Nuovi Cereali/Pseudocereali

Nuovi Cereali/Pseudocereali
Alessandro CASINI CdL Magistrale in Scienze dell’Alimentazione Dip. Medicina Sperimentale e Clinica Università di Firenze Pseudocereals
Pseudocereals do not belong to the cereal family but
still produce flours and seeds which can be used as
flour
The three main used pseudocereals are:
•  Amaranth (Amaranthus sp)
•  Buckwheat (Fagopyrum spp)
•  Quinoa (Chenopodium quinoa) Botanically they are dicotyledonae (unlike cereals, which
are monocotyledonae)
Pseudocereals
All pseudocereals are naturally gluten-free and have
a low glycemic index The content of minerals and protein is higher
and amino acid composition it better balanced than
in most cereal species
Pseudocereals present a healthy alternative in
order to increase the range of used plants for human
nutrition
Amaranth
Native to the Americas. Was a
staple of the Aztecs. Cultivated since ca. 6.000 BC.
High in:
•  vitamin A, B and C
•  iron, phosphorus,
magnesium, calcium •  alpha linolenic acid •  lysine
Quinoa
Native to the highland plains of
South-American Andes region.
Was a staple of the Incas. Quinoa has been classified as one
of the humanity’s most promising
crops High in:
•  vitamin A, folate, lutein,
carotene
•  phosphorus, copper,
magnesium, calcium,
potassium, iron •  all of the essential amino
acids
Buckwheat
Native to Southeast Asia. It can be
grown in high latitude or northern
areas. Cultivated since ca. 6.000
BC.
High in:
•  vitamin B
•  magnesium,
manganese
phosphorus, iron, zinc
•  rutin, tannins
•  lysine
Potential use of pseudocereals
BUCKWHEAT
it can be consumed as
grains or as flour
AMARANTH
seeds are usually used
as wholegrain
QUINOA
seeds need to be
dehulled in order to
remove bitter tasting
saponins
GLUTEN-FREE PRODUCTS
Pseudocereals and gluten-related
disorders Journal of the American Dietetic Association,
2001
C o n c e r n i n g bu c k wh e a t ,
amaranth, and quinoa,
t h e r e i s n o s c i e n t i fi c
evidence suggesting these
plant foods are harmful
Pseudocereals and gluten-related
disorders Comparison of
s e l e c t
nu t r i e n t s o f
the standard
a
n
d
alternative
gluten-free
d i e t a r y
pattern to the
d
a
i
l
y
The British
Dietetic Association, 2009 recommended
Non-celiac gluten sensitivity
Non-celiac gluten sensitivity (NCGS) is an emerging syndrome in
people who have tested negative for celiac disease and wheat
allergy and who have symptoms that are evoked by ingestion of
gluten
It is a complex disorder characterized by gastrointestinal
symptoms as well as systemic symptoms
• 
• 
• 
• 
• 
abdominal pain
bloating
diarrhea
constipation
nausea
• 
• 
• 
• 
• 
headache
fatigue musculoskeletal pain
brain fog
tingling/numbness in
hands and feet
Estimated prevalence of NCGS
The precise cause and progression of NCGS is
unknown as is the prevalence of such conditions across
different populations; estimates range from 0.6% to 6%
The implications of adopting a gluten-free diet both in
terms of nutritional value of the gluten-free alternatives
and the risk of nutritional deficiency as a result of
removing a staple food group have, as yet, received little
consideration
Symptomatic efficacy of buckwheat
products in non-celiac gluten
sensitivity: a randomized dietary
intervention trial
M. Dinu,1 F. Sofi,1,2 D. Macchia,3 A. Casini1
1 Department
of Experimental and Clinical Medicine, School of Human Health Sciences, University of
Florence,
of Clinical Nutrition, Careggi University Hospital, Florence, Italy; 2 Don Carlo Gnocchi
Foundation Italy, Onlus IRCCS, Florence, Italy ; 3 Unit of Allergology and Clinical Immunology, S. Giovanni di
Dio Hospital, Florence, Italy
Italy ; Unit
Nutritional composition of
buckwheat
Ø  CARBOHYDRATES: buckwheat contains mainly carbohydrates, in the
form of starches, wich give it thickening properties
Ø  PROTEIN: specially lysine, deficent amino acid in all cereals, and
methionine, limiting amino acid in legumes. It has no gluten.
