed by 56236

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Dr. Fabiana Zingone

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Department of Surgery, Oncology and Gastroenterology, University of Padua, 35100 Padua, Italy
Interests: nutrition in coeliac disease and gluten-related disorders; nutrition in inflammatory bowel disease; autoimmune atrophic gastritis
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Dear Colleagues

Wheat is one of the most consumed cereal grains worldwide and represents an important part of the human diet. The protein content of wheat is between 7% and 22%, with gluten constituting about 80% of the total protein of the seed. The aim of this proposed Special Issue entitled “Grain Intake and Human Health” is to offer a robust and critical updated view on the relationship between grain intake and human health, with a particular focus on gluten-related diseases like coeliac disease, non-coeliac gluten sensitivity, and gluten allergy. Furthermore, studies evaluating the level of nutritional knowledge of patients affected by these diseases will be also welcome. We would like different types of manuscript submissions, including original preclinical and clinical research articles and up-to-date reviews (narrative and systematic reviews, as well as meta-analyses).

Prof. Dr. Fabiana Zingone
Guest Editor

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Keywords

wheat
cereals
inflammation
nutritional knowledge
coeliac disease
allergy
gluten
gluten sensitivity

Published Papers (11 papers)

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Editorial

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3 pages, 185 KiB

Open AccessEditorial

Grain Intake and Human Health

by Fabiana Zingone

Nutrients 2020, 12(12), 3733; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12123733 - 04 Dec 2020

Cited by 1 | Viewed by 1862

Abstract

Wheat is one of the most consumed cereal grains worldwide and represents an important part of the human diet [...] Full article

(This article belongs to the Special Issue Grain Intake and Human Health)

Research

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12 pages, 7130 KiB

Open AccessArticle

Quality of Life and Psychological Disorders in Coeliac Disease: A Prospective Multicentre Study

by Cristina Canova, Isabella Rosato, Ilaria Marsilio, Flavio Valiante, Valerio Zorzetto, Giovanni Cataudella, Anna D’Odorico and Fabiana Zingone

Nutrients 2021, 13(9), 3233; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13093233 - 16 Sep 2021

Cited by 10 | Viewed by 2930

Abstract

Coeliac disease (CeD) has been associated with psychological disorders and reduced quality of life. Our prospective study evaluated the changes in the quality of life, anxiety and depression in CeD patients up to two years after diagnosis. We recruited adult patients residing in the Veneto region with a new diagnosis of CeD. Several validated questionnaires were administered to measure quality of life, psychological symptoms and adherence to a gluten-free diet (GFD) at the time of diagnosis and after 1 and 2 years. Ninety-three patients reached the 1-year follow-up (81.7% were females with a median age at diagnosis of 35 years), and 55 patients reached the 2-year follow-up. We observed a significant improvement in quality of life, anxiety and depression scores at 1 year after diagnosis, particularly in patients who complied with a GFD. The improvements among classical CeD patients were similar to those observed in nonclassical patients except for anxiety, which improved only in patients with a classical presentation at diagnosis. Age, sex and other disease factors did not affect the change in quality of life (QoL) or other mood disorders. Most of the improvements measured 1 year after diagnosis and 2 years after diagnosis were not significant. In conclusion, QoL and mood disorders must be considered, and psychological counselling should be used when needed. Full article

(This article belongs to the Special Issue Grain Intake and Human Health)

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13 pages, 2027 KiB

Open AccessArticle

Commensal Bacterium Rothia aeria Degrades and Detoxifies Gluten via a Highly Effective Subtilisin Enzyme

by Guoxian Wei, Ghassan Darwish, Frank G. Oppenheim, Detlef Schuppan and Eva J. Helmerhorst

Nutrients 2020, 12(12), 3724; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12123724 - 02 Dec 2020

