Gluten and FODMAPs Relationship with Mental Disorders: Systematic Review

Nowadays, gluten and FODMAP food components (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) are increasingly studied due to their possible relation with extraintestinal-associated conditions. In recent years, gluten-free diets (GFD) and low-FODMAP diets (LFD) are becoming more popular not only in order to avoid the food components that cause intolerances or allergies in some people, but also due to the direct influence of marketing movements or diet trends on feeding habits. Likewise, neurological and psychiatric diseases are currently of increasing importance in developed countries. For this reason, a bibliographic systematic review has been carried out to analyse whether there is a pathophysiological relationship between the dietary intake of gluten or FODMAPs with mental disorders. This review collects 13 clinical and randomized controlled trials, based on the PRISMA statement, which have been published in the last ten years. Based on these results, limiting or ruling out gluten or FODMAPs in the diet might be beneficial for symptoms such as depression, anxiety (7 out of 7 articles found any positive effect), or cognition deficiency (improvements in several cognition test measurements in one trial), and to a lesser extent for schizophrenia and the autism spectrum. Nevertheless, further studies are needed to obtain completely reliable conclusions.Silvia Matias is IKASIKER fellowships of the Education Department of the Basque Government. The GLUTEN3S research group is supported by a grant (GIU 18/78) from the University of the Basque Country, UPV/EHU

Gluten Assessment in Beers: Comparison by Different Commercial ELISA Kits and Evaluation of NIR Analysis as a Complementary Technique

Traditionally, beers are made with gluten-containing cereals. It is crucial to have rapid analytical methodologies that allow gluten content control of the beers for celiac consumers. We assess the content of gluten in 65 conventional and 41 gluten-free labeled beers commercialized in Europe and compare the results in a subgroup of 71 beers with three ELISA kits. This research allows gathering information on the potential complementary utility of NIR analysis applied to gluten analysis of gluten-free beers in terms of time saving. Results obtained with the ELISA technique identified competitive R5 to be the most sensitive in detecting the prolamins, by eliciting a higher number of beers containing gluten above 20 mg/kg. The gluten content in conventional beers tested increased with the presence of wheat as raw material and with the use of ale-type yeasts. By using competitive R5, 3 out of the 41 gluten-free labeled beers appeared to contain gluten above 20 mg/kg, and conversely, 15 out of 65 of the conventional beers showed a gluten content below this threshold. According to our approaches, NIR did not achieve a suitable correlation with ELISA results, neither for gluten quantification nor for discrimination, and therefore, it cannot be proposed as a complementary technique.This research was funded by the Associació SMAP—Celíacs Catalunya. The GLUTEN3S research group is supported by a grant (GIU 18/78) from the University of the Basque Country, UPV/EHU

Micronutrient Analysis of Gluten-Free Products: Their Low Content Is Not Involved in Gluten-Free Diet Imbalance in a Cohort of Celiac Children and Adolescent

Data about the nutritional composition of gluten-free products (GFP) are still limited. Most studies are based on ingredient and nutrition information described on the food label. However, analytical determination is considered the gold standard for compositional analysis of food. Micronutrient analytical content differences were observed in a selection of GF breads, flakes and pasta, when compared with their respective gluten-containing counterparts. In general terms, lower iron, piridoxin, riboflavin, thiamin, niacin, folate, manganese and vitamin B5 can be underlined. Variations in biotin and vitamin E content differed among groups. In order to clarify the potential contribution of the GFP to the gluten-free diet's (GFD) micronutrient shortages, analytical data were used to evaluate GFD in a cohort of celiac children and adolescent. Participants did not reach recommendations for vitamin A, vitamin E, folic acid, vitamin D, biotin, iodine, and copper. It does not seem that the lower micronutrient content of the analyzed GFP groups contributed to the micronutrient deficits detected in GFD in this cohort, whose diet was not balanced. Nevertheless, GFP fortification for folate and biotin is proposed to prevent the deficiencies observed in GFD, at least in the case of pediatric celiac disease.Idoia Larretxi is a fellowship of the University of the Basque Country, UPV/EHU. This research was supported by a grant from the Basque Government (Proyectos de Investigacion Focalizada Agricultura PA15/01) and a grant from the University of the Basque Country, UPV/EHU, (University-Society US15/06 and US18/15). The authors thank for technical and human support provided by SCAB from SGIker of UPV/EHU

