Cereal-based gluten-free food: how to riconcile nutritional and technological properties of wheat proteins with safety for celiac disease patients

The gluten-free diet is, to date, the only efficacious treatment for patients with Celiac Disease. In recent years, the impressive rise of Celiac Disease incidence, dramatically prompted changes in the dietary habit of an increasingly large population, with a rise in demand of gluten-free products. The formulation of gluten-free bakery products presents a formidable challenge to cereal technologists. As wheat gluten contributes to the formation of a strong protein network, that confers visco-elasticity to the dough and allows the wheat flour to be processed into a wide range of products, the preparation of cereal-based gluten-free products is a process somehow difficult process. This review focuses on nutritional and technological quality of products made with gluten-free cereals available on the market. The possibility of using flour from naturally low toxic ancient wheat species or detoxified wheat for the diet of celiacs is also discussed

Temperature-treated gluten proteins in Gluten-Friendly™ bread increase mucus production and gut-barrier function in human intestinal goblet cells

Abstract The effects of a control bread (CB) and a Gluten Friendly™ bread (GFB) on intestinal epithelium mucus production and barrier function in healthy human mucus-secreting goblet cells HT-29-16E were investigated. Mucus production in cells exposed to digested breads (GFB and CB) was preliminarily investigated using staining techniques, Periodic Acid-Schiff (PAS) and Alcian blue (AB), and MUC2 and MUC3 were also quantified by ELISA assay. The barrier function of the cell monolayer was evaluated by trans-epithelial electrical resistance (TEER) measurements. GFB increased the secretion of mucins, expressed as the level of PAS and AB staining in comparison with the control. MUC3 levels were not affected, whereas higher MUC2 concentrations (

A Preliminary Report on the Use of the Design of Experiments for the Production of a Synbiotic Yogurt Supplemented With Gluten FriendlyTM Flour and Bifidobacterium infantis

The main goal of this paper was to design a synbiotic yogurt containing Bifidobacterium infantis and Gluten Friendly FlourTM; the proposed approach relies upon milk fermentation through the classical starter of yogurt (Lactobacillus delbrueckii subsp. bulgaricus and Streptococcus thermophilus) to avoid a strong production of acetic acid by bifidobacterial and inoculum of B. infantis after the fermentation. The research was divided in 3 steps. The aim of the first step was the optimization of fermentation kinetic by L. delbureckii and S. thermophilus, by combining the amount of flour (either Gluten Friendly Flour-GF- or Control Flour-CF) in milk, temperature and inoculum level; the factors were combined through a mixture design. As a result of this step, the best combination was pointed out: flour at 2.5 g/l; L. delbrueckii subsp. bulgaricus at 6 log cfu/ml; temperature at 37–40°C. The goal of the second step was to study the effect of flour (2.5 g/l) on the viability of B. infantis. GF prolonged the viability of the probiotic for 14 days. In the last step, a synbiotic yogurt, supplemented with GF and fermented with L. delbureckii and S. thermophilus, and then inoculated with B. infantis, was produced. The product was stored at 8 and 15°C. A positive effect of GF was found at 15°C, with B. infantis at 7.0 log cfu/g in GF sample and 5.5.5.7 log cfu/g in CF sample

An In Vitro Fermentation Study on the Effects of Gluten FriendlyTM Bread on Microbiota and Short Chain Fatty Acids of Fecal Samples from Healthy and Celiac Subjects

Recently, an innovative gluten detoxification method called Gluten FriendlyTM (GF) has been developed. It induces structural modifications, which abolish the antigenic capacity of gluten and reduce the in vitro immunogenicity of the most common epitopes involved in celiac disease, without compromising the nutritional and technological properties. This study investigated the in vitro effects of GF bread (GFB) on the fecal microbiota from healthy and celiac individuals by a three-stage continuous fermentative system, which simulates the colon (vessel 1, proximal colon; vessel 2, transverse colon; and vessel 3, distal colon), as well as on the production of short chain fatty acids (SCFA, acetate, propionate, butyrate). The system was fed with GFB and the changes in microbiota through fluorescence in situ hybridization and in SCFA content were assessed. GFB exerted beneficial modulations such as bifidogenic effects in each compartment of the model both with healthy- and celiac-derived samples, as well as growth in Clostridium clusters XIVa+b in celiac-derived samples. Furthermore, increased levels of acetic acid were found in vessel 1 inoculated with the fecal microbiota of healthy individuals, as well as acetic and propionic in vessel 1 and 2 with celiac-derived samples. In addition, the use of multivariate approaches showed that the supplementation of GFB could result in a different modulation of the fecal microbiota and SCFA, as a function of initial equilibrium

Impact of gluten-friendly bread on the metabolism and function of in vitro gut microbiota in healthy human and coeliac subjects

The main aim of this paper was to assess the in vitro response of healthy and coeliac human faecal microbiota to gluten-friendly bread (GFB). Thus, GFB and control bread (CB) were fermented with faecal microbiota in pH-controlled batch cultures. The effects on the major groups of microbiota were monitored over 48 h incubations by fluorescence in situ hybridisation. Short-chain fatty acids (SCFAs) were measured by high-performance liquid chromatography (HPLC). Furthermore, the death kinetics of Lactobacillus acidophilus, Bifidobacterium animalis subsp. lactis, Staphylococcus aureus, and Salmonella Typhimurium in a saline solution supplemented with GFB or CB were also assessed. The experiments in saline solution pinpointed that GFB prolonged the survival of L. acidophilus and exerted an antibacterial effect towards S. aureus and S. Typhimurium. Moreover, GFB modulated the intestinal microbiota in vitro, promoting changes in lactobacilli and bifidobacteria members in coeliac subjects. A final multivariate approach combining both viable counts and metabolites suggested that GFB could beneficially modulate the coeliac gut microbiome; however, human studies are needed to prove its efficacy

