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Discovering Celiac Disease: Mass Screening Reveals Unknown Details | Chapter 6 | I live GlutenFree – Gordon Ramsay’s version

Discovering Celiac Disease: Mass Screening Reveals Unknown Details |  Chapter 6 |  I live GlutenFree

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Celiac disease, a condition influenced by genetics and gluten intake, affects only a small percentage of those at risk. The recent Law n. 130 of 15 September 2023 in Italy established a program to early identify both type 1 diabetes and celiac disease in the pediatric population. This program aims to prevent serious complications and identify individuals at risk, as both conditions are becoming increasingly common and can coexist in a single individual.

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The two diseases share many genetic and immunological characteristics but require different diagnostic and therapeutic approaches. While eliminating gluten from your diet can cure celiac disease, type 1 diabetes has no definitive cure and its causes remain unknown.

Mass screening is crucial for detecting celiac disease in children with type 1 diabetes, as symptoms are often subtle or absent. The prevalence of celiac disease in patients with type 1 diabetes is higher than in the general population, and vice versa. Both diseases increase the risk of other autoimmune conditions, such as thyroid disease.

Celiac disease affects about 8% of patients with type 1 diabetes, but many of them have no obvious symptoms. The diagnosis often occurs randomly during annual checks, especially if celiac disease is asymptomatic or presents non-specific symptoms.

This mass screening not only improves the chances of early diagnosis, but also helps identify patients who might otherwise escape diagnosis. Table 3 illustrates the common and distinctive characteristics between the two patient groups, providing a detailed picture of the challenges and hidden opportunities in the early diagnosis of celiac disease in patients with type 1 diabetes.

Table 3. Characteristics in common and distinct between T1D and celiac patients

Type 1 diabetes

Celiac disease

Celiac disease and type 1 diabetes

Pathogenesis

Autoimmune destroyer of pancreatic islet cells

Autoimmunity-mediated inflammation and damage to the intestinal mucosa

Possible tissue transglutaminase autoantibodies

deposits in the pancreatic islets

Causal agent

Unknown; suspected viruses and environmental factors

Food gluten; other factors such as suspected viruses

No common antigen was found

Autoantibodies

Insulin autoantibodies, islet cell autoantibodies, glutamic acid decarboxylase autoantibodies, insulinoma antigen-2 autoantibodies, and zinc transporter T8 autoantibodies; low specificity

Tissue transglutaminase autoantibodies and endomysial autoantibodies; high sensitivity and specificity

No shared autoantibodies were found

Clinical presentation

Uniform, symptoms appear late in the course of the disease

Heterogeneous, symptoms may appear before obvious histological damage

Celiac disease is often asymptomatic when diabetes is diagnosed

High risk HLA

genotype

HLA-DR3-DQ2 and HLA-DR4-DQ8

HLA-DR3-DQ2 homozygous

HLA-DR3-DQ2 and HLA-DR4-DQ8

Distribution by sex

Predominance in males, particularly in high prevalence countries

Dominance in females

More males are affected among children with coexisting diabetes and celiac disease than is generally seen among those with celiac disease alone

Age at diagnosis

Peak incidence at the beginning of adolescence

The diagnosis can be made at any age depending on the diagnostic approach

Celiac disease is usually diagnosed through screening after the onset of diabetes

In Light of Diabetes: Screening for Celiac Disease is Crucial

Screening for celiac disease in patients with type 1 diabetes is a debated topic among experts, but many authors agree on its importance. The majority recommend screening both patients with type 1 diabetes and their first-degree relatives, as the prevalence of celiac disease in these individuals is significantly higher than average. This risk increases further if diabetes is associated with another autoimmune condition.

Studies show that up to 36% of first-degree relatives of patients with type 1 diabetes may have celiac disease, and this percentage can rise up to 75% if other autoimmune diseases are present. Importantly, screening does not replace case-finding, as even previously screen-negative children may develop suspicious symptoms later, requiring further diagnostic testing for celiac disease.

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Sources:

Makharia GK, Chauhan A, Singh P, Ahuja V. Review article: Epidemiology of coeliac disease. Aliment Pharmacol Ther. 2022;56:S3-S17. doi: 10.1111/apt.16787.

GU General Series n.226 of 09.27.2023

Tatti P, Pavandeep S. Gender Difference in Type 1 Diabetes: An Underevaluated Dimension of the Disease. Diabetology. 2022;3(2):364-368

Oliveira DR, Rebelo JF, Maximiano C, Gomes MM, Martins V, Meireles C, Antunes H, et al. HLA DQ2/DQ8 haplotypes and anti-transglutaminase antibodies as celiac disease markers in a pediatric population with type 1 diabetes mellitus. Arch. Endocrinol. Metab. 2022;66(2):229-36

Kurppa K, Laitinen A, Agardh D. Coeliac disease in children with type 1 diabetes. Lancet Child Adolescent Health. 2018;2(2):133-143

lucadeejay

Father, Husband, Journalist. A #GlutenFree and #Fearless traveller.

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Genoese risotto, tastier and creamier than pasta. The chef reveals the sugar trick for a mouth-watering first course – Gordon Ramsay’s version

Genoese risotto

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The Genoese risotto it is a revisited version of the classic Neapolitan dishhowever made with rice and without meat like the Genoese fujuta. The recipe is from Piero Benigni. This dish of mine, good and delicate, fascinates and conquers with its flavor those who taste it for the first time. It is easily prepared in about 45 minutes. You can do it for your loved ones or when you have guests, who will appreciate it and remember it for a long time.

