Abstract
Objective
To develop a composition database of a number of foods representative of different categories of gluten-free products in the Italian diet.
Design
The database was built using the nutritional composition of the products, taking into consideration both the composition of the ingredients and the nutritional information reported on the product label.
Setting
The nutrient composition of each ingredient was obtained from two Italian databases (European Institute of Oncology and the National Institute for Food and Nutrition).
Subjects
The study developed a food composition database including a total of sixty foods representative of different categories of gluten-free products sold on the Italian market. The composition of the products included in the database is given in terms of quantity of macro- and micronutrients per 100 g of product as sold, and includes the full range of nutrient data present in traditional databases of gluten-containing foods.
Results
As expected, most of the products had a high content of carbohydrates and some of them can be labelled as a source of fibre (>3 g/100 g). Regarding micronutrients, among the products considered, breads, pizzas and snacks were especially very high in Na content (>400–500 mg/100 g).
Conclusions
This database provides an initial useful tool for future nutritional surveys on the dietary habits of coeliac people.
Keywords: Coeliac disease, Gluten-free products, Gluten-free diet, Food composition database
Coeliac disease is an immune-mediated systemic disorder occurring in genetically susceptible individuals. It is elicited by gluten and related prolamines and characterized by the presence of a variable combination of gluten-dependent clinical manifestations( 1 ). Several studies have brought to light an increase in the occurrence of such disease, with an estimated prevalence worldwide of approximately 1 %( 2 , 3 ). Coeliac disease is currently treated with a lifelong exclusion of gluten from the diet. The coeliac diet is characterized by a combination of naturally occurring gluten-free (GF) foods and GF substitutes of bread, cookies, pasta and other cereal-based foods. The GF foods are made by either ingredients that do not include gluten-containing cereals (e.g. wheat, rye, barley) or by ingredients from such cereals that have been specially processed to remove gluten. Because derivates of gluten-rich grains are important sources of nutrients in the general diet( 4 ), their exclusion from the diet of coeliac patients could potentially have a major effect on their nutritional status if such foods are not replaced with balanced alternatives.
In previous years, a large amount of research has been carried out on the development of GF products. Starches, dairy products, gums and hydrocolloids, non-gluten proteins, prebiotics and combinations thereof have been explored as alternatives to gluten to improve the structure, mouthfeel, acceptability and shelf-life of GF bakery products( 5 ). However, little information is available on the nutritional composition of these GF products. Composition data useful to evaluate the adequacy of nutrient intake of coeliac patients, on which the debate is still open( 6 – 9 ), are therefore strongly needed. In the present work, we built a database of composition of a number of foods representing the main sources of intake of GF products in the Italian diet. For this purpose, we estimated the nutritional composition of the products taking into consideration both the composition of the ingredients and the nutritional information reported on the product label.
Methods
Five commercial brands of GF foods were selected based on the results of a nutritional survey carried out on forty coeliac patients( 9 ), on the Italian National Register of GF products (2010) and on the data from an Italian market share of GF products( 10 ). The GF products selected in the portfolio of such brands were grouped according to categories of non-GF foods reported in two Italian food databases made by the European Institute of Oncology( 11 ) and the National Institute for Food and Nutrition( 12 ).
The categories considered were the following: cookies, breakfast products, sweet products, breads, pizzas, savoury snacks, pasta dishes and flours. The products included in each category were those most consumed in Italy by coeliac individuals on a market share basis. Each food category included different foods, further grouped into sub-categories according to common dietary habits of the general population. As an example of this strategy, the five brands selected included in their portfolios a total of thirty-six types of bread products, which were grouped in eight sub-categories: sliced white bread (sandwich-type); bread prepared with olives; white table bread of different sizes (i.e. loaf of 250 g and loaf of 50 g); whole-meal bread; bread prepared with oil; and flat breads (ciabatta and piadina).
