Nelda Mercer MS RD FADA March 14 2013 Celiac Disease Also known as Celiac Sprue Glutensensitive Enteropathy Nontropical Sprue How Common is Celiac Disease Celiac disease affects people in all parts of the world ID: 697928
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Slide1
Celiac Disease
Presented by:
Nelda Mercer, MS, RD, FADA
March 14, 2013Slide2
Celiac Disease
Also known as:
Celiac
Sprue
Gluten-sensitive EnteropathyNon-tropical SprueSlide3
How Common is Celiac Disease?
Celiac disease affects people in all parts of the world.
Originally thought to be a rare childhood syndrome, celiac disease is now known to be a
common genetic disorder
. More than 2 million people in the United States have the disease, or about 1 in 133 people – approx. 1% of populationAmong people who have a first-degree relative—a parent, sibling, or child—diagnosed with celiac disease,
as many as 1 in 22 people may have the disease. Celiac disease is also more
common among people with other genetic disorders including Down syndrome and Turner syndrome, a condition that affects girls' development
.
Fasano
A,
Berti
I,
Gerarduzzi
T, et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States.
Archives of Internal Medicine
. 2003;163(3):268–292.Slide4
What is Celiac Disease?
Non-IgE
Mediated Food Allergy
National Institute of Allergy and Infectious Disease - Sponsored Expert Panel
Boyce, J. et al. Guidelines for the diagnosis and management of food allergy in the United States: Report Journal of Allergy and Clinical Immunology. 2010; 126(6):S1-S58. A unique disorder that is both a food intolerance and autoimmune disorder
American Gastroenterological Association
American Gastroenterological Association (AGA) Institute Technical Review on the Diagnosis and Management of Celiac Disease. Gastroenterology. 2006 Dec;131(6):1981–2002. Slide5
Autoimmune Disorder
The immune system can't tell the difference between healthy body tissue and antigens. The result is an immune response that destroys normal body tissues. This response is a hypersensitivity reaction similar to the response in allergic conditions.
Precipitated by the ingestion of
gluten
(a protein in wheat, rye, and barley)
Attack the micro-
villi
small intestineSlide6
A disease of malabsorption and an abnormal immune reaction to gluten
The immune system responds by damaging or destroying the intestinal
villi
Slide7
Malabsorption
Results in malabsorption of key nutrients:
iron, calcium,
folate
absorbed in the first part of the small intestine -Damage further down the small intestinal tract results in malabsorption of: carbohydrates (lactose), fat and fat-soluble vitamins, protein and other nutrients.Slide8
Symptoms Common in Children
WIC Nutrition Risk, Celiac Disease, pg. 5Slide9
Celiac Disease
Symptoms – Common in Adults
WIC Nutrition Risk, Celiac Disease, pg. 5Slide10
Diarrhea
Failure to Thrive
Fatigue
Emotional Issues
Stomach Pain
Distended Belly
Vomiting
Constipation
Anemia
Other
PREVALENCE
OF
SYMPTOMS Slide11
Celiac Disease
Continuing to ingest gluten results in increased risk for developing other autoimmune disorders:
Thyroid disease
Type 1 diabetes
Addison’s diseaseSlide12
Risk for Celiac Disease
Depends on:
Genetic
Immunological
EnvironmentalSlide13
Risk – Recent Studies*
Introduction of small amounts of gluten
while the infant is still breastfed may reduce the risk of CD.
Both breastfeeding during the introduction of dietary gluten, and increasing the duration of breastfeeding
were associated with reduced risk in the infant developing CD.
Not clear from these studies whether
breastfeeding delays the onset of symptoms or provides a permanent protection against the disease.
Therefore prudent to
avoid both early (< 4 months) and late (>7 months) introduction of gluten
and
to introduce gluten gradually while the infant is still breastfed
; this may reduce the risk of CD.
