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A GLUTEN-FREE DIET is a special type of DIET intended for people with celiac disease. The objective of this article is to report the past, present production, supply of GLUTEN-FREE products as well as their future position in our market. In the past, there were only limited GLUTEN-FREE products available and the awareness of the DIET was limited to paediatric community. There were only few raw GLUTENFREE materials and almost all the production was created in households. Later with the introduction of targeted screening into the practice, celiac diagnosis has improved, with an increase in newly diagnosed patients who have remained life-long dependents on a GLUTEN-FREE DIET. This was associated with an increased production of GLUTEN-FREE products, referred to as weight loss DIET, with their positive effects on health. Subsequently, the GLUTEN-FREE DIET has also been voluntarily adopted by both people with other diseases and healthy individuals. In the future, the GLUTEN-FREE DIET consumption is expected to increase, due to its increased popularity in populations. In this regard, GLUTEN-FREE DIETs have been misinterpreted as a "miracle drug" that is effective on a variety of problems. The medical community will be confronting the future problems of people who are dependent on a GLUTEN-FREE DIET as well as the complications arising from the consumers of a GLUTEN-FREE DIET for no medical reasons. Compliance to the principles of a GLUTEN-FREE DIET should be maintained and should not be recommended to healthy individuals or those without relevant reasons.

Background: Celiac disease (CD) is a common autoimmune disorder that presents intestinal and extra-intestinal symptoms. It is also associated with cardiovascular diseases and malignancies, and mortality risk. The only way to control the disease is to follow a strict GLUTEN-FREE DIET (GFD) for the rest of life. Objectives: This survey aimed to investigate GFD non-adherence and causes in the pediatric setting. Methods: In this study, 187 children aged between 2. 5 to 14 years old with a confirmed diagnosis of CD at least for a year were studied using a questionnaire-based interview in a census study between 2018 to 2019 in a referral center in southern Iran. Results: About 40% of children adhered to a GFD poorly. This group significantly complained of more symptoms than the group with high adherence. Improper access was the most important cause of non-adherence to a GFD. The mean current weight and at the time of diagnosis as well as the mean current BMI and at the time of diagnosis in the non-adherent group were significantly lower than the adherent group. However, IgA anti-transglutaminase antibodies and histopathologic examination did not change remarkably. Furthermore, no significant relationship was found between following a GFD and age, age at the time of diagnosis, gender, and parental educational status. Conclusions: According to our results, inaccessibility, high costs, and lack of food labeling were the primary reasons for nonadherence to GDF. Therefore, to increase compliance, easy access to GFD with proper food labeling and suitable price should be implemented.

Aim: This study was aimed to evaluate symptomatic as well as histopathologic response to GFD in patients with GLUTEN-sensitive enteropathies including celiac disease, lymphocytic duodenosis and non-specific duodenitis.Background: GLUTEN-FREE DIET (GFD) is the main treatment of celiac disease. However, its impact on other disorders of GLUTEN sensitivity spectrum is less clear.Patients and methods: In a prospective observational study in Modarres hospital Tehran, Iran, 35 patients with chronic manifestations including low BMI, diarrhea, greasy stool and bloating were evaluated using serology for anti-tTG, endoscopy and histopathology. Patients were categorized in three diagnostic groups accordingly including celiac disease (CD), lymphocytic doudenosis (LD) and non-specific duodenitis (NSD). All patients were put on a GFD for 6 months, and subjective symptomatic response, serology, endoscopy and histopathologic tests were repeated and compared with baselines and among groups.Results: Of the total 35 patients, 5 had CD (14.3%), 9 had LD (25.7%) and 21 (60%) had NSD. Bloating was the most common symptom followed by diarrhea. Majority of patients (80%) had low BMI. All symptoms alleviated following a GFD but bloating was the only significant one. A significant increase was found in total mean BMI (17.3±0.7 v.s. 17.9±0.9). Histopathologic examination showed a complete resolution in 48.5% (n=17) patients, 10 in NSD group, 4 in LD group and 3 in CD group. Final prevalence of GLUTEN-sensitive enteropathy (LD and NSD cases that responded to GFD) was 46.6%.Conclusion: GFD may have more implications other than celiac disease. Other GLUTEN-sensitive enteropathies, like LD and NSD, might also respond to this treatment particularly in patients with low BMI.

