The basic food basket (BFB), formed by the more economical products available, is used by less-affluent countries to establish the minimum daily food consumption to satisfy nutritional requirements in less-privileged individuals. There is no information about groups that depend on the BFB and in addition follow gluten-free diet (GF/BFB). We measured availability, cost, main ingredients and nutritional composition of GF/BFB. Data were collected in the area that was first in the social priority list in the capital city, matching BFB components with gluten-free equivalents (GF/BFB). GF/BFB characterized by being 42% less available, three times more costly (>500% higher for bread), with up to 69% lower protein content and with no fortifications, leaving at nutritional risk celiac individuals that depend on GF/BFB. Results raise concerns on the capacity of the GF/BFB to encourage adherence, maintain adequate nutritional status and quality of life in celiac patients.
INTRODUCCIÓNEl mercado mundial de los productos sin gluten ha tenido un aumento sin precedente en los últimos años (1). Entre las razones que explican este aumento está el aumento significativo que han tenido los problemas de salud relacionados con la ingesta de gluten (enfermedad celíaca) (EC) (2, 3), sensibilidad no celíaca al gluten (SNCG) (4-7), y alergia al trigo (AT) (6,8,9), además de un grupo creciente de personas aparentemente sanas que optan por una dieta sin gluten por considerarla más saludable. Revisaremos en qué consisten cada uno de estos cuadros y su relación con el gluten de la dieta, y comentaremos los alimentos sin gluten disponibles a nivel nacional. LAS PATOLOGÍAS QUE REQUIERENTRATAMIENTO CON DLG Enfermedad celíaca. Condición crónica autoinmune que resulta de la interacción de genes que aportan el riesgo, el gluten de la dieta (ambiente), el sistema inmune que actúa como efector, y la microbiota intestinal, cuyo rol aún está en estudio. En Chile la frecuencia de EC se estima en alrededor de 0,6-0,8% de la población (10); tiene manifestaciones clínicas muy variables, que incluyen síntomas digestivos y extra digestivos. Esta condición es la más estudiada y la que más aporta al Chil Nutr Vol. 43, Nº4, 2016 La dieta sin gluten y los alimentos libres de gluten conocimiento de lo que ocurre en el intestino delgado cuando se ingiere gluten. Su único tratamiento eficaz es la dieta libre de gluten (DLG) (3, 11), mantenida de manera estricta y por toda la vida (tabla 1). Aunque despiertan gran interés entre los celíacos, hasta ahora no hay opciones de tratamientos no dietarios (12). Por otro lado y salvo excepciones (casos refractarios), tampoco hay terapia medicamentosa. Rev Gluten-free diet and gluten-free foodsSensibilidad no celíaca al gluten. Aunque reconocida desde hace décadas (13), la descripción moderna tiene menos de cinco años (4, 6). De acuerdo a los consensos vigentes entre especialistas, se caracteriza por la aparición rápida de síntomas tras ingerir trigo/gluten, que pueden ser digestivos y/o extra digestivos. En los pacientes se demuestra ausencia de fenómenos alérgicos y autoinmunes, los auto anticuerpos medidos en sangre son negativos y las biopsias yeyunales son normales (lo cual de acuerdo al conocimiento actual descarta la EC) (4, 6,). Sin embargo, hay clara mejoría clínica en respuesta a la DLG, con desaparición de la sintomatología y rápida reaparición de ellos al realizar una contraprueba con gluten (4, 6). Se discute si se trata de una respuesta al gluten y/o a otras proteínas del trigo (14). Hasta ahora, el tratamiento consiste en eliminar o disminuir la ingesta de trigo hasta la desaparición de los síntomas (tabla 1). Tanto en Chile como
BackgroundGluten-free diet is the treatment of celiac disease and other gluten-related disorders and excludes wheat, rye, and barley, while oats inclusion/exclusion has long been a matter of debate. A logo or catchphrase indicating the gluten-free condition in a product is all the consumer relies on to accept the product as suitable for his/her treatment. The oat-based gluten-free products represents a small market, which may have changed, and become more limited during COVID-19 pandemic.ObjectiveTo assess gluten contamination in all labeled oat-based gluten-free local and imported products available in the market, comparing them to matched regular gluten containing counterparts. As a secondary objective, unconventional flours available in the same sale points were also assessed.ResultsThe search yielded 25 gluten-free labeled oat flours, rolled, and instant cereals, which were compared to 27 regular gluten containing equivalents. Gluten content was above the local (5 ppm) and the Codex Alimentarius cutoff (20 ppm) in 40 and 36% of the gluten-free labeled products, respectively. When all positive products were analyzed together, there were no differences in gluten content between labeled and unlabeled products. Locally produced products were more expensive, while rolled/instant oats were less contaminated than flours (p = 0.01). Precautionary labels advising presence of gluten as allergen was omitted in 37.0% of regular products. Only 33.3% of unconventional flours obtained from open markets and sold in bulk, were gluten contaminated.ConclusionOat-based gluten-free products are currently highly contaminated. It is urgent to regulate them and implement protocols that allow safe consumption of these products.
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