To estimate the full nutrient composition of single GF foods, we used the data on nutrient composition of the ingredients reported on the label and the nutrition information of each product. First, the nutrient composition of each ingredient was obtained from the two Italian databases cited above, complemented, when necessary, by data from the National Nutrient Database for Standard References of the US Department of Agriculture( 13 ). For each ingredient, we placed in quantity order on a Microsoft Excel worksheet the composition in macro- and micronutrients per 100 g in its raw form. As a second step, we estimated for each GF product the quantity of each ingredient (as a percentage of the final recipe) based on its rank order reported on the label and the percentage of some ingredients when explicitly stated on the label. Then, after calculating the theoretical nutrient composition of the product based on the ingredient data and their percentage in the final product, we compared the results of macronutrients with those present on the nutrition label, which, at least in its short form (i.e. macronutrients and energy), is mandatory for GF products. Finally, the process was reiterated by adjusting the percentage of the different ingredients until results reflected the values of macronutrients reported on the nutrition label. In addition, as thermal treatments and other food preparation steps can affect the nutrient composition, especially that of micronutrients, to estimate the nutrient content of processed and composite foods (e.g. biscuits and pizzas) we applied, when available, the retention factors of the following micronutrients( 14 ): thiamin, riboflavin, niacin, folate, vitamin C and β-carotene equivalents. Such retention factors account for the nutrient content retained in a food after losses due to heating or other food preparation steps.
In the case of special food additives, such as gums and protein isolates, the purity, quantity and nutrient composition of those generally used in GF products were estimated with the assistance of experts in the industrial production of GF foods.
The calculated nutritional components of each food item were: energy expressed in kcal and kJ, water, macronutrients (i.e. available carbohydrates, sugar, protein, lipids, saturated lipids), fibre, cholesterol, minerals (i.e. Fe, Ca, Na, K, P and Zn) and vitamins (D, E, retinol, β-carotene equivalents, thiamin, riboflavin, niacin, folate and C).
The described process was done for 149 products. However, the developed composition database includes sixty foods because the nutritional values of each food item were calculated as the average of the nutritional values for all the single similar foods from each brand included in each sub-category.
Results
The composition of the sixty products included in the database is given in terms of quantity of macro- and micronutrients per 100 g of product as sold, and includes the full range of nutrient data present in the traditional databases of non-GF foods.
Table 1 reports the macronutrient composition of sweet products. As expected, the energy content was similar among the products considered and most of them showed a high content of fat and sugar. With regard to the micronutrient content (see online supplementary material, Supplemental Table 1), panettone and pandoro cakes exhibited the highest content of Ca; brioches had a very high content of Na (>500 mg/100 g), whereas pastry with cream filling can be classified as a food with a ‘low sodium content’ (<120 mg/100 g)( 15 ). Concerning folate content, there was a great variability among the samples considered.