Objective: We aimed to assess the effect and duration of GLUTEN-FREE DIET on bone health in children with celiac disease in our study.Methods: Sixty three patients with celiac disease (CD) formed the study group. They were divided into two subgroups according to their DIETary compliance. Bone mineral density (BMD) values of the patients at two and five years of GLUTEN-FREE DIET (GFD) were determined.Findings: The relationship between BMD and compliance to GFD was found to be statistically significant (P<0.01). BMD z-scores were increased (0.12±0.15 and 0.10±0.14 units respectively) (P<0.01). The patients in group 1 and 2 had mean -1.18±0.83 and -2.06±0.73 z-scores in the first DXA. In the second DXA, these values were -1.10±0.73 and-1.94±0.93 respectively.Conclusion: DIETary compliance is important for bone health, and the time needed to normalize the BMD is not known. Patients with positive anti-endomysium antibody (EMA), poor DIETary history and history of bone pain should be evaluated with DXA during follow-up.

Background Celiac disease (CD) is an autoimmune mediated GLUTEN sensitive enteropathy and a chronic inflammatory condition caused by immune pathology in the small intestines in genetically susceptible individuals. This study aimed to determine the efficacy of GLUTEN FREE DIET on cardiac functions using conventional and Doppler tissue echocardiography (DTE) in children with CD compared to controls. Materials and Methods This case-control study was conducted on 107 children with CD and 45 healthy children. The study was performed in the Ali Ebne Abi Talib hospital, affiliated to Zahedan University of Medical Sciences, Zahedan (ZaUMS), Iran. After considering exclusion criteria, participants underwent echocardiography. Data were analyzed through SPSS software version 20. 0. Results: Results showed that tTG-IgA was different in participants. Left MPI was different in control-positive (p<0. 001), control-newly diagnosed (p=0. 024), and positive-negative (p<0. 001). Right MPI was different in control-positive (p<0. 001), control-newly diagnosed (p=0. 024), positive-negative (p<0. 001), and negative-newly diagnosed (p<0. 001). Left MPI’ was different in control-positive (p<0. 001), control-newly diagnosed (p<0. 001), positive-negative (p=0. 014), and negative-newly diagnosed (p=0. 010). Right MPI’ was different in control-positive (p<0. 001), control-newly diagnosed (p<0. 001), positive– negative (p=0. 010), and negative-newly diagnosed (p=0. 034). Left DT was different in positive-negative. Right ET was different in control-positive, control-newly diagnosed, positive-negative and negative-newly diagnosed. Right AT was different in positive-negative and positive-newly diagnosed. Conclusion It was concluded in patients with positive response to GLUTEN FREE DIET that some heart functions were similar to the controls and in patients with negative response, some were similar to newly diagnosed patients. Diastolic and systolic dysfunctions are important findings in CD children and TDE is a better method to identify cardiac involvements in subclinical patients with CD.

Introduction: Celiac disease (CD) is one of the most common reasons for malnutrition. This study aimed to determine the status of the micronutrients, including vitamins and minerals in children with CD. Methods: The participants of this study included children <18 years old newly diagnosed with CD from January 2016 to December 2017 in the Clinic of Gastrointestinal and Digestive Diseases affiliated with Shiraz University of Medical Sciences. The diagnosis of CD was based on serological and pathologic findings. Finally, the data was analyzed using SPSS 22. Results: In the present study, 78 children with CD were evaluated, including 30 (38. 5%) males and 48 (61. 5%) females. The levels of hemoglobin and iron significantly improved after 6 months of treatment (P = 0. 001). In the present study, the level of calcium was below the normal range in 5 (6. 4%) patients at diagnosis. However, its level was within a normal range in all patients 6 months after the treatment. Based on the results, the level of phosphorus was low in 24 (30. 7%) and 5 (6. 4%) patients before and after the treatment, respectively (P = 0. 001). Further, the vitamin D level was below a normal range in 66 (84. 6%) and 15 (19. 2%) patients at diagnosis and 6 months after the treatment, respectively (P = 0. 001). On the other hand, the mean level of folic acid increased from 16. 5 at diagnosis to 22. 39 after 6 months of treatment (P = 0. 001). Finally, the mean level of zinc also increased from 73. 3 at diagnosis to 81. 6 after 6 months of treatment (P = 0. 001). Conclusion: In general, the levels of iron, folate, vitamin D, and zinc reduced in patients with CD. In most patients, these deficiencies improved by receiving a GLUTEN-FREE DIET (GFD). Monitoring patients with CD is recommended for the diagnosis of micronutrient deficiencies.