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Nutritional education, a must for coeliac patients

The GLUTEN3S group of the UPV/EHU-University of the Basque Country will be adding didactic material to its 'GlutenFreeDiet' software to improve the life quality of this group

  • Research

First publication date: 13/04/2022

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Gesala Perez-Junkera. Photo: Nuria Gonzalez.UPV/EHU

The UPV/EHU’s GLUTEN3S research group is dedicated to research relating to food-based gluten, balancing the gluten-free diet, as well as educating the coeliac and general population, with the aim of improving the life quality of this group. After years of work on gluten detection, the GLUTEN3S group has become aware of the need to assess the gluten-free diet of these patients more accurately; this is because the usual food composition databases do not include the composition of specific gluten-free foods, which leads to inaccuracies when assessing diets based on the information that dietitians receive from their patients.

In a bid to facilitate this task, the team designed software ('GlutenFreeDiet') for the purpose of assessing gluten-free diets by using a single database containing nutritional information on more than 700 specific gluten-free foods of more than 50 commercial brands, in addition to the usual information on conventional foods. Thanks to this database, the software, which provides two user profiles (individual and professional), makes it possible to assess a diet of a specific patient in a didactic and visual way; that way, the foods widely consumed in the diet of these patients can be selected.

The GLUTEN3S team has recently published an article in the journal 'Sensors' in which they apply this software to a programme involving coeliac patients, and provide a practical overview of its use. 27 adults and 31 children who had recently been diagnosed with coeliac disease participated in the study and they were followed up by three visits: when diagnosed, three months later and twelve months later. Collaboration with the paediatric gastroenterology services of University Hospital Cruces and University Hospital Donostia, as well as with the Association of Coeliacs and Gluten-sensitive Individuals of Madrid (ACSG) enabled this work to be carried out. {0>El trabajo pudo llevarse a cabo gracias a la colaboración con los servicios de gastroenterología pediátrica del hospital de Cruces y el hospital Donostia, así como a la Asociación de Celiacos y Sensibles al Gluten de Madrid.<}0{>{0>En las visitas se tomaron datos sobre el estado nutricional, perfil dietético y presencia de síntomas mediante cuestionarios, datos que los dietistas introducían y analizaban en el software ‘GlutenFreeDiet’.<}0{>During the visits, data on nutritional status, dietary profile and presence of symptoms were collected through questionnaires, which were incorporated by dietitians into the 'GlutenFreeDiet' software and analysed.<0} The participants were informed about the status of their diet through written reports sent by email.

Study  findings

"The study revealed that these individuals consumed low quantities of cereals, fruit and vegetables and high quantities of meat," explained Gesala Perez-Junkera, a researcher in the group. It was also possible to detect that the consumption of specific gluten-free products and ultra-processed products fell in adults after one year keeping to the gluten-free diet. "While the symptoms recorded decreased 3 months later, they increased again 12 months later, probably indicating a relaxation in preventive measures, and there was no change in any dietary parameter other than the reduced consumption of ultra-processed products in adults by the end of the programme," the researcher added. So, although the software proved very useful in managing the gluten-free diet, the programme was not effective enough to bring about significant changes in the balance of the patients' diets.

So, the team concluded that although the software is a very interesting tool, when it comes to designing and assessing gluten-free diets, it needs to be complemented or include modules with educational and informative material that can impact on knowledge and eating behaviour. "With these modules, a more complete programme could be set up together with face-to-face sessions involving direct interaction with patients; that would increase the support which, in turn, would increase adherence to the study and to the gluten-free diet itself," the research group said.

The team is currently running a project with this new perspective in collaboration with hospitals in the Autonomous Community of the Basque Country, but without ruling out extending this participation to other hospitals and associations across Spain; the aim is to demonstrate the need and usefulness of nutritional education to improve the quality of care and life of these people, especially after diagnosis.

Gluten-free diet

Coeliac disease is a chronic autoimmune disorder of the small intestine affecting certain genetically predisposed individuals. The condition requires that a strict, lifelong gluten-free diet be followed; the reason is that, if a diet including gluten is continued, the evolution of the condition may become very serious and may lead to serious diseases such as intestinal lymphoma. However, it can also have a series of significant consequences that have a direct impact on the quality of life (diabetes, anaemia, osteoporosis, infertility, etc.).

In addition to being strictly gluten-free, a gluten-free diet should be followed in a similar way to other recommended diets, i.e. it should be balanced. This ensures the intake of all the nutrients necessary for optimal health. However, restrictive diets constitute an added difficulty when it comes to eating a balanced diet.

Cereals are an essential food group in the diet; they are at the base of the food pyramid and provide very important nutrients that are not easily obtained from other food groups while nutritional balance is maintained. In fact, many people with coeliac disease eliminate gluten in their diets by replacing cereal-based products by their gluten-free counterparts (bread, biscuits, cake and pastries, pasta, etc.). However, the composition of these products is not exactly the same as their counterparts, which may have a negative impact on the balance of the diet, as has been widely reported in the scientific literature.

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