Table 1.
Macronutrient composition of commercial gluten-free cookies, breakfast and sweet products in Italy. Values are expressed per 100 g of product
| Food | Energy (kcal) | Energy (kJ) | Water (g) | Available carbohydrates (g) | of which sugar (g) | Fibre (g) | Protein (g) | Lipids (g) | of which saturates (g) | Cholesterol (mg) |
|---|---|---|---|---|---|---|---|---|---|---|
| Cookies | ||||||||||
| Chocolate biscuits | 463 | 1939 | 2 | 68·0 | 25·3 | 2·5 | 6·2 | 20·5 | 7·9 | 44 |
| Biscuits filled with chocolate | 489 | 2045 | 4 | 61·9 | 34·1 | 2·4 | 5·1 | 26·0 | 10·6 | 35 |
| Biscuits plain | 453 | 1894 | 3 | 72·9 | 17·8 | 1·8 | 5·5 | 17·3 | 6·9 | 30 |
| Chocolate-coated biscuits | 484 | 2026 | 4 | 63·6 | 32·8 | 2·0 | 5·7 | 24·6 | 13·4 | 15 |
| Ladyfinger biscuits | 367 | 1536 | 12 | 74·9 | 30·7 | 2·5 | 5·8 | 6·5 | 1·2 | 176 |
| Breakfast cookies | 451 | 1885 | 4 | 72·3 | 21·3 | 1·6 | 5·3 | 17·5 | 7·1 | 63 |
| Whole-meal biscuits | 456 | 1908 | 5 | 69·1 | 16·3 | 5·1 | 3·9 | 18·9 | 3·8 | 0 |
| Breakfast products | ||||||||||
| Melba toast | 403 | 1688 | 5 | 7·8 | 6·4 | 4·5 | 3·7 | 9·1 | 2·9 | 0 |
| Muesli | 374 | 1567 | 13 | 60·0 | 29·8 | 6·0 | 13·1 | 10·7 | 4·0 | 0 |
| Sweet products | ||||||||||
| Margherita cake | 431 | 1804 | 16 | 53·6 | 29·7 | 2·5 | 5·1 | 22·8 | 4·7 | 176 |
| Sponge cake | 458 | 1914 | 17 | 52·3 | 25·5 | 1·7 | 5·4 | 26·3 | 12·2 | 146 |
| Panettone cake | 336 | 1407 | 26 | 51·1 | 22·9 | 3·1 | 5·8 | 13·6 | 5·4 | 243 |
| Pandoro cake | 337 | 1411 | 29 | 47·3 | 16·4 | 2·1 | 6·4 | 15·4 | 6·1 | 347 |
| Tiramisu cake | 184 | 771 | 63 | 22·3 | 16·6 | 0·9 | 4·7 | 8·9 | 3·9 | 146 |
| Plum cake | 390 | 1633 | 22 | 47·2 | 22·3 | 1·5 | 5·0 | 21·1 | 7·4 | 153 |
| Plum cake with chocolate | 423 | 1768 | 19 | 50·3 | 27·2 | 2·2 | 5·3 | 23·3 | 8·9 | 135 |
| Brioche bread | 340 | 1423 | 35 | 52·5 | 12·2 | 2·2 | 3·1 | 7·4 | 2·8 | 50 |
| Brioches | 352 | 1471 | 34 | 42·2 | 6·9 | 2·6 | 3·6 | 18·9 | 3·8 | 23 |
| Croissant with jam | 331 | 1384 | 36 | 45·5 | 11·6 | 2·2 | 2·8 | 16·1 | 3·3 | 10 |
| Croissant with chocolate | 365 | 1527 | 30 | 45·6 | 14·1 | 2·9 | 3·3 | 19·5 | 5·3 | 10 |
| Pastry with chocolate filling | 397 | 1660 | 19 | 53·2 | 31·3 | 3·5 | 5·3 | 19·1 | 5·3 | 87 |
| Pastry with jam filling | 367 | 1536 | 20 | 58·5 | 25·3 | 3·5 | 5·2 | 13·1 | 3·7 | 111 |
| Pastry with cream filling | 452 | 1891 | 5 | 70·8 | 41·8 | 1·5 | 4·9 | 18·3 | 8·5 | 0 |
| Cereal bars | 389 | 1627 | 8 | 67·1 | 26·6 | 5·3 | 5·9 | 11·4 | 5·6 | 4 |
| Muffin | 391 | 1636 | 17 | 60·7 | 29·4 | 0·8 | 5·5 | 15·6 | 6·6 | 136 |
| Puff pastry | 404 | 1688 | 39 | 29·7 | 4·1 | 12·6 | 2·3 | 28·8 | 5·8 | 0 |
| Chocolate ice cream | 307 | 1353 | 45 | 35·2 | 21·8 | 4·7 | 3·7 | 16·4 | 5·3 | 10 |
Table 2 presents the macronutrient composition of breads, pizzas, snacks and flours. Unsurprisingly, all of the products had a high content of available carbohydrates and sugar, and most of them can be labelled as a source of fibre (>3 g/100 g)( 15 ), whereas there was a wide range of protein, fat and cholesterol content. Concerning micronutrient content (online supplementary material, Supplemental Table 2), all items considered showed a similar amount of Fe, with the exception of the frozen pastry pockets with cheese that exhibited the highest value. Interestingly, all GF products belonging to these categories, with the exception of calzone and two flours, showed a very high Na content (>400–500 mg/100 g).
Table 2.