Cited by 11 | Viewed by 3424

Abstract

Celiac disease is characterized by a chronic immune-mediated inflammation of the small intestine, triggered by gluten contained in wheat, barley, and rye. Rothia aeria, a gram-positive natural colonizer of the oral cavity and the upper digestive tract is able to degrade and detoxify gluten in vitro. The objective of this study was to assess gluten-degrading activity of live and dead R. aeria bacteria in vitro, and to isolate the R. aeria gluten-degrading enzyme. Methods: After an overnight fast, Balb/c mouse were fed a 1 g pellet of standard chow containing 50% wheat (and 4% gliadin) with or without 1.6 × 10⁷ live R. aeria bacteria. After 2 h, in vivo gluten degradation was assessed in gastric contents by SDS-PAGE and immunoblotting, and immunogenic epitope neutralization was assessed with the R5 gliadin ELISA assay. R. aeria enzyme isolation and identification was accomplished by separating proteins in the bacterial cell homogenate by C18 chromatography followed by gliadin zymography and mass spectrometric analysis of excised bands. Results: In mice fed with R. aeria, gliadins and immunogenic epitopes were reduced by 20% and 33%, respectively, as compared to gluten digested in control mice. Killing of R. aeria bacteria in ethanol did not abolish enzyme activity associated with the bacteria. The gluten degrading enzyme was identified as BAV86562.1, here identified as a member of the subtilisin family. Conclusion: This study shows the potential of R. aeria to be used as a first probiotic for gluten digestion in vivo, either as live or dead bacteria, or, alternatively, for using the purified R. aeria enzyme, to benefit the gluten-intolerant patient population. Full article

(This article belongs to the Special Issue Grain Intake and Human Health)

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10 pages, 415 KiB

Open AccessArticle

Quality-of-Life Evaluation in Coeliac Patients on a Gluten-Free Diet

by Ilaria Marsilio, Cristina Canova, Anna D’Odorico, Matteo Ghisa, Letizia Zingone, Greta Lorenzon, Edoardo Vincenzo Savarino and Fabiana Zingone

Nutrients 2020, 12(10), 2981; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12102981 - 29 Sep 2020

Cited by 17 | Viewed by 3117

Abstract

The treatment for coeliac disease (CD) has a considerable psychological impact on patients, which may vary depending on subjects and clinical characteristics. The aim of this study was to describe the quality of life (QoL) in CD patients during follow-up, evaluating which factors can influence it. Patients with CD who consecutively visited the outpatient clinic of CD Unit of the University Hospital of Padua from January to September 2019 were enrolled. Demographics and clinical information were collected, and all patients were asked to answer the CD-QoL and Biagi’s validated questionnaires. Student’s t-test and chi-square test were used to compare the continuous and categorical variables, respectively. One hundred patients were enrolled (86 females, mean age at test ± SD: 39.73 ± 13.51; mean age at diagnosis ± SD: 33.09 ± 12.92), with 61% of them having been diagnosed with CD within the previous 5 years. At the time of diagnosis, 43 CD patients reported classical CD presentation, 32 non-classical features, 16 only anaemia and 9 were asymptomatic. The mean CD-QoL value was overall high (80.54 ± 11.91). We found that the “health concerns” subscale score was significantly lower in subjects aged more than 35 years compared to younger subjects (p = 0.03). We also observed that the CD-QoL score in gluten-free diet (GFD)-adherent patients tended to be higher compared to subjects who were non-compliant, with a significantly higher percentage of patients with low score for the “dysphoria” subscale (p = 0.05). This study showed an overall good QoL in subjects on a GFD. However, subjects older and non-compliant to GFD appear to experience more health concerns and suffer from dysphoria, respectively. Full article

(This article belongs to the Special Issue Grain Intake and Human Health)

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7 pages, 234 KiB

Open AccessArticle

A Survey on Nutritional Knowledge in Coeliac Disease Compared to Inflammatory Bowel Diseases Patients and Healthy Subjects

by Ilaria Marsilio, Edoardo Vincenzo Savarino, Brigida Barberio, Greta Lorenzon, Daria Maniero, Linda Cingolani, Anna D’Odorico, Renata D’Incà and Fabiana Zingone

Nutrients 2020, 12(4), 1110; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12041110 - 16 Apr 2020

