Bascuñán Karla A, Vespa María Catalina, Araya Magdalena
Department of Nutrition, Faculty of Medicine, University of Chile, Av. Independencia 1027, Independencia, Santiago, Chile.
Laboratory of Gastroenterology, Institute of Nutrition and Food Technology, INTA, University of Chile, Independencia, Chile.
Eur J Nutr. 2017 Mar;56(2):449-459. doi: 10.1007/s00394-016-1238-5. Epub 2016 Jun 22.
The only effective and safe treatment of celiac disease (CD) continues being strict exclusion of gluten for life, the so-called gluten-free diet (GFD). Although this treatment is highly successful, following strict GFD poses difficulties to patients in family, social and working contexts, deteriorating his/her quality of life. We aimed to review main characteristics of GFD with special emphasis on factors that may interfere with adherence to it.
We conducted a search of various databases, such as PubMed, Google Scholar, Embase, and Scielo, with focus on key words such as "gluten-free diet", "celiac disease", "gluten" and "gluten-free diet adherence". Available literature has not reached definitive conclusions on the exact amount of gluten that is harmless to celiac patients, although international agreements establish cutoff points for gluten-free products and advise the use of clinical assessment to tailor the diet according to individual needs. Following GFD must include eliminating gluten as ingredient as well as hidden component and potential cross contamination in foods. There are numerous grains to substitute wheat but composition of most gluten-free products tends to include only a small number of them, especially rice. The diet must be not only free of gluten but also healthy to avoid nutrient, vitamins and minerals deficiencies or excess. Overweight/obesity frequency has increased among celiac patients so weight gain deserves attention during follow up. Nutritional education by a trained nutritionist is of great relevance to achieve long-term satisfactory health status and good compliance.
A balanced GFD should be based on a combination of naturally gluten-free foods and certified processed gluten-free products. How to measure and improve adherence to GFD is still controversial and deserves further study.
乳糜泻（CD）唯一有效且安全的治疗方法仍然是终身严格排除麸质，即所谓的无麸质饮食（GFD）。尽管这种治疗非常成功，但遵循严格的无麸质饮食在家庭、社交和工作环境中给患者带来困难，会降低其生活质量。我们旨在回顾无麸质饮食的主要特点，特别强调可能影响其依从性的因素。
我们对多个数据库进行了检索，如PubMed、谷歌学术、Embase和Scielo，重点关注“无麸质饮食”、“乳糜泻”、“麸质”和“无麸质饮食依从性”等关键词。现有文献尚未就对乳糜泻患者无害的麸质的确切含量得出明确结论，尽管国际协议为无麸质产品设定了临界值，并建议使用临床评估来根据个体需求调整饮食。遵循无麸质饮食必须包括消除食品中作为成分以及隐藏成分和潜在交叉污染的麸质。有许多谷物可替代小麦，但大多数无麸质产品的成分往往只包含少数几种，尤其是大米。饮食不仅必须无麸质，而且要健康，以避免营养、维生素和矿物质缺乏或过量。乳糜泻患者中超重/肥胖的发生率有所增加，因此在随访期间体重增加值得关注。由训练有素的营养师进行营养教育对于实现长期令人满意的健康状况和良好的依从性非常重要。
均衡的无麸质饮食应基于天然无麸质食品和经认证的加工无麸质产品的组合。如何衡量和提高对无麸质饮食的依从性仍存在争议，值得进一步研究。