Macronutrient composition of commercial gluten-free breads, pizzas, snacks and flours in Italy. Values are expressed per 100 g of product
| Food | Energy (kcal) | Energy (kJ) | Water (g) | Available carbohydrates (g) | of which sugar (g) | Fibre (g) | Protein (g) | Lipids (g) | of which saturates (g) | Cholesterol (mg) |
|---|---|---|---|---|---|---|---|---|---|---|
| Breads | ||||||||||
| Sliced white bread (sandwich-type) | 248 | 1039 | 45 | 42·1 | 3·5 | 4·7 | 4·2 | 5·5 | 1·1 | 0 |
| Bread prepared with olives | 227 | 951 | 52 | 32·2 | 2·0 | 3·5 | 5·4 | 8·7 | 1·0 | 0 |
| Bread white (loaf 250 g) | 247 | 1034 | 41 | 47·4 | 3·6 | 5·6 | 3·6 | 5·1 | 1·0 | 0 |
| Breadcrumbs | 403 | 1686 | 7 | 73·7 | 6·3 | 4·5 | 5·0 | 11·0 | 3·2 | 10 |
| Whole-meal bread | 230 | 963 | 44 | 40·7 | 3·5 | 6·4 | 4·1 | 5·3 | 1·0 | 0 |
| Bread white (loaf 50 g) | 277 | 1157 | 38 | 54·1 | 3·8 | 3·8 | 2·5 | 4·4 | 1·1 | 0 |
| Bread prepared with oil | 246 | 1030 | 42 | 46·1 | 2·4 | 5·7 | 3·0 | 5·5 | 0·9 | 0 |
| Ciabatta bread | 307 | 1283 | 44 | 45·3 | 2·4 | 5·4 | 3·1 | 3·6 | 0·9 | 0 |
| Piadina bread | 330 | 1380 | 24 | 56·4 | 5·8 | 4·4 | 4·6 | 10·2 | 2·0 | 5 |
| Pizzas | ||||||||||
| Focaccia | 293 | 1225 | 35 | 49·8 | 2·6 | 4·3 | 2·8 | 8·0 | 1·6 | 0 |
| Pizza with tomato | 198 | 829 | 56 | 38·2 | 2·4 | 4·8 | 3·3 | 3·7 | 0·4 | 0 |
| Pizza with tomato and mozzarella | 235 | 982 | 52 | 32·1 | 5·1 | 4·4 | 6·6 | 8·8 | 2·6 | 10 |
| Calzone | 284 | 1187 | 40 | 39·2 | 5·0 | 2·8 | 6·9 | 11·5 | 4·1 | 11 |
| Pizza dough | 367 | 1534 | 32 | 57·1 | 3·0 | 2·9 | 2·8 | 5·3 | 1·1 | 0 |
| Frozen pastry pockets with cheese | 169 | 707 | 65 | 25·2 | 6·0 | 4·4 | 4·5 | 5·6 | 2·3 | 25 |
| Savoury snacks | ||||||||||
| Salted crackers | 401 | 1676 | 5 | 80·0 | 3·1 | 2·7 | 3·5 | 9·2 | 2·9 | 10 |
| Cracotte (crisp bread) | 348 | 1457 | 8 | 79·0 | 3·4 | 1·6 | 7·4 | 2·6 | 0·9 | 0 |
| Saltine crackers | 459 | 1919 | 7 | 72·3 | 3·1 | 0·1 | 0·5 | 20·6 | 9·4 | 0 |
| Bread sticks | 414 | 1732 | 7 | 78·3 | 3·9 | 2·0 | 3·4 | 10·5 | 2·5 | 14 |
| Flours | ||||||||||
| Mixed flours | 336 | 1405 | 10 | 82·7 | 4·3 | 4·4 | 3·1 | 0·5 | 0·1 | 1 |
| Flour for cake | 344 | 1437 | 9 | 86·8 | 22·9 | 1·8 | 2·0 | 0·7 | 0·1 | 0 |
| Flour for bread | 329 | 1378 | 11 | 79·4 | 3·3 | 4·5 | 3·6 | 0·9 | 0·2 | 2 |
The macronutrient content of pasta dishes is reported in Table 3. The energy and carbohydrate content was similar, with the exception of gnocchi and pastas filled with meat and with vegetables that had lower values because of a high content of water. The whole-meal pasta showed the highest fibre content followed by the fresh egg pasta. With regard to the micronutrient content (online supplementary material, Supplemental Table 3), different types of GF pastas had a quite similar amount of Fe, but different Ca and Na contents. Five GF pasta samples could be labelled as ‘without sodium content’ (≤5 mg/100 g) and the egg pasta (fresh and dry) and the whole-meal pasta can be considered as foods with a ‘low sodium content’ (≤120 mg/100 g)( 15 ).
