Diet Quality and Food Additive Exposure in Children with and without Celiac Disease

Abstract

Treatment of celiac disease (CeD) requires adherence to a gluten-free (GF) diet, a restriction that affects food choices and impacts dietary patterns. Pre-clinical research suggests that certain food additives may contribute to ongoing mucosal damage, including increased intestinal permeability and inflammation. The purpose of this study was to quantify the frequency of food additive exposure and assess diet quality in children with and without CeD. Twenty-eight children with (n=15) and without (n=13) CeD between the ages of 6-18 years (mean: 11.29 ± 3.2) were recruited as study participants from Seattle Children’s Hospital. Three-day food records and anthropometric data were obtained for all participants. The intake frequency of 9 common food additives (polysorbate 80, carboxymethyl cellulose, xanthan gum, guar gum, soy lecithin, carrageenan, maltodextrin, titanium dioxide, and aluminosilicates) and macro- and micronutrient intake relative to individualized DRI/AI values were analyzed. Results show that children in the celiac group had a higher number of exposures to xanthan gum and fewer met recommendations for thiamin, folate, magnesium, manganese, and potassium compared to their non-celiac counterparts. Secondary analyses revealed that both groups had similar intake of processed foods, however gluten-free products (GFPs) contributed 29% of total energy in the GF diet and a higher proportion of GFPs contained food additives compared to other processed foods. In the celiac group, those with higher consumption of GFPs had s higher frequency of exposure to food additives. This research provides insight into the nuances of the GF diet and the contribution of GPFs. Such an understanding may inform dietary recommendations for children with CeD and highlights a need for additional research to explore the health implications of food additive intake in this population.