Ø  FAT: buckwheat contains very little fat, which makes it a very helathy
food for people with vascular problems and cholesterol
Ø  FIBER: buckwheat is very rich in fiber, specially soluble fiber
Ø  VITAMINS: specially niacin, folic acid, pantothenic acid, thiamine and
riboflavin
Ø  MINERALS: being high in potassium and low in sodium, it is diuretic.
It also contains magnesium, copper, zinc, selenium
Ø  PHENOLIC COMPOUNDS: specially routine, quercetin and hesperidin,
flavonoid with antioxidant effect
Health effects of buckwheat
Hypocolesterolemic
Anticancer
Neuroprotection
Hypoglucemic
Hypotensive
Anti-inflammatory
Antioxidant activity of buckwheat
Cardiovascolar risk Tumor risk 328,2 mg/100g d.w. 34,3 mg/100g d.w. Range: 4-­‐6 % Aim
To investigate whether a diet based on
Buckwheat products can improve:
1.  gastrointestinal symptoms
2.  systemic symptoms
3.  quality of life
4.  biochemical parameters Study population
19 patients with a diagnosis of NCGS
Inclusion criteria
• 
Age >18 years
• 
Symptoms of NCGS
• 
Absence of celiac disease
• 
Negative immune allergy tests to wheat
Exclusion criteria
• 
Patients with chronic inflammatory gastrointestinal
• 
Alcohol abusers
Study population
19 patients with a diagnosis of NCGS
Variable
Age, yrs, median (range)
Males/Females
Body Mass Index, kg/m2(mean ± SD)
44 (28-65)
1 / 18
23.7 ± 5
Total SSS Score, (mean ± SD)
261 ± 153
Hypercolesterolemia, n (%)
4 (21%)
Smoking habit, n (%)
3 (16%)
Sedentary lifestyle, n (%)
5 (26%)
Study design
Group B
(n=10)
Control
6 weeks
Buckwhe
at
T0
Group A
(n=9)
T2
Group B
(n=10)
Control
6 weeks
Buckwhea
t
T1
Group A
(n=9)
Material and methods
Participants in Buckwheat group received 80 g per day of
pasta, 60 g per day of hard tacks, 40 g per day of biscuits and 50 g
per day of flakes. The subjects were instructed not to consume any
other cereal products throughout the experimental period of the
study.
During the Control period participants were permitted to eat all
foods according to their “normal eating habits”. Material and methods
Clinical evaluation
Patients were evaluated at baseline and every week of both
intervention phases by using two different clinical questionnaires:
1.  IBS Global Assessment of Improvement
Scale (IBS-GAI)
2.  IBS Symptom Severity Scale (IBS-SSS)
IBS-GAI
IBS Global Improvement Scale (IBS-GAI) asks participants:
“Compared to the way you felt before you entered the
study, have your IBS symptoms over the past 7 days
been: 1) “Substantially worse” 2) “Moderately worse” 3) “Slightly worse” 4) “No change” 5) “Slightly improved” 6) “Moderately improved”
7) “Substantially improved”
IBS-SSS
The IBS Symptom Severity Scale (IBS-SSS) contains five
questions that measure, on a 100-point VAS: 1.  the severity of abdominal pain
2.  the frequency of abdominal pain 3.  the severity of abdominal distention
4.  dissatisfaction with bowel habits
5.  interference with quality of life How do you measure the gravity of… in the last week?
