Gastrointestinal Unit, Department of Translational Sciences and New Technologies in Medicine and Surgery, University of Pisa, 56124 Pisa, Italy.
Nutrients. 2020 Dec 10;12(12):3785. doi: 10.3390/nu12123785.
The gluten-free diet (GFD) has gained increasing popularity in recent years, supported by marketing campaigns, media messages and social networks. Nevertheless, real knowledge of gluten and GF-related implications for health is still poor among the general population. The GFD has also been suggested for non-celiac gluten/wheat sensitivity (NCG/WS), a clinical entity characterized by intestinal and extraintestinal symptoms induced by gluten ingestion in the absence of celiac disease (CD) or wheat allergy (WA). NCG/WS should be regarded as an "umbrella term" including a variety of different conditions where gluten is likely not the only factor responsible for triggering symptoms. Other compounds aside from gluten may be involved in the pathogenesis of NCG/WS. These include fructans, which are part of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs), amylase trypsin inhibitors (ATIs), wheat germ agglutinin (WGA) and glyphosate. The GFD might be an appropriate dietary approach for patients with self-reported gluten/wheat-dependent symptoms. A low-FODMAP diet (LFD) should be the first dietary option for patients referring symptoms more related to FODMAPs than gluten/wheat and the second-line treatment for those with self-reported gluten/wheat-related symptoms not responding to the GFD. A personalized approach, regular follow-up and the help of a skilled dietician are mandatory.
近年来,无麸质饮食(GFD)越来越受欢迎,这得益于营销活动、媒体信息和社交网络的支持。然而,普通民众对麸质和与 GF 相关的健康影响的真正认识仍然很差。GFD 也被建议用于非乳糜泻麸质/小麦敏感性(NCG/WS),这是一种临床实体,其特征是在没有乳糜泻(CD)或小麦过敏(WA)的情况下,摄入麸质会引起肠内和肠外症状。NCG/WS 应被视为一个“伞式术语”,包括各种不同的情况,在这些情况下,麸质可能不是引发症状的唯一因素。除了麸质之外,其他化合物可能参与 NCG/WS 的发病机制。这些包括部分发酵寡糖、双糖、单糖和多元醇(FODMAPs)的果聚糖、淀粉酶胰蛋白酶抑制剂(ATIs)、麦胚凝集素(WGA)和草甘膦。GFD 可能是有自述麸质/小麦依赖症状的患者的一种适当的饮食方法。对于症状更多与 FODMAPs 相关而不是与麸质/小麦相关的患者,低 FODMAP 饮食(LFD)应是首选饮食方案,对于自述与麸质/小麦相关的症状对 GFD 无反应的患者,LFD 是二线治疗方案。个性化方法、定期随访和熟练营养师的帮助是强制性的。
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