Table 3.
Macronutrient composition of commercial gluten-free pasta dishes in Italy. Values are expressed per 100 g of product
| Food | Energy (kcal) | Energy (kJ) | Water (g) | Available carbohydrates (g) | of which sugar (g) | Fibre (g) | Protein (g) | Lipids (g) | of which saturates (g) | Cholesterol (mg) |
|---|---|---|---|---|---|---|---|---|---|---|
| Egg pasta (fresh) | 274 | 1148 | 46 | 57·6 | 0·5 | 3·9 | 5·4 | 3·3 | 0·7 | 76 |
| Egg pasta (dry) | 351 | 1470 | 11 | 76·6 | 1·2 | 1·9 | 7·4 | 3·5 | 0·9 | 119 |
| Whole-meal pasta | 381 | 1595 | 9 | 80·3 | 0·9 | 4·8 | 7·6 | 2·9 | 0·6 | 0 |
| Pasta made with different flours | 333 | 1392 | 12 | 75·7 | 0·7 | 2·1 | 7·4 | 2·0 | 0·2 | 0 |
| Corn pasta | 336 | 1405 | 15 | 75·0 | 1·4 | 2·4 | 8·0 | 2·5 | 0·3 | 0 |
| Rice pasta | 337 | 1410 | 11 | 79·9 | 0·0 | 1·0 | 6·6 | 1·2 | 0·1 | 0 |
| Pasta for broth | 333 | 1392 | 12 | 75·7 | 0·7 | 2·1 | 7·4 | 2·0 | 0·2 | 0 |
| Pasta filled with meat | 219 | 916 | 52 | 33·7 | 2·0 | 2·4 | 7·3 | 6·6 | 2·5 | 50 |
| Pasta filled with vegetables | 262 | 1096 | 44 | 36·4 | 2·9 | 2·2 | 11·2 | 8·5 | 3·0 | 94 |
| Gnocchi | 153 | 642 | 59 | 36·5 | 0·5 | 3·3 | 3·0 | 0·5 | 0·1 | 10 |
| Cous cous | 339 | 1420 | 12 | 75·8 | 1·4 | 2·4 | 8·1 | 2·5 | 0·3 | 0 |
Discussion
The present study represents a systematic attempt to build a composition database of GF products based on the ingredients listed on the label. The overall results from the sixty foods representative of different categories of GF products sold on the Italian market demonstrate that almost all products had a high content of available carbohydrates and 50 % of them contained a good amount of dietary fibre due to the presence of hydrocolloids in their formulation.
Having these data at hand can allow an accurate assessment of the dietary habits of coeliac patients and then an evaluation of the nutritional adequacy of the GF diet. To date, several studies have been carried out in different countries on the nutritional adequacy of the GF diet in terms of macro- and micronutrients, mostly presenting conflicting results. In fact regarding the macronutrient intake, several authors have reported similar intakes of energy( 9 , 16 – 18 ), fat( 17 ), protein, carbohydrates( 9 , 17 ), including starch and sugars, fibre and cholesterol between coeliac patients and controls. Conversely, other authors showed significantly lower energy( 6 , 16 ) and fibre intakes( 17 , 18 ), but higher intakes of total and saturated fat( 16 ) in the diet of coeliac patients compared with healthy controls. In relation to micronutrient intakes, the majority of studies showed lower levels of folate, niacin, vitamin B12, vitamin E, vitamin A, P, Ca, Zn and Se in coeliac individuals than in controls( 8 , 9 , 17 – 20 ). As a consequence, despite the relatively abundant literature on the dietary habits of coeliac individuals, it is still difficult to draw a conclusion on the nutritional adequacy of the GF diet. This discrepancy among the studies could be partly linked to the limited data on GF foods in the databases. In fact, in almost all of the cited studies the process applied to calculate the nutrient composition data of GF products, used to estimate the nutritional intake of the coeliac group investigated, was not clearly described. On the contrary, in the present communication the process applied for the construction of the composition database of GF products is described step-by-step and several strategies were applied to minimize errors. In particular, the weight changes of ingredients during cooking and food processing were taken into account as the quantity of each ingredient (as a percentage of the final recipe) was adjusted on the basis of the values of macronutrients reported on the nutrition label. This approach allows us to avoid applying the yield factors traditionally used in estimating the nutrient content of composite dishes by using the ingredients( 21 ). Moreover, to improve the accuracy of the nutrient estimation in calculating the nutrient content of composite foods, the losses of micronutrients (i.e. vitamins) due to heating or other food preparation processes were taken into account by applying the nutrient retention factors evaluated for cereal-based foods( 14 ) at the ingredient level. Finally, the nutritional values of each single food item included in the developed database were calculated as the average of the nutritional values of all the single similar foods from each brand included in each sub-category (e.g. sliced white bread). Therefore, this allows for the consideration of the nutritional composition variability for each food item due to its ingredient formulation.