FODMAP Intake in Spanish Population: Open Approach for Risk Assessment

Fermentable oligo-, di- and monosaccharides and polyols’ (FODMAP) were related with intestinal complications. The present study aimed to determine the FODMAP consumption of Spanish children, adolescents and adults, analyzing the real FODMAP risk of foods, and to set an open methodology for the measurement of this intake in other regions as well as nutrient intake assurance. Total fructan analysis was performed analytically in eighty-seven food samples. Daily intake of FODMAPs, fiber and micronutrients was calculated by combining the food composition for selected fermentable carbohydrates with the national food consumption stratified by age in an open software. Spanish child and adolescent total FODMAP consumption was settled as 33.4 ± 92.4 and 27.3 ± 69.0 g/day, respectively. Both intakes were higher than that of the adult population (21.4 ± 56.7 g/day). The most important food sources of lactose, excess of fructose and total fructan, considering their content and dietary intake were different between age groups. The contribution of these foods to dietary calcium and fiber and the consequent risk of deficiency if they are withdrawn was highlighted. We demonstrated the relevance of stratifying the total FODMAP intake by age. An open approach for FODMAP intake quantification and nutrient control was provided.Maialen Vazquez-Polo and Gesala Perez-Junkera are IKASIKER fellowships of the Education Department of the Basque Government. This research was supported by a grant (University-Society US18/15 and GIU 18/78) from the University of the Basque Country, UPV/EHU

Self-management in heart failure using mHealth: A content validation.

AIM: To describe the development of a mobile health application -mICardiApp- designed by a multidisciplinary professional team and patients with heart failure and to evaluate its content validity. METHODS: Critical reviews of the literature, semi-structured interviews with patients, and user stories guided the development of the content of the mobile application. These contents were refined and validated through a modified Delphi process. An expert panel of healthcare and social care professionals together with patients and academics evaluated the content through two content validity indicators, relevance, and adequacy, and provided narrative feedback. The content validity of the app and each screen was determined by calculating the Content Validity Index (CVI). Similarly, the Adequacy Index (AI) was analyzed. RESULTS: The developed app is composed by 8 topics: (1) available resources, (2) cardiac rehabilitation, (3) control of signs and symptoms, (4) emotional support, (5) learning and having fun, (6) medication, (7) nutrition, and (8) physical activity. The results demonstrated high CVI of the screens and the full app. 57 of the 59 screens in the app reached an excellent CVI≥0.70 for both relevance and adequacy, except for 2 screens. The CVI Average Method of the app was 0.851. CONCLUSIONS: mICardiApp is presented as an application to improve health literacy and self-management of patients with multimorbidity and heart failure, with proven validation

NURSES' evidence-based practice competence and hospital practice environment after specific training under the best practice spotlight organization® programme. A cross sectional study

Producción CientíficaThe aim of the study was to evaluate the impact of a specific training within the framework of the Best Practice Spotlight Organization® programme, on nurses' evidence-based practice competence and the practice environment in two hospitals. The study sample were 204 nurses working at medical and surgical inpatient units at two hospitals involved in the Best Practice Spotlight Organization® programme. They were classified into two groups: those who had received specific training within the framework of the programme, called trained-champions (n = 66), and those who had not yet received training, control group (n = 138). The trained-champions exhibited better evidence-based practice competence values than the control group in all dimensions (p < 0.001), with a higher difference in means in the “Utilisation” dimension (−0.80; CI:-0.99,-0.60) and the “Knowledge” dimension (−0.63; CI:-0.88,-0.38). The conclusions are that Specific EBP training within the framework of the Best Practice Spotlight Organization® programme has succeeded in nurses (trained-champions) obtaining better EBP competence than others without this training

Performance of Apple Pomace for Gluten-Free Bread Manufacture: Effect on Physicochemical Characteristics and Nutritional Value

Apple pomace has been proposed as a quality enhancer for gluten-free bread, but its composition and physicochemical features differ significantly depending on the apple cultivar. The objective of this article was to characterize apple pomace powder (APP) from certain varieties from the Basque Country and to study the feasibility of adding it to gluten-free bread, focusing on physicochemical and nutritional aspects. APP was obtained by washing, drying and grinding, and it was added at 0, 5, 6 and 8%, together with other ingredients, such as gluten-free flours, corn starch and whey protein. APP had a reddish-grey coloration (L* 56.49 ± 1.39, a* 11.07 ± 0.47, b* 27.69 ± 1.76), pH 4.19 ± 0.15 and Aw 0.235 ± 0.084. Pomace powder was used successfully in higher amounts than experiences reported before. Key physicochemical parameters such as specific volume (≥2.5 cm3/g) and cohesiveness or resilience values (0.538 and 0.378, respectively) suggested good acceptability for gluten-free breads with 8% APP. Additionally, breads were a source of antioxidant potential (437.66 ± 38.95 µM DPPHeq/g APP), fiber (80.13 ± 6.07 g/100 g) and micronutrients such as Cu, Mg, Mn and Fe. In conclusion, local apple varieties are a good source of raw material for gluten-free bread manufacture, which offers a solution for environmental pollution and may contribute to boosting the circular economy.This research was developed within a project funded by the Department of Food Quality and Food Industries of the Basque Government (00025-IDA2019-38) and was possible thanks to a grant received for labor costs by the Department of Economic Development, Sustainability and Environment of the same institution

