Nutritional quality and costs of gluten-free products: a case-control study of food products on the Norwegian marked

  • Mari C.W. Myhrstad Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway https://orcid.org/0000-0003-1982-1792
  • Marlene Slydahl Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
  • Monica Hellmann Det Glutenfrie Verksted, Oslo, Norway
  • Lisa Garnweidner-Holme Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
  • Knut E. A. Lundin K.G. Jebsen Coeliac Disease Research Centre, University of Oslo; and Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
  • Christine Henriksen Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
  • Vibeke H. Telle-Hansen Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
DOI: https://doi.org/10.29219/fnr.v65.6121
Keywords: Gluten-free products, Gluten-containing products, Database, Nutritional quality, Macronutrients, fiber, Price, Unhealthy diet

Abstract

Background: Celiac disease is a chronic autoimmune disease triggered by gluten exposure in genetically predisposed individuals. A life-long intake of a gluten-free (GF) diet is required for its management. Wheat, rye and barley are eliminated in a GF diet and the nutritional adequacy of the diet has been questioned. In Norway, cereals and bread constitute a key role of the diet and are the main source of fiber intake. Gluten restrictions may therefore offer important implications for nutrient adequacy especially linked to fiber intake in people with celiac disease.

Objective: The aim of the study was to investigate the nutritional quality and price of GF products and compare with gluten-containing counterparts available at instead of in the Norwegian market.

Design: The macronutrient content of 423 unique GF products were compared with 337 equivalents with gluten. All products were selected from grocery stores and web-based shops, with the aim of including as many GF products as possible. Listed macronutrients content and price in 11 different food categories were compared to gluten-containing counterparts with Wilcoxon signed rank test.

Results: The GF products contained less protein and fiber, and higher content of saturated fat, carbohydrate and salt compared to the gluten-containing products. The total amount of fat was not different between the groups. A similar pattern was found within several of the food categories. More gluten-containing products met the nutrition claim “high in fiber” (fiber > 6 g/100 g) compared to the GF products. The price of the GF products was higher; ranging from 46%–443% more expensive than the gluten-containing products.

Conclusion: GF products are less nutritious and have a higher price compared to equivalent gluten-containing products. Knowing that an unhealthy diet is the most important risk factor for developing non-communicable diseases, the nutritional quality of a GF diet needs to be addressed and should be improved.

Downloads

Download data is not yet available.

References


  1. Al-Toma A, Volta U, Auricchio R, Castillejo G, Sanders DS, Cellier C, et al. European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United European Gastroenterol J 2019; 7(5): 583–613. doi: 10.1177/2050640619844125
  2. Lindfors K, Ciacci C, Kurppa K, Lundin KEA, Makharia GK, Mearin ML, et al. Coeliac disease. Nat Rev Dis Primers 2019; 5(1): 3. doi: 10.1038/s41572-018-0054-z
  3. Dube C, Rostom A, Sy R, Cranney A, Saloojee N, Garritty C, et al. The prevalence of celiac disease in average-risk and at-risk Western European populations: a systematic review. Gastroenterology 2005; 128(4 Suppl 1): S57–67. doi: 10.1053/j.gastro.2005.02.014
  4. Domsa EM, Berindan-Neagoe I, Para I, Munteanu L, Matei D, Andreica V. Celiac disease: a multi-faceted medical condition. J Physiol Pharmacol 2020; 71(1): 3–4. doi: 10.26402/jpp.2020.1.01
  5. De Re V, Magris R, Cannizzaro R. New insights into the pathogