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      Nutritional inadequacies of the gluten-free diet in both recently-diagnosed and long-term patients with coeliac disease

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      Journal of Human Nutrition and Dietetics

      Wiley

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          Abstract

          Life-long gluten-free diet (GFD) is the only recognised treatment for coeliac disease (CD). The present study aimed to determine the nutritional adequacy of the 'no detectable gluten' diet. Seven-day prospective food intake was assessed in 55 patients who were adherent to a GFD for more than 2 years and in 50 newly-diagnosed age- and sex-matched patients (18-71 years, 24% male) studied prospectively over 12 months on GFD. Historical precoeliac intake was also assessed in the latter group. Intake was compared with Australian Nutritional Recommendations and the Australian population data. Nutritional intake was similar between groups. Of macronutrients, only starch intake fell over 12 months (26% to 23%, P = 0.04). Fibre intake was inadequate for all except in diet-experienced men. More than one in 10 of both newly-diagnosed and experienced women had inadequate thiamin, folate, vitamin A, magnesium, calcium and iron intakes. More than one in 10 newly-diagnosed men had inadequate thiamin, folate, magnesium, calcium and zinc intakes. Inadequate intake did not relate to nutrient density of the GFD. Inadequacies of folate, calcium, iron and zinc occurred more frequently than in the Australian population. The frequency of inadequacies was similar pre- and post-diagnosis, except for thiamin and vitamin A, where inadequacies were more common after GFD implementation. Dietary intake patterns at 12 months on a GFD are similar to longer-term intake. Dietary inadequacies are common and may relate to habitual poor food choices in addition to inherent deficiencies in the GFD. Dietary education should also address the achievement of adequate micronutrient intake. Fortification of GF foods also need to be considered. © 2012 The Authors Journal of Human Nutrition and Dietetics © 2012 The British Dietetic Association Ltd.

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          Most cited references 37

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          Revised criteria for diagnosis of coeliac disease. Report of Working Group of European Society of Paediatric Gastroenterology and Nutrition.

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            Gluten, major histocompatibility complex, and the small intestine

             Michael Marsh (1992)
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              Increased consumption of refined carbohydrates and the epidemic of type 2 diabetes in the United States: an ecologic assessment.

              Type 2 diabetes is an epidemic that is affecting an ever-increasing proportion of the US population. Although consumption of refined carbohydrates has increased and is thought to be related to the increased risk of type 2 diabetes, the ecologic effect of changes in the quality of carbohydrates in the food supply on the risk of type 2 diabetes remains to be quantified. The objective was to examine the correlation between consumption of refined carbohydrates and the prevalence of type 2 diabetes in the United States. In this ecologic correlation study, the per capita nutrient consumption in the United States between 1909 and 1997 obtained from the US Department of Agriculture was compared with the prevalence of type 2 diabetes obtained from the Centers for Disease Control and Prevention. In a univariate analysis, a significant correlation with diabetes prevalence was observed for dietary fat (r = 0.84, P < 0.001), carbohydrate (r = 0.55, P < 0.001), protein (r = 0.71, P < 0.001), fiber (r = 0.16, P = 0.03), corn syrup (r = 0.83, P < 0.001), and total energy (r = 0.75, P < 0.001) intakes. In a multivariate nutrient-density model, in which total energy intake was accounted for, corn syrup was positively associated with the prevalence of type 2 diabetes (beta = 0.0132, P = 0.038). Fiber (beta = -13.86, P < 0.01) was negatively associated with the prevalence of type 2 diabetes. In contrast, protein (P = 0.084) and fat (P = 0.79) were not associated with the prevalence of type 2 diabetes when total energy was controlled for. Increasing intakes of refined carbohydrate (corn syrup) concomitant with decreasing intakes of fiber paralleled the upward trend in the prevalence of type 2 diabetes observed in the United States during the 20th century.
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                Author and article information

                Journal
                JHN
                Journal of Human Nutrition and Dietetics
                J Hum Nutr Diet
                Wiley
                09523871
                August 2013
                August 2013
                November 30 2012
                : 26
                : 4
                : 349-358
                Affiliations
                [1 ]Department of Gastroenterology and Central Clinical School; Monash University; Alfred Hospital; Melbourne Victoria Australia
                Article
                10.1111/jhn.12018
                23198728
                © 2012

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