Systematic Review and Dose-Response Meta-Analysis on the Relationship between Different Gluten Doses and Risk of Coeliac Disease Relapse

Abstract

Gluten proteins are known as immunological triggers for inflammation resulting in mucosal lesions in patients with coeliac disease (CD). Adherence to a strict gluten-free diet (GFD) is currently known as the only effective treatment for CD. In this study, we performed a systematic review and dose-response meta-analysis on data from previous studies to investigate the association between different gluten doses administered and the risk of CD relapse. Electronic databases were systematically searched to retrieve studies that investigated the response of CD patients to different amounts of gluten intake and evaluated the clinical, serologic, and/or histologic evidence to recognize disease relapse. Study-specific relative risks (RRs) were combined using a random effects model. A total of 440 identified published papers were screened, of which 7 records were selected following full-text reviewing and eligibility assessment for dose-response meta-analysis. According to our analysis, the risk of CD relapse is estimated to be 0.2% (RR: 1.002; 95% CI: 1.001 to 1.004) following the consumption of 6 mg gluten/day, which was increased to 7% (RR: 1.07; 95% CI: 1.03 to 1.10), 50% (RR: 1.50; 95% CI: 1.23 to 1.82), 80% (RR: 1.80; 95% CI: 1.36 to 2.38), and 100% (RR: 2.00; 95% CI: 1.43 to 2.78) by the daily intake of 150, 881, 1276, and 1505 mg gluten, respectively. Although good adherence to a GFD can adequately control CD-related symptoms, disease relapse might happen even with a very low dose of gluten, and the duration of exposure to gluten is also an important matter. The current literature has substantial limitations, such as relying on the data from just a few countries that were different in terms of the amount of gluten administered, the duration of the challenge, etc. Therefore, more randomized clinical trials using a standardized gluten challenge protocol are needed to confirm the findings of the present study.

Metabolite signature of human malignant thyroid tissue: A systematic review and meta‐analysis

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“…Next, bipartite network projection that is extensively used for compacting data about bipartite networks was obtained. 23 , 24 , 25 Network projection was employed to streamline bipartite networks by converting them into unipartite networks. This conversion aided in the more efficient analysis of the relationships within the data.…”

Celiac Disease: Risks of Cross-Contamination and Strategies for Gluten Removal in Food Environments

“…Rostami-Nejad et al [47] carried out a systematic review and meta-analysis in Iran and found that an intake of 6 ppm/day of gluten was accompanied by a 0.2% chance of CD recurrence, which increased to 1.8% with the consumption of 40 ppm/day of gluten, reaching 50% at the amount of 881 ppm and 100% at the amount of 1500 ppm of gluten per day. The duration of gluten ingestion also showed a positive relationship with CD recurrence, showing that exposure time is as important as quantity.…”

Gluten-Free Diet and Other Celiac Disease Therapies: Current Understanding and Emerging Strategies

“…Indeed, a study that analysed the gluten contamination of oats used in 12 important clinical studies showed how this contamination was related to the presence of symptoms in study patients, even if the estimated amount of gluten in the products did not seem to have an impact on the morphological outcome in treated patients [68]. Studies indicate a dose-dependent association between gluten intake and CD-relapse risk, ranging from 0.2% with 6 mg/day to 100% with 1.5 g/day of gluten [69]. However, to date, there are no consistent data that allow us to specifically quantify the impact that gluten contamination has on the course of a patient's disease.…”