Some limitations related to our data should be taken into account. First of all, since the nutritional composition data of GF products have been estimated, they cannot substitute a direct analysis. As a consequence, the comparison between these data and those of their gluten-containing counterparts, included in the databases( 11 , 12 ) and obtained by a direct analysis, in some cases would be misleading. However, our newly developed database will facilitate research into assessment of the dietary habits of coeliac patients and will provide the basis for improvement of the nutritional quality of GF foods. Moreover, the composition data of the ingredients were taken from food composition databases which, in some cases, report approximate data. However, it is already permitted for generic foods to produce the nutritional labelling based on the ingredients used for the recipe, thus our data are likely to be just as accurate as the majority of data reported for any kind of food product present on the market. Finally, it must be highlighted that the nutrient composition concerns GF products sold in Italy, even though more than 50 % of them are produced by companies that distribute their products all over Europe.
Nowadays there is a lack of data on the nutritional adequacy of the coeliac diet. Despite the limitations, the present database provides a first attempt to increase the accuracy of the dietary assessment tools used for future nutritional surveys on the dietary habits of coeliac people.
Acknowledgements
Financial support: This research received no specific grant from any funding agency, commercial or not-for-profit sectors. Conflict of interest: None. Authorship: S.C. was responsible for the collection and calculation of composition data; N.P. was responsible for formulating the research question; N.P., F.B. and T.M. were responsible for analysing the data; T.M. and N.P. were the primary authors of the manuscript; F.B. reviewed the manuscript. Ethics of human subject participation: Ethical approval was not required.
Supplementary material
For supplementary material accompanying this paper visit https://doi.org/10.1017/S1368980014001682.
click here to view supplementary material
References
- 1. Husby S, Koletzko S, Korponay-Szabó IR et al. (2012) European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr 54, Suppl. 1, S136–S160. [DOI] [PubMed] [Google Scholar]
- 2. Fasano A, Araya M, Bhatnagar S et al. (2008) Federation of International Societies of Pediatric Gastroenterology, Hepatology, and Nutrition Consensus Report on Celiac Disease. J Pediatric Gastroenterol Nutr 47, 214–219. [DOI] [PubMed] [Google Scholar]
- 3. Ludivgsson JF & Green PH (2011) Clinical management of coeliac disease. J Intern Med 269, 560–571. [DOI] [PubMed] [Google Scholar]
- 4. Sette S, Le Donne C, Piccinelli R et al. (2013) The third National Food Consumption Survey, INRAN-SCAI 2005–06: major dietary sources of nutrients in Italy. Int J Food Sci Nutr 64, 1014–1021. [DOI] [PubMed] [Google Scholar]
- 5. Gallagher E, Gormley TR & Arendt EK (2004) Recent advances in the formulation of gluten free cereal based products. Trends Food Sci Technol 15, 143–152. [Google Scholar]
- 6. Bardella MT, Fredella C, Prampolini L et al. (2000) Body composition and dietary intakes in adult celiac disease patients consuming a strict gluten free diet. Am J Clin Nutr 72, 937–939. [DOI] [PubMed] [Google Scholar]
- 7. Thompson T (2000) Folate, iron, and dietary fiber contents of the gluten free diet. J Am Diet Assoc 100, Suppl. 11, S1389–S1396. [DOI] [PubMed] [Google Scholar]
- 8. Thompson T, Dennis M, Higgins LA et al. (2005) Gluten-free diet survey: are Americans with coeliac disease consuming recommended amounts of fibre, iron, calcium and grain foods? J Hum Nutr Diet 18, 163–169. [DOI] [PubMed] [Google Scholar]
- 9. Dall’Asta C, Scarlato AP, Galaverna G et al. (2012) Dietary exposure to fumonisins and evaluation of nutrient intake in a group of adult celiac patients on a gluten-free diet. Mol Nutr Food Res 56, 632–664. [DOI] [PubMed] [Google Scholar]
- 10. Finco A, Galeotafiore A, Palomba TN et al. (2011) Il Celiaco: Una Persona, Un Paziente, Un Target, ‘Una Vita Senza Glutine’. Programma Scienziati in Azienda, XI Edizione. http://www.istud.it/up_media/pw_scienziati/celiachia.pdf (accessed January 2012).
