{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T08:05:11Z","timestamp":1784966711047,"version":"3.55.0"},"reference-count":19,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2021,1,9]],"date-time":"2021-01-09T00:00:00Z","timestamp":1610150400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>A strict gluten-free diet is extremely difficult to maintain. Protracted ingestion of gluten traces (&gt;10 mg\/day) is sufficient to cause significant damage in the architecture of the small intestinal mucosa in patients on treatment for celiac disease. The aim of this study was to directly measure the level of contaminating gluten in the daily diet of celiac children following a gluten-free diet. From April 2019 to December 2019, celiac disease children (2\u201318 years old) on a gluten-free diet for \u22656 months were offered to participate in this prospective-observational study. Patients and their caregivers were invited to provide a representative portion (about 10 g) of all meals consumed during a 24-h period. Participants were requested to weigh all ingested food and report items in a 24-h food diary. The gluten content was quantified by the R5 sandwich enzyme-linked immunosorbent assay method. Sixty-nine children completed the protocol. Overall, 12\/448 (2.7%) food samples contained detectable amounts of gluten; of them, 11 contained 5\u201320 ppm and 1 &gt;20 ppm. The 12 contaminated food samples belonged to 5\/69 enrolled patients. In these 5 children, the daily gluten intake was well below the safety threshold of 10 mg\/day. The present findings suggest that in a country characterized by high celiac disease awareness, the daily unintended exposure to gluten of treated celiac children on regular follow-up is very low; reassuringly, the presence of gluten traces did not lead to exceed the tolerable threshold of 10 mg\/day of gluten intake in the gluten-free diet.<\/jats:p>","DOI":"10.3390\/nu13010190","type":"journal-article","created":{"date-parts":[[2021,1,10]],"date-time":"2021-01-10T21:21:45Z","timestamp":1610313705000},"page":"190","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Quantification of Accidental Gluten Contamination in the Diet of Children with Treated Celiac Disease"],"prefix":"10.3390","volume":"13","author":[{"given":"Chiara","family":"Monachesi","sequence":"first","affiliation":[{"name":"Celiac Disease Research Laboratory, Polytechnic University of Marche, 60123 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1507-6417","authenticated-orcid":false,"given":"Anil K.","family":"Verma","sequence":"additional","affiliation":[{"name":"Celiac Disease Research Laboratory, Polytechnic University of Marche, 60123 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia N.","family":"Catassi","sequence":"additional","affiliation":[{"name":"Division of Pediatrics, DISCO Department, Polytechnic University of Marche, 60123 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiziana","family":"Galeazzi","sequence":"additional","affiliation":[{"name":"Celiac Disease Research Laboratory, Polytechnic University of Marche, 60123 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Franceschini","sequence":"additional","affiliation":[{"name":"Division of Pediatrics, DISCO Department, Polytechnic University of Marche, 60123 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Perticaroli","sequence":"additional","affiliation":[{"name":"Division of Pediatrics, DISCO Department, Polytechnic University of Marche, 60123 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4255-8972","authenticated-orcid":false,"given":"Elena","family":"Lionetti","sequence":"additional","affiliation":[{"name":"Division of Pediatrics, DISCO Department, Polytechnic University of Marche, 60123 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Catassi","sequence":"additional","affiliation":[{"name":"Division of Pediatrics, DISCO Department, Polytechnic University of Marche, 60123 Ancona, Italy"},{"name":"Mucosal Immunology and Biology Research Center, Division of Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital, Boston, MA 02114-2696, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,1,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2419","DOI":"10.1056\/NEJMcp1113994","article-title":"Clinical practice. Celiac disease","volume":"367","author":"Fasano","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1093\/ajcn\/85.1.160","article-title":"A prospective, double-blind, placebo-controlled trial to establish a safe gluten threshold for patients with celiac disease","volume":"85","author":"Catassi","year":"2007","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_3","unstructured":"Codex Alimentarius Commission (2008). Foods for Special Dietary Use for Persons Intolerant to Gluten Codex STAN 118\u20131979, Codex Alimentarius Commission."},{"key":"ref_4","unstructured":"U.S. Food and Drug Administration (2013). Food Labeling; Gluten-Free Labeling of Foods, Final Rule. Fed. Regist., 78, 47154\u201347179. Available online: https:\/\/www.federalregister.gov\/articles\/2013\/08\/05\/2013-18813\/food-labeling-gluten-free-labeling-of-foods."