The Impact of Gluten Friendly Flour on the Functionality of an Active Drink: Viability of Lactobacillus acidophilus in a Fermented Milk

The Gluten FriendlyTM Technology is an innovative method that induces structural changes in gluten proteins. In this paper a synbiotic fermented milk, containing Lactobacillus acidophilus La-5 and Gluten Friendly Flour (GFF), was proposed. A mixture design was used to combine flour, temperature and probiotic to study the effects of these variables on the acidification. The experiments were done on both GFF and control flour (CF). Thus, the following conditions were chosen to produce the fermented milk: L. acidophilus at 6.5 log cfu/ml; flour at 2.5 g/l; temperature at 37°C. Then, the fermented milk was produced and stored at 4°C for 90 days. The most important result was the positive effect of GFF on the viability of the probiotic, with a prolongation of the shoulder length to 20 days (12–13 days in the control). Moreover, GFF did not act on the sensory scores and on the physico-chemical parameters

Similar effectiveness of dapagliflozin and GLP-1 receptor agonists concerning combined endpoints in routine clinical practice: A multicentre retrospective study

Aims According to cardiovascular outcome trials, some sodium-glucose contransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) are recommended for secondary cardiovascular prevention in type 2 diabetes (T2D). In this real-world study, we compared the simultaneous reductions in HbA1c, body weight and systolic blood pressure after initiation of dapagliflozin or GLP-1RA as second or a more advanced line of therapy. Materials and methods DARWIN-T2D was a retrospective multi-centre study conducted at diabetes specialist clinics in Italy that compared T2D patients who initiated dapagliflozin or GLP-1RA (exenatide once weekly or liraglutide). Data were collected at baseline and at the first follow-up visit after 3 to 12 months. The primary endpoint was the proportion of patients achieving a simultaneous reduction in HbA1c, body weight and systolic blood pressure. To reduce confounding, we used multivariable adjustment (MVA) or propensity score matching (PSM). Results Totals of 473 patients initiating dapagliflozin and 336 patients initiating GLP-1RA were included. The two groups differed in age, diabetes duration, HbA1c, weight and concomitant medications. The median follow-up was 6 months in both groups. Using MVA or PSM, the primary endpoint was observed in 30% to 32% of patients, with no difference between groups. Simultaneous reduction of HbA1c, BP and SBP by specific threshold, as well as achievement of final goals, did not differ between groups. GLP-1RA reduced HbA1c by 0.3% more than the reduction achieved with dapagliflozin. Conclusion In routine specialist care, initiation of dapagliflozin can be as effective as initiation of a GLP-1RA for attainment of combined risk factor goals

Healthy and pro-inflammatory gut ecology plays a crucial role in the digestion and tolerance of a novel Gluten Friendly™ bread in celiac subjects : Randomized, double blind, placebo control in vivo study

Gluten Friendly™ (GF) is a new gluten achieved through a physicochemical process applied to wheat kernels. The goal of this research was to assess the in vivo effects of Gluten Friendly™ bread on celiac gut mucosa and microbiota. In a double-blind placebo-controlled intervention study, 48 celiac disease (CD) patients were randomized into 3 groups to eat 100 g of bread daily, containing different doses (0; 3 g; 6 g) of GF for 12 weeks. The small-bowel morphology (VH/CrD), intraepithelial densities of CD3+, celiac serology, MUC2, CB1, gut permeability, proinflammatory cytokines, gluten in stools, symptoms, and gut microbial composition were assessed. All 48 CD subjects experienced no symptoms. K-means analysis evidenced celiac subjects clustering around unknown parameters independent of GF dosage: K1 35%; K2 30%; K3 35%. VH/CrD significantly decreased in K1 and K2. VH/CrD did not correlate with IEL increase in K2. 33-mer was not detected in 47% and 73% of patients in both K1 and K2, respectively. VH/CrD and IEL did not change significantly and strongly correlated with the absence of 33-mer in K3. Inflammation and VH/CrD decrease are strongly related with the presence of proinflammatory species at the baseline. A boost in probiotic, butyrate-producing genera, is strongly related with GF tolerance at the end of the trial. Our research suggests that a healthy and proinflammatory ecology could play a crucial role in the digestion and tolerance of the new gluten molecule in celiac subjects. However, GF can be completely digested by gut microbiota of CD subjects and shapes it toward gut homeostasis by boosting healthy butyrate-producing populations. The clinical trial registry number is NCT03137862 (https://clinicaltrials.gov).publishedVersionPeer reviewe

Prevalence of hepatic steatosis in patients with type 2 diabetes and response to glucose-lowering treatments. A multicenter retrospective study in Italian specialist care

Type 2 diabetes (T2D) is a risk factor for metabolic dysfunction-associated fatty liver disease (MAFLD), which is becoming the commonest cause of chronic liver disease worldwide. We estimated MAFLD prevalence among patients with T2D using the hepatic steatosis index (HSI) and validated it against liver ultrasound. We also examined whether glucose-lowering medications (GLM) beneficially affected HSI