Cited by 5 | Viewed by 2184

Abstract

Background and aim: Nutritional deficiencies are frequent in coeliac disease (CeD), mostly because of the nutritional deficits in gluten-free foods and because of wrong behaviors. We aimed to investigate the level of nutritional knowledge in a cohort of CeD patients in comparison with patients with inflammatory bowel disease (IBD) and healthy subjects. Materials and methods: We consecutively recruited CeD patients and matched-sex and -age IBD patients between April and December 2019 at the University Hospital of Padua outpatient clinic. Healthy subjects were also recruited from family and friends of the hospital staff. The CeD patients were asymptomatic on a gluten-free diet, whereas the IBD patients were in remission. All of the subjects completed the Moynihan validated questionnaire to measure their nutritional knowledge. Results: We included 96 CeD patients, 96 IBD patients, and 65 healthy controls. We found that CeD patients were less aware of nutritional recommendations compared with healthy subjects (HS), and were less able to identify nutrient sources compared with IBD patients and to choose healthy food compared with both groups. The Moynihan questionnaire mean total score was not significantly different between CeD and IBD groups (mean 22.5 ± 2.3 for CeD, 22.0 ± 2.2 for IBD), while it was statistically significantly worse in CeD compared with healthy subjects (mean 21.2 ± 2.3 for HS, p = 0.001). Conclusions: CeD patients tend to focus their diet on gluten avoidance, while IBD patients tend to follow a healthier diet, probably because they believe that diet plays a major role in regulating inflammation and, therefore, their symptoms. A dietitian consultation at CeD diagnosis is recommended. Full article

(This article belongs to the Special Issue Grain Intake and Human Health)

11 pages, 420 KiB

Open AccessArticle

25-Hydroxyvitamin D, 1,25-Dihydroxyvitamin D, and Peripheral Bone Densitometry in Adults with Celiac Disease

by Carolina Ciacci, Giancarlo Bilancio, Ilaria Russo, Paola Iovino, Pierpaolo Cavallo, Antonella Santonicola, Cristina Bucci, Massimo Cirillo and Fabiana Zingone

Nutrients 2020, 12(4), 929; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12040929 - 27 Mar 2020

Cited by 19 | Viewed by 3070

Abstract

Background: Adults with celiac disease (CeD) show low bone mineral density (BMD) and high fracture risk. CeD guidelines suggest measurements of serum minerals and vitamin D. However, studies on vitamin levels in CeD patients are contradictory. Aim: To investigate in CeD, 25-hydroxy-vitamin D [25(OH)D], 1,25-dihydroxy-vitamin D [1,25(OH)2D], and related analytes and to evaluate their relationships to peripheral BMD as assessed by peripheral quantitative computed tomography (pQCT). Methods: Gluten-free diet (GFD)-treated, and untreated adult CeD patients naïve to vitamin D and calcium supplementation underwent measurements of serum 25(OH)D, 1,25(OH)2D, parathyroid hormone (PTH), total calcium, phosphate, and of radius BMD by pQCT. Results: Complete data were collected in 105 patients for lab tests and 87 patients for BMD. For lab tests, untreated CeD differed from treated CeD for 22.0% lower serum 25(OH)D (p = 0.023), 42.5% higher serum PTH (p < 0.001), and 13.0% higher serum 1,25(OH)2D (p = 0.029) in the presence of similar serum calcium and phosphorus (p > 0.35). For BMD, untreated CeD differed from treated CeD for lower diaphyseal cortical BMD (1133 and 1157 mg/cm³, p = 0.004) but not for distal BMD (total, trabecular, and subcortical, p > 0.13). Independent correlates of diaphyseal cortical BMD were GFD treatment and body mass index (p < 0.05). Conclusions: Data indicated that, compared to CeD patients on a gluten-free diet, untreated adult CeD patients at diagnosis had lower 25(OH)D, higher PTH, and higher 1,25(OH)₂D in the absence of difference in serum calcium and phosphorus. 25(OH)D and 1,25(OH)₂D, even below the normal range, were not associated with BMD. Our findings do not support the use of vitamin D supplementation for all CeD adults. Full article

(This article belongs to the Special Issue Grain Intake and Human Health)

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10 pages, 397 KiB

Open AccessArticle

Adherence and Effects Derived from FODMAP Diet on Irritable Bowel Syndrome: A Real Life Evaluation of a Large Follow-Up Observation

by Antonietta Gerarda Gravina, Marcello Dallio, Mario Romeo, Antonietta Di Somma, Gaetano Cotticelli, Carmelina Loguercio and Alessandro Federico

Nutrients 2020, 12(4), 928; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12040928 - 27 Mar 2020

