Gibert Anna, Espadaler Montserrat, Angel Canela Miguel, Sánchez Anna, Vaqué Cristina, Rafecas Magda
SMAP Celíacs de Catalunya, Coeliac Society, Barcelona, Spain.
Eur J Gastroenterol Hepatol. 2006 Nov;18(11):1187-95. doi: 10.1097/01.meg.0000236884.21343.e4.
The threshold of gluten contamination in gluten-free products of both dietary and normal consumption is under debate. The objective of this study was to gather information on consumption of gluten-free products intended for dietary use of people under a gluten-free diet. This information is essential to ascertain the exposure of coeliac patients to gluten through their diet and deduce the maximum gluten content that these products should contain to guarantee a safe diet.
A diet diary of consumption of gluten-free products intended for dietary use was distributed to the coeliac societies of two typical Mediterranean countries (Italy and Spain) and two Northern countries (Norway and Germany). The diet diary included a self-weigh table of the selected food items and a 10-day consumption table. Results were reported in percentiles as distributions were clearly right skewed.
The respondents included in the study accounted for 1359 in Italy, 273 in Spain, 226 in Norway and 56 in Germany. Gluten-free products intended for dietary use contributed significantly to the diet of coeliac patients in Italy, Germany and Norway and to a lesser degree in Spain. The most consumed gluten-free product in all countries was bread, and it was double consumed in the Northern countries (P<0.001). Mediterranean countries showed consumption of a wider variety of gluten-free foods and pasta was eaten to a large degree in Italy.
The differences between Northern and Mediterranean countries were not in the total amount of gluten-free products but in the type of products consumed. The observed daily consumption of gluten-free products results in the exposure to rather large amounts of gluten, thus the limit of 200 p.p.m. should be revised. A limit of 20 p.p.m. for products naturally gluten-free and of 100 p.p.m. for products rendered gluten-free is proposed to guarantee a safe diet and to enable coeliac patients to make an informed choice. These limits should be revised as new data become available.
无麸质产品用于饮食和正常消费时的麸质污染阈值仍存在争议。本研究的目的是收集有关无麸质饮食人群食用的无麸质产品的消费信息。这些信息对于确定乳糜泻患者通过饮食接触麸质的情况以及推断这些产品应含有的最大麸质含量以确保安全饮食至关重要。
向两个典型的地中海国家（意大利和西班牙）以及两个北欧国家（挪威和德国）的乳糜泻协会发放了一份用于饮食的无麸质产品消费饮食日记。饮食日记包括所选食品的自我称重表和一份10天的消费表。由于分布明显右偏，结果以百分位数报告。
参与研究的受访者在意大利有1359人，在西班牙有273人，在挪威有226人，在德国有56人。用于饮食的无麸质产品对意大利、德国和挪威的乳糜泻患者饮食有显著贡献，在西班牙的贡献程度较小。所有国家中消费最多的无麸质产品是面包，在北欧国家的消费量是其他国家的两倍（P<0.001）。地中海国家消费的无麸质食品种类更多，意大利大量食用面食。
北欧国家和地中海国家之间的差异不在于无麸质产品的总量，而在于消费的产品类型。观察到的无麸质产品每日消费量导致接触相当大量的麸质，因此应修订200 ppm的限量。建议对天然无麸质产品设定20 ppm的限量，对去除麸质的产品设定100 ppm的限量，以确保安全饮食并使乳糜泻患者能够做出明智的选择。随着新数据的出现，这些限量应进行修订。
