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- Risk of Gluten Cross-Contamination Due to Food Handling Practices: A Mini-ReviewPublication . Damasceno, Renatta Pereira B.; Zandonadi, Renata Puppin; Mendes, Marcela; Cunha Junior, Luis Carlos; Raposo, António; Teixeira-Lemos, Edite; Margarida Correia Balula Chaves, Cláudia; Farage, PriscilaAbstract Celiac disease (CD) is an autoimmune disease triggered by the ingestion of gluten in genetically predisposed individuals, affecting 1.4% of the world population. CD induces an inflammatory reaction that compromises small intestine villi, leading to nutrient malabsorption, and gastro and extraintestinal manifestations. Although other treatment approaches are being studied, adherence to a gluten-free diet (GFD) is the only effective intervention to date. Despite this, about 50% of patients experience persistent inflammation, often associated with unintentional gluten ingestion through contaminated food. There are regulations for labeling gluten-free foods which specify a limit of 20 mg/kg (20 ppm). The risks of gluten cross-contamination above that level are present throughout the whole food production chain, emphasizing the need for caution. This review explores studies that tested different procedures regarding the shared production of gluten-containing and gluten-free food, including the use of shared equipment and utensils. A literature review covering PubMed, Scielo, Web of Science, VHL and Scopus identified five relevant studies. The results indicate that shared environments and equipment may not significantly increase gluten cross-contamination if appropriate protocols are followed. Simultaneous cooking of gluten-containing and gluten-free pizzas in shared ovens has demonstrated a low risk of contamination. In general, shared kitchen utensils and equipment (spoon, ladle, colander, knife, fryer, toaster) in controlled experiments did not lead to significant contamination of samples. On the other hand, cooking gluten-free and gluten-containing pasta in shared water resulted in gluten levels above the established limit of 20 ppm. However, rinsing the pasta under running water for a few seconds was enough to reduce the gluten content of the samples to less than 20 ppm.
- Health-related quality of life among celiacs in Portugal: a comparison between general and specific questionnairesPublication . Margarida Correia Balula Chaves, Cláudia; Zandonadi, Renata Puppin; Raposo, António; Nakano, Eduardo Yoshio; Ramos, Fernando; Farage, Priscila; Teixeira-Lemos, EditeObjective: This study aimed to compare the 36-Item Short Form Survey Instrument version 2 (SF-36-v2) (generic) and Celiac Disease Questionnaire (CDQ) (specific) questionnaires used to evaluate the quality of life (QoL) in celiac Portuguese adult individuals. Methods: This cross-sectional study used non-probabilistic sampling based on Portuguese celiac patients who accessed the online survey in 2022. The online data collection used a self-reported instrument composed of three parts: (i) socioeconomic, health, and gluten-free diet (GFD) adherence questions; (ii) SF-36 v2 - Portuguese version (generic questionnaire) and (iii) Celiac Disease Questionnaire (CDQ) (specific questionnaire). Results: A total of 234 individuals who accessed the survey completed the questionnaire. Seven of the eight SF-36 domains positively correlated to the specific questionnaire CDQ. The "General Health" domain (domain 4) showed a negative correlation with the CDQ. Differences in content between the two instruments might be able to explain this finding since the CDQ explores issues regarding the specificities of celiac disease (CD) and the lifelong GFD burden. About half of the sample from this study displayed poor diet adherence, it is possible that the SF-36 could not reflect the impact of CD treatment - the complete elimination of gluten from the diet - on patients' health. Therefore, this issue should be carefully evaluated in future research. Conclusion: Specific validated questionnaires for CD individuals, such as the CDQ, contemplate social, economic, and clinical variables that permeate the patient's life context. Therefore, these instruments may be more suitable for evaluating QoL in this public. However, using a general questionnaire such as the SF-36 would be indicated for comparing QOL between celiac patients and the general population or even between CD and other disease individuals. In this case, we recommend assessing GFD compliance for control parallelly.
- Quality of Life Perception among Portuguese Celiac Patients: A Cross-Sectional Study Using the Celiac Disease Questionnaire (CDQ)Publication . Margarida Correia Balula Chaves, Cláudia; Raposo, António; Zandonadi, Renata Puppin; Nakano, Eduardo Yoshio; Ramos, Fernando; Teixeira-Lemos, Editehe aim of this study is to assess Portuguese celiac patients’ quality of life (QoL) perception. A cross-sectional study was performed with a non-probability convenience sample of Portuguese celiac patients using an online self-administered celiac disease quality of life questionnaire (CDQ), previously validated for the Portuguese population. The final sample comprised 234 celiac patients, which included the following: primarily women (69.2%); aged between 18 and 49 years old (56.4%); with a partner (60.6%); with a high educational level (58.9%—graduated or post-graduated); following a gluten-free diet (GFD) (55.1%); and not using antidepressants (93.1%). The Portuguese CDQ presented good reliability and responsiveness in this sample of Portuguese celiac patients. In general, the CDQ in Portugal was affected by age at diagnosis (p = 0.017), educational level (p = 0.005), and compliance with GFD (p = 0.034). The emotion domain was affected only by using antidepressants (p = 0.036). The social domain was affected by gender (females had lower rates, p = 0.016), age at diagnosis (p = 0.009), educational level (p = 0.000), and compliance with a GFD (p = 0.002). The worries domain did not differ according to socioeconomic data. The symptoms domain was affected by compliance with GFD (p = 0.000), age at diagnosis (p = 0.000), and educational level (p = 0.014). Data on celiac QoL is essential to support the formulation and implementation of strategies to minimize the issues suffered by celiac patients, lowering their physical, emotional, and social burden. Additionally, data on Portuguese celiac disease patients using the CDQ will allow future comparative research among celiac populations from different countries.