Cited by 21 | Viewed by 6683

Abstract

Introduction: Irritable bowel syndrome represents one of the most difficult gastroenterological diseases to treat, that usually induces the patients to follow different drug therapies, often not useful in symptom control. In this scenario low FODMAP diet could have positive effects in patients with irritable bowel syndrome, even because this type of diet regimen is characterized by a low gluten amount due to the exclusion of cereals. Methods: We enrolled 120 patients with irritable bowel syndrome, according to the Rome IV criteria, who were referred to Hepatogastroenterology Division of the University of Campania L. Vanvitelli from June to December 2018. They underwent a low FODMAP diet for six weeks, followed by a gradual weekly reintroduction of every category of food for three months. The patients had a follow-up evaluation for six months after the end of food reintroduction period. We measured abdominal pain with subjective numerical scale from 0 to 10. We evaluated other gastrointestinal symptoms with a questionnaire about symptoms of lower digestive tract, evaluating their frequency and intensity. We also evaluated the impact of irritable bowel syndrome on daily life with neurological bowel dysfunction score. Results: We obtained a good patient-adherence to diet and a statistically significant decrease of abdominal pain, bloating, flatulence, diarrhea, constipation, and neurological bowel dysfunction score (p < 0.001) at the end of the diet. These results remained constant in the follow-up period. Conclusions: We recommend the use of a low FODMAP diet regimen in patients with irritable bowel syndrome in order to control the symptoms and improve the quality of life. Full article

(This article belongs to the Special Issue Grain Intake and Human Health)

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10 pages, 371 KiB

Open AccessArticle

Prospective Association between Whole Grain Consumption and Hypertension: The Furukawa Nutrition and Health Study

by Ikuko Kashino, Masafumi Eguchi, Takako Miki, Takeshi Kochi, Akiko Nanri, Isamu Kabe and Tetsuya Mizoue

Nutrients 2020, 12(4), 902; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12040902 - 26 Mar 2020

Cited by 18 | Viewed by 5666

Abstract

Hypertension has become a major public health issue worldwide. Whole grains contain higher levels and a broader range of nutrients with potential health benefits and may decrease the risk of hypertension. However, no prospective studies have investigated this association in the high-income Asia Pacific region, which has the lowest whole grain intake worldwide. Thus, we examined the prospective association between whole grain consumption and the development of hypertension in Japan. Participants included 944 working Japanese adults aged 19–68 years who had no hypertension at baseline and completed a 3-year follow-up survey. Whole grain consumption was assessed via a self-administered dietary questionnaire. Multivariate logistic regression analysis was carried out to examine the association between whole grain consumption and hypertension, adjusting for potential confounding factors, such as sociodemographic, lifestyle, dietary, and occupational characteristics. After 3 years, 9.4% (86 cases) of the study participants had developed hypertension. More frequent whole grain consumption, classified as an intake frequency of “sometimes or always”, was associated with lower odds of hypertension (multivariate-adjusted odds ratio: 0.36; 95% confidence interval: 0.16–0.83; p for trend = 0.04) compared with no consumption. Consuming more whole grains may decrease the risk of developing hypertension. Full article

(This article belongs to the Special Issue Grain Intake and Human Health)

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Review

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17 pages, 759 KiB

Open AccessReview

Probiotics, Prebiotics and Other Dietary Supplements for Gut Microbiota Modulation in Celiac Disease Patients

by Giovanni Marasco, Giovanna Grazia Cirota, Benedetta Rossini, Lisa Lungaro, Anna Rita Di Biase, Antonio Colecchia, Umberto Volta, Roberto De Giorgio, Davide Festi and Giacomo Caio

Nutrients 2020, 12(9), 2674; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12092674 - 02 Sep 2020

Cited by 43 | Viewed by 7802

Abstract

To date, the only available treatment for celiac disease (CD) patients is a life-lasting gluten-free diet (GFD). Lack of adherence to the GFD leads to a significant risk of adverse health consequences. Food cross-contamination, nutritional imbalances, and persistent gastrointestinal symptoms are the main concerns related to GFD. Moreover, despite rigid compliance to GFD, patients struggle in achieving a full restoring of the gut microbiota, which plays a role in the nutritive compounds processing, and absorption. Pivotal studies on the supplementation of GFD with probiotics, such as Bifidobacterium and Lactobacilli, reported a potential to restore gut microbiota composition and to pre-digest gluten in the intestinal lumen, reducing the inflammation associated with gluten intake, the intestinal permeability, and the cytokine and antibody production. These findings could explain an improvement in symptoms and quality of life in patients treated with GFD and probiotics. On the other hand, the inclusion of prebiotics in GFD could also be easy to administer and cost-effective as an adjunctive treatment for CD, having the power to stimulate the growth of potentially health-promoting bacteria strains. However, evidence regarding the use of prebiotics and probiotics in patients with CD is still insufficient to justify their use in clinical practice. Full article