0
10
20
30
40
50
60
70
80
90
100
Material and methods
Laboratory evaluation
Biochemical
profile
Lipid profile
White blood cells
Blood glucose
Serum electrolytes
Liver enzymes
Creatinine
Conventional
methods
Total cholesterol
LDL-cholesterol
HDL-cholesterol
Triglycerides
Conventional
methods
Glucometaboli
c profile
Fasting glucose
Insulin
HbA1C
HOMA-index
Inflammatory
profile
Pro- and antiinflammatory
cytokines
Conventional
methods
Multiplex bead-based
assay (Bioplex)
Characteristics of study population
Baseline characteristics
Variable
Group A (n=9)
Group B (n=10)
P value
Age, yrs
49 (28-57)
42 (28-66)
0.7
BMI, kg/m2
24.4 ± 7
23 ± 2.3
0.7
BMI > 25, n
2/9
2/10
1
Hypercolesterolemia, n
1/9
3/10
0.5
MD score, (mean±SD)
10.8 ± 1.3
12.7 ± 1.2
0.08
Abominal pain, GAI
3.6 ± 2.4
4.2 ± 2
0.6
Bloating, GAI
3.4 ±2.3
4.2±2
0.4
66.7 ± 33.5
46.5 ± 27.1
0.2
314.4 ± 124.3
259.5 ± 124.1
0.5
Total cholesterol, mg/dl
209 ± 23.5
194.6 ± 30
0.4
Triglycerides, mg/dl
78.2 ± 37.6
92.4 ± 52.2
0.6
Insulin, U/L
10.5 ± 6.3
9.3 ± 5.3
0.5
Quality of life, VAS
Total score, VAS
MD = Mediterranean Diet; GAI = Global Improvement Scale; VAS = Visual Analogue Scale
Results – IBS-SSS
Severity of ABDOMINAL PAIN (100=Very severe; 0=No pain)
60 50 General linear model adjusted for age and
sex
p=0.03
40 p n.s.
30 20 10 p=0.7
p n.s.
Results – IBS-SSS
Severity of BLOATING (100=Very severe; 0=No bloating)
60 50 General linear model adjusted for age and
sex
p for
trend=0.04
p n.s.
40 30 p n.s.
20 p for trend=0.3
10 Results – IBS-SSS
TOTAL IBS-SSS Score (100=Very severe; 0=Not severe)
*
* p < 0.05
-27%
+30%
Buckwheat intervention period Patients with
moderate and
severe NCGS
manifestations at
baseline were more
likely to indicate
significant
improvements in
NCGS symptoms,
compared to
patients with mild
NCGS symptoms
at baseline Results – IBS-GAI
Severity of HEADACHE
(1=Worst; 7=Better)
* - 25,5 %
+ 2,4 %
* p < 0.05
General linear model adjusted for age and
Results – IBS-GAI
Severity of JOINT/MUSCLE PAIN
(1=Worst; 7=Better)
* - 28,3 %
+ 25,7 %
* p < 0.05
General linear model adjusted for age and
Results – IBS-GAI
Severity of NAUSEA
(1=Worst; 7=Better)
* - 24,1 %
- 6,3 %
* p < 0.05
General linear model adjusted for age and
Results – IBS-GAI
Satisfaction with STOOL CONSISTENCY (1=Worst; 7=Better)
* - 18,8 %
- 9,1 %
* p < 0.05
General linear model adjusted for age and
Results – IBS-GAI
ATTENTION SPAN
(1=Worst; 7=Better)
* - 18,8 %
+16,2 %
* p < 0.05
General linear model adjusted for age and
Results – Biochemical parameters
Serum magnesium, mg/dL
* + 4,7 %
* p < 0.05
General linear model adjusted for age and
Results – Inflammatory parameters
IFN-gamma (pg/mL)
* - 33,3 %
- 18,3 %
* p < 0.05
General linear model adjusted for age and
Results – Inflammatory parameters
MCP-1 (pg/mL)
* - 26,2 %
* p < 0.05
General linear model adjusted for age and
Conclusions
Buckwheat products determine
significant improvements of self-reported
symptoms related to non-celiac gluten
sensitivity
These results seem to be extremely
important for tailoring treatment and
lifestyle recommendations in patients
with such relevant syndrome