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Nutrition in acute and chronic diseases

Gluten content in labeled and unlabeled gluten-free food products used by patients with celiac disease

Abstract

Objective

Gluten-free (GF) diet is the only reliable treatment for patients with celiac disease (CeD), but data on the extent of gluten contamination in GF food available in India is scanty. We evaluated gluten content in labeled, imported, and non-labeled GF food products currently available in the Indian market.

Methods

Overall, 794 processed and commercially available packaged GF products (labeled GF (n = 360), imported GF (n = 80), and non-labeled/naturally GF (n = 354)) were collected from supermarkets of National Capital Region of India. Those unavailable in stores were purchased from e-commerce sites or directly from the manufacturers. Gluten level in them was determined by Ridascreen Gliadin sandwich R5 enzyme-linked immunosorbent assay (R-Biopharm AG, Germany). As per Codex Alimentarius and Food Safety and Standard Authority of India, “gluten free” labeled products must not contain > 20 mg/kg of gluten.

Results

Overall, 10.1% of 794 GF products including 38 (10.8%) of 360 labeled and 42 (11.8%) of 354 non-labeled/naturally GF food products had gluten content > 20 mg/kg (range: 24.43–355 and 23.2–463.8 mg/kg, respectively). None of the imported GF products had gluten more than the recommended limits. Contaminated products most commonly belonged to cereal and their products (flours, coarse grains, pasta/macaroni, snack foods) pulse flours, spices, and bakery items.

Conclusions

A substantial proportion (10.1%) of GF food products (both labeled and non-labeled) available in India have gluten content greater than the prescribed limits of <20 mg/kg. Physicians, dietitians, support group, and patients with CeD should be made aware of this fact and regulatory bodies should ensure quality assurance.

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Acknowledgements

We acknowledge Indian Council of Medical Research, Department of Health Research, Government of India for providing funding for this study. We also acknowledge R-Biopharm, Darmstadt, Germany for providing us the ELISA kits. WM acknowledges the University Grant Commission for providing her the Fellowship.

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Authors and Affiliations

Authors

Contributions

WM: market survey and procurement of food products, laboratory work, data analysis, drafting of paper; VS: laboratory testing; AS: laboratory testing, critical review of the paper; SA: statistical analysis; NS: study supervision, critical review of the paper; RM: critical review of the paper; AM: critical review of the paper; VA: study supervision, critical review of the paper; GM: overall guarantor of the paper, designed the study concept, supervised the study, data analysis, and finalization of the paper. All authors revised and approved the final version.

Corresponding author

Correspondence to Govind Makharia.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Ethics Committee of All India Institute of Medical Sciences, New Delhi (Ref. No. IEC-192/07.4.2017, RP-14/2017). The identity of the samples and their manufacturer had been blinded and were not disclosed on the public forum.

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Mehtab, W., Sachdev, V., Singh, A. et al. Gluten content in labeled and unlabeled gluten-free food products used by patients with celiac disease. Eur J Clin Nutr 75, 1245–1253 (2021). https://doi.org/10.1038/s41430-020-00854-6

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