(This article belongs to the Special Issue Grain Intake and Human Health)

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15 pages, 1514 KiB

Open AccessReview

Gluten Degrading Enzymes for Treatment of Celiac Disease

by Guoxian Wei, Eva J. Helmerhorst, Ghassan Darwish, Gabriel Blumenkranz and Detlef Schuppan

Nutrients 2020, 12(7), 2095; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12072095 - 15 Jul 2020

Cited by 47 | Viewed by 13765

Abstract

Celiac disease (CeD) affects about 1% of most world populations. It presents a wide spectrum of clinical manifestations, ranging from minor symptoms to mild or severe malabsorption, and it may be associated with a wide variety of autoimmune diseases. CeD is triggered and maintained by the ingestion of gluten proteins from wheat and related grains. Gluten peptides that resist gastrointestinal digestion are antigenically presented to gluten specific T cells in the intestinal mucosa via HLA-DQ2 or HLA-DQ8, the necessary genetic predisposition for CeD. To date, there is no effective or approved treatment for CeD other than a strict adherence to a gluten-free diet, which is difficult to maintain in professional or social environments. Moreover, many patients with CeD have active disease despite diet adherence due to a high sensitivity to traces of gluten. Therefore, safe pharmacological treatments that complement the gluten-free diet are urgently needed. Oral enzyme therapy, employing gluten-degrading enzymes, is a promising therapeutic approach. A prerequisite is that such enzymes are active under gastro-duodenal conditions, quickly neutralize the T cell activating gluten peptides and are safe for human consumption. Several enzymes including prolyl endopeptidases, cysteine proteases and subtilisins can cleave the human digestion-resistant gluten peptides in vitro and in vivo. Examples are several prolyl endopeptidases from bacterial sources, subtilisins from Rothia bacteria that are natural oral colonizers and synthetic enzymes with optimized gluten-degrading activities. Without exception, these enzymes must cleave the otherwise unusual glutamine and proline-rich domains characteristic of antigenic gluten peptides. Moreover, they should be stable and active in both the acidic environment of the stomach and under near neutral pH in the duodenum. This review focuses on those enzymes that have been characterized and evaluated for the treatment of CeD, discussing their origin and activities, their clinical evaluation and challenges for therapeutic application. Novel developments include strategies like enteric coating and genetic modification to increase enzyme stability in the digestive tract. Full article

(This article belongs to the Special Issue Grain Intake and Human Health)

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18 pages, 990 KiB

Open AccessReview

Pitfalls in the Diagnosis of Coeliac Disease and Gluten-Related Disorders

by Annalisa Schiepatti, Jessica Savioli, Marta Vernero, Federica Borrelli de Andreis, Luca Perfetti, Antonio Meriggi and Federico Biagi

Nutrients 2020, 12(6), 1711; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12061711 - 07 Jun 2020

Cited by 21 | Viewed by 4861

Abstract

The spectrum of gluten-related disorders (GRD) has emerged as a relevant phenomenon possibly impacting on health care procedures and costs worldwide. Current classification of GRD is mainly based on their pathophysiology, and the following categories can be distinguished: immune-mediated disorders that include coeliac disease (CD), dermatitis herpetiformis (DH), and gluten ataxia (GA); allergic reactions such as wheat allergy (WA); and non-coeliac gluten sensitivity (NCGS), a condition characterized by both gastrointestinal and extra-intestinal symptoms subjectively believed to be induced by the ingestion of gluten/wheat that has recently gained popularity. Although CD, DH, and WA are well-defined clinical entities, whose diagnosis is based on specific diagnostic criteria, a diagnosis of NCGS may on the contrary be considered only after the exclusion of other organic disorders. Neither allergic nor autoimmune mechanisms have been found to be involved in NCGS. Mistakes in the diagnosis of GRD are still a relevant clinical problem that may result in overtreatment of patients being unnecessary started on a gluten-free diet and waste of health-care resources. On the basis of our clinical experience and literature, we aim to identify the main pitfalls in the diagnosis of CD and its complications, DH, and WA. We provide a practical methodological approach to guide clinicians on how to recognize and avoid them. Full article

(This article belongs to the Special Issue Grain Intake and Human Health)

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