Genoese risotto

Ingredients for 2 people

• 150 g Carnaroli or Arborio rice
• 200 g onion
• 1 liter vegetable broth
• 30 g grated parmesan
• 20 g butter
• 1 teaspoon balsamic vinegar (added to taste)
• 1 teaspoon sugar
• 1 glass of dry white wine (about 150 ml)
• 2 tablespoons olive oil
• to taste parsley, paprika, grated lemon zest

Preparation

Preparation is easy, just follow the instructions and quantities indicated. You can use onions of every variety. The addition of very little balsamic vinegar it is not mandatory but I suggest it because it greatly increases the aroma and flavor of the finished dish. The same goes for the paprika, which can be sweet or spicy to your taste. Prepare about 1 liter of perfectly salted vegetable broth and place it on the stove next to the risotto pan. Make sure that it is at a gentle boil when you begin to stir the risotto and it should be this way for the entire duration of cooking. Grate and weigh the cheese, weigh the rice and butter, prepare the glass of dry white wine, keep it handy balsamic, paprika, lemon and grater. Finely chop a sprig of rosemary.

Coarsely chop onion and put it to fry gently in the saucepan with 2 tablespoons of olive oil. If you have one, place the flame spreader between the stove and the saucepan. The onion should be sautéed over a very low heat for one twenty minutes, stirring often and being careful that it does not burn. Finally add salt and taste. When the onion is well stewed, remove the net, raise the heat and add the rice. Toast it for 3 minutes, stirring almost constantly.

When the rice will have a translucent and mother-of-pearl appearance pour the wine, bring to a moderate boil and stir often until it has been completely absorbed. Pour a ladle of boiling broth and start to make the risotto, stirring very often. Adjust the flame so as to have a quiet boil. When this broth has been completely absorbed, pour another ladle and continue like this, pouring new broth only when the previously poured one has not been absorbed. After 10 minutes add the teaspoon of sugarthat of abalsamic class and a tip of a teaspoon of paprika. Continue rolling the risotto. The cooking will last 17-18 minutes since you poured the first broth.

When the rice is still al dente and with very little broth, turn off the heat and add cheese and butter. Mix to blend, cover and let rest (whisk) for 3 minutes. At the end, evaluate whether the risotto is properly creamy: add one or two tablespoons of broth if he had settled in too much. Serve without delay, placing a little parmesan on the plates and sprinkling them with chopped parsley and grating a little on top Lemon peel. A little pepper is also good for those who want it. Due to its characteristics, this risotto should be consumed as soon as it is ready. In any case, it can be kept for 2 days in the fridge in a closed container and can be frozen, with a shelf life of 3 months in the freezer.

Read also: Luisella woman risotto: a mix of vegetables for a creamy and delicious first course all in a single pan and in 10 minutes

Genoese risotto
Photo by Piero Benigni

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Starry Neapolitan lasagne by Peppe Guida, the chef reveals how to make them at home with the pan trick – Gordon Ramsay’s version

Naples-Lasagna

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Naples-Lasagna

Peppe Guida’s Neapolitan lasagna it is different from all the others. Usually this dish is cooked in the oven, but the chef finds that preparation too heavy and has modified it in his own way. Always use dry pasta, but season it with simple sauce and prepares it in the pan. What also changes is the pasta shape chosen, the mafaldone, which is no longer used so much in our cuisine. But according to him they are perfect to be roll up on the plate with the right seasoning. And they are also beautiful to look at, as well as good. Listen, listen, the result is incredibly exceptional.

Pan-fried lasagna

Ingredients

  • mafaldone 400 g
  • ricotta 2 tbsp
  • parmesan 2 tbsp
  • mozzarella 100 g
  • salt
  • pepper
  • minced beef 250 g
  • minced pork 250 g
  • slices of stale bread 3
  • eggs 2
  • pecorino romano 100 g
  • flour 50 g
  • white wine 1\2 glass
  • extra virgin olive oil
  • tomato puree 2 l
  • garlic 2 cloves

Preparation

The first thing to do to prepare pan-fried lasagna is to combine the meat, salt, pepper, pecorino and the soaked and squeezed bread in a large bowl, mixing with a wooden spoon. Add the eggs and mix vigorously. With slightly wet hands, form meatballs, lightly flour them and brown them in a pan, adding the white wine. Let’s move on to ragù. In a pan, fry two cloves of garlic with extra virgin olive oil. Add the tomato and let it simmer for approximately 20 minutes. Add the meatballs to the sauce and continue cooking for another 15 minutes, adding salt to taste.

Keep warm. Chop the mozzarella. Lower the mafaldone in lightly salted boiling water and cook until al dente. One minute before the end of cooking, stir the pasta into the ragù for a few seconds. Out of the fire add the ricotta, parmesan, mozzarella and a pinch of pepper. Stir well and serve. Your pan-fried lasagna they are ready. Obviously, even in this case, they will always be much better the day after. All you need to do is put them back in the pan. Enjoy your meal.

Read also: Lasagne with pistachio and mortadella, stringy and creamy, are ready in just 10 minutes for Sunday lunch

Naples-Lasagna

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