Prevalencia, incidencia y factores de riesgo de los trastornos de la conducta alimentaria en la Comunidad de Cantabria.

RESUMEN: Los trastornos de la conducta alimentaria (TCA) se manifiestan como una alteración en la salud mental, que se asocia a un patrón irregular en la ingesta de alimentos con el consecuente deterioro de la salud física y psicológica. En los últimos años estas patologías han suscitados gran interés social debido en parte al número creciente de pacientes y a la población afectada, en su mayoría mujeres jóvenes. Por otro lado, desde el punto de vista médico se consideran trastornos que implican una importante morbilidad física y psicosocial, cuyas complicaciones clínicas conllevan una elevada tasa de cronicidad. El origen de estas enfermedades no está claramente elucidado y se consideran el resultado de la interacción de múltiples factores. La identificación de estos marcadores de riesgo ha permitido desarrollar programas de detección e intervención precoz mejorando los resultados terapéuticos y minimizando los costes personales y sanitarios. En este artículo se revisan los estudios realizados hasta la fecha en distintas localizaciones del mundo y en concreto en la Comunidad Autónoma de Cantabria, con el objetivo de conocer las cifras de prevalencia e incidencia que realmente esconden estas patologías y los factores de riesgo implicados en su desarrollo.ABSTRACT: Eating disorders manifest as a disturbance of the mental health associated with an irregular pattern in food intake, with a detriment in physic and psychological health as consequence. In the latest years, these pathologies have aroused growing interest in the society because of the increasing incidence and the subtype affected population, young women mostly. On the other hand, from the medical point of view eating disorders are considered disturbances that imply a significant physic and psychosocial morbidity, and whose clinical complications lead to a high chronicity rate. The etiology of these diseases is not clear, and is considered as multifactorial. The detection of risk markers has allowed the development of early identification and treatment programs, improving therapeutic outcomes and personal and healthcare costs. This article reviews the studies carried out among the world, specifically in the Spanish autonomous community of Cantabria. The aim is to know the actually hidden incidence and prevalence of these disorders and the risk factors that are implied in their development

IgG4-related disease: results from a multicenter Spanish registry

IgG4-related disease (IgG4-RD) is a rare entity consisting of inflammation and fibrosis that has been described in multiple organs. Concrete diagnostic criteria have been established recently and there is a lack of large series of patients.To describe the clinical presentation, histopathological characteristics, treatment and evolution of a series of IgG4-RD Spanish patients.A retrospective multicenter study was performed. Twelve hospitals across Spain included patients meeting the current 2012 consensus criteria on IgG4-RD diagnosis.Fifty-five patients were included in the study, 38 of whom (69.1%) were male. Median age at diagnosis was 53 years. Thirty (54.5%) patients were included in the Histologically Highly Suggestive IgG4-RD group and 25 (45.5%) in the probable IgG4-RD group. Twenty-six (47.3%) patients had more than 1 organ affected at presentation. The most frequently affected organs were: retroperitoneum, orbital pseudotumor, pancreas, salivary and lachrymal glands, and maxillary sinuses.Corticosteroids were the mainstay of treatment (46 patients, 83.6%). Eighteen patients (32.7%) required additional immunosuppressive agents. Twenty-four (43.6%) patients achieved a complete response and 26 (43.7%) presented a partial response (<50% of regression) after 22 months of follow-up. No deaths were attributed directly to IgG4-RD and malignancy was infrequent.This is the largest IgG4-RD series reported in Europe. Patients were middle-aged males, with histologically probable IgG4-RD. The systemic form of the disease was frequent, involving mainly sites of the head and abdomen. Corticosteroids were an effective first line treatment, sometimes combined with immunosuppressive agents. Neither fatalities nor malignancies were attributed to IgG4-RD