},{"key":"ref_5","unstructured":"European Union (2011). Regulation (EU) No 1169\/2011 of the European Parliament and of the Council of 25 October 2011 on the Provision of Food Information to Consumers, Amending Regulations (EC) No 1924\/2006 and (EC) No 1925\/2006 of the European Parliament and of the Council, and Repealing Commission Directive 87\/250\/EEC, Council Directive 90\/496\/EEC, Commission Directive 1999\/10\/EC, Directive 2000\/13\/EC of the European Parliament and of the Council, Commission Directives 2002\/67\/EC and 2008\/5\/EC and Commission Regulation (EC) No 608\/2004, European Union."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Verma, A.K., Gatti, S., Galeazzi, T., Monachesi, C., Padella, L., Del Baldo, G., Annibali, R., Lionetti, E., and Catassi, C. (2017). Gluten Contamination in Naturally or Labeled Gluten-Free Products Marketed in Italy. Nutrients, 9.","DOI":"10.3390\/nu9020115"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1080\/19440049.2011.579626","article-title":"Gluten contamination in the Canadian commercial oat supply","volume":"28","author":"Koerner","year":"2011","journal-title":"Food Addit. Contam. Part A"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2017","DOI":"10.1080\/19440049.2013.840744","article-title":"Gluten contamination of naturally gluten-free flours and starches used by Canadians with celiac disease","volume":"30","author":"Koerner","year":"2013","journal-title":"Food Addit. Contam. Part A"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1830","DOI":"10.4315\/0362-028X.JFP-14-149","article-title":"Gluten Contamination in Foods Labeled as \u201cGluten Free\u201d in the United States","volume":"77","author":"Lee","year":"2014","journal-title":"J. Food Prot."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1017\/S1368980016002433","article-title":"Gluten contamination in gluten-free bakery products: A risk for coeliac disease patients","volume":"20","author":"Zandonadi","year":"2017","journal-title":"Public Health Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1080\/19440049.2020.1711970","article-title":"Gluten contamination in labelled and naturally gluten-free grain products in southern India","volume":"37","author":"Raju","year":"2020","journal-title":"Food Addit. Contam. Part A"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1097\/MPG.0000000000002497","article-title":"European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020","volume":"70","author":"Husby","year":"2020","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"6093","DOI":"10.1007\/s00216-016-9721-7","article-title":"Comparative analysis of prolamin and glutelin fractions from wheat, rye, and barley with five sandwich ELISA test kits","volume":"408","author":"Lexhaller","year":"2016","journal-title":"Anal. Bioanal. Chem."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1097\/01.meg.0000059119.41030.df","article-title":"Innovative approach to low-level gluten determination in foods using a novel sandwich enzyme-linked immunosorbent assay protocol","volume":"15","author":"Llorente","year":"2003","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.1053\/j.gastro.2019.12.016","article-title":"Most Patients With Celiac Disease on Gluten-Free Diets Consume Measurable Amounts of Gluten","volume":"158","author":"Silvester","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Stefanolo, J.P., T\u00e1lamo, M., Dodds, S., de la Paz Temprano, M., Costa, A.F., Moreno, M.L., Pinto-S\u00e1nchez, M.I., Smecuol, E., V\u00e1zquez, H., and Gonzalez, A. (2020). Real-World Gluten Exposure in Patients with Celiac Disease on Gluten-Free Diets, Determined from Gliadin Immunogenic Peptides in Urine and Fecal Samples. Clin. Gastroenterol. Hepatol.","DOI":"10.1016\/j.cgh.2020.03.038"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1093\/ajcn\/nqx049","article-title":"Determination of gluten consumption in celiac disease patients on a gluten-free diet","volume":"107","author":"Syage","year":"2018","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1111\/j.1572-0241.2003.07284.x","article-title":"Reliability of antitransglutaminase antibodies as predictors of gluten-free diet compliance in adult celiac disease","volume":"98","author":"Vahedi","year":"2003","journal-title":"Am. J. Gastroenterol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1097\/MPG.0000000000002519","article-title":"Trend of Antitissue Transglutaminase Antibody Normalization in Children With Celiac Disease Started on Gluten-free Diet","volume":"70","author":"Sansotta","year":"2020","journal-title":"J. Pediatr. Gastroenterol. Nutr."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/1\/190\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:09:12Z","timestamp":1760159352000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/1\/190"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,9]]},"references-count":19,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,1]]}},"alternative-id":["nu13010190"],"URL":"https:\/\/doi.org\/10.3390\/nu13010190","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,9]]}}}