*
ESPGHAN Committee on Nutrition:
Agostoni
, C. et al. Complementary feeding: A commentary by the ESPGHAN Committee on Nutrition, Medical Position Paper. Journal of Pediatric Gastroenterology and Nutrition, January 2008: 46:99-110. Slide14
Diagnosis
1st Physical exam and blood testing
2
nd
Duodenal biopsy 3rd Implement gluten-free diethttp://www.csaceliacs.org/celiac_diagnosis.phpSlide15
Celiac Disease
TreatmentLifetime
Gluten-Free DietSlide16
Dangerous vs. Safe Grains
Dangerous Grains
Wheat
Bran
RyeBarleyBarley maltBulgurCouscous
SpeltKamutSemolina
Triticale
Safe Grains
Rice, Brown Rice
*
Corn, whole grain
*
Millet
*
Teff
, whole grain
*
Sorghum, whole grain
*
Wild rice
*
Buckwheat
*
Quinoa
*
Garbanzo
Potato
Soy
Gluten-free Oats
*Slide17
Implications for WIC Professionals
Client-centered Counseling
Assist clients in making gluten-free food choices that improve quality of life and promote nutritional well-being.
Provide nutrition education/counseling on alternatives to gluten-containing food products as well as provide gluten-free grain selections available in the WIC food packages.
Slide18
Implications for WIC Professionals
Based on the needs and interests of the client, WIC staff may (as appropriate):
Promote breastfeeding throughout the first year of life
, with exclusive breastfeeding until 4-6 months of age. In consultation with the guidance of a medical provider, introduce gluten-containing foods between 4 and 6 months to infants at risk of CD, including infants with a parent or sibling with CD. Tailor food packages
to substitute or remove gluten-containing foods. Slide19
Implications for WIC Professionals
(cont’d) Educate clients on meeting nutritional needs
in the absence of gluten-containing foods.
Encourage high fiber, gluten-free grain selections.
Planning gluten-free meals and snacks for outside the home. Provide educational materials outlining allowed foods and foods to avoid.Monitor client’s growth pattern and weight status. Provide referrals
as appropriate. Slide20
Pediatric Nutrition Care Manual Slide21Slide22Slide23Slide24
FDA Gluten Free Labeling
Currently, FDA has no current definition for
“gluten-free”
In 2007, FDA proposed to allow manufacturers to label a food
“gluten-free” if the food does not contain any
of the following:Slide25
Must Not Contain Any of the Following:
an ingredient that is any type of wheat, rye, barley, or crossbreeds of these grains
an ingredient derived from these grains and that has not been processed to remove gluten
an ingredient derived from these grains and that has been processed to remove gluten, if it results in the food containing 20 or more parts per million (
ppm) gluten 20
ppm or more glutenSlide26
FDA Gluten-Free Labeling
Federal Register Notice of Reopening of the Comment Period on the Proposed Rule (August 3, 2011)To date
NO Final Rule
has been issued
Voluntary LabelingRead label ingredients!!http://www.gpo.gov/fdsys/pkg/FR-2011-08-03/pdf/2011-19620.pdfSlide27Slide28
Continue to read food labels!Slide29Slide30
Our premium gluten free oats starts as pedigreed seed planted in oats-only fields. At harvest, R5 Elisa testing verifies their purity. Our dedicated gluten free facility and
additional R5
Elisa testing ensure their integrity.*
Are Oats Allowed on
a
Gluten-Free Diet?Slide31Slide32Slide33
Eating Out Gluten Free
Gluten-free menus: http://www.glutenfreetravelsite.com/restaurants/
Menu must be requested
Ask questions?
What’s in the dish? How is it prepared? May I see the label?A severe allergy!Be skeptical, cross contamination happens.Slide34
The Latest Fad
A new diet trend
Gluten only harmful to those with CD
No current evidence to back up gluten-free diet health claims
Wheat flour fortification: B1, B2, B3 and IronSlide35
Thank You!
Questions???