- 11. European Institute of Oncology (2008) Food Composition Database for Epidemiological Studies in Italy, Version 2008. http://www.ieo.it/bda (accessed December 2012).
- 12. National Institute for Food and Nutrition (2004) Food Composition Database 2004. http://www.inran.it/646/tabelle_di_composizione_degli_alimenti.html (accessed December 2012).
- 13. US Department of Agriculture, Agricultural Research Service (2007) USDA National Nutrient Database for Standard Reference, Release 20. http://www.nal.usda.gov/fnic/foodcomp (accessed December 2012).
- 14. Vásquez-Caicedo AL, Bell S & Hartmann B (2008) Report on collection of rules on use of recipe calculation procedures including the use of yield and retention factors for imputing nutrient values for composite foods. EuroFIR (European Food Information Resource). http://www.langual.org/download/RecipeCalculation/EuroFIR%20recipe%20calculation%20procedures%20including%20yield%20and%20retention%20factors.pdf (accessed February 2014).
- 15. Parlamento Europeo e del Consiglio (2006) Regolamento (CE) N. 1924/2006 del Parlamento Europeo e del Consiglio del 20 dicembre 2006 relativo alle indicazioni nutrizionali e sulla salute fornite sui prodotti alimentari. Gazzetta ufficiale dell’Unione europea 30.12.2006, L404/9–L404/25.
- 16. Kinsey L, Burden ST & Bannerman E (2008) A dietary survey to determine if patients with celiac disease are meeting current healthy eating guidelines and how their diet compares to that of the British general population. Eur J Clin Nutr 62, 1333–1342. [DOI] [PubMed] [Google Scholar]
- 17. Grehn S, Fridell K, Lilliecreutz M et al. (2001) Dietary habits of Swedish adult coeliac patients treated by a gluten-free diet for 10 years. Scand J Nutr 45, 178–182. [Google Scholar]
- 18. Wild D, Robins GG, Burley VJ et al. (2010) Evidence of high sugar intake, and low fibre and mineral intake, in the gluten free diet. Aliment Pharmacol Ther 32, 573–581. [DOI] [PubMed] [Google Scholar]
- 19. Shepherd SJ & Gibson PR (2013) Nutritional inadequacies of the gluten-free diet in both recently-diagnosed and long-term patients with coeliac disease. J Hum Nutr Diet 26, 349–358. [DOI] [PubMed] [Google Scholar]
- 20. Hallert C, Grant C, Grehn S et al. (2012) Evidence of poor vitamin status in coeliac patients on a gluten-free diet for 10 years. Aliment Pharmacol Ther 16, 1333–1339. [DOI] [PubMed] [Google Scholar]
- 21. Reinivuo H, Bell S & Ovaskainen ML (2009) Harmonisation of recipe calculation procedures in European food composition databases. J Food Compost Anal 22, 410–413. [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
For supplementary material accompanying this paper visit https://doi.org/10.1017/S1368980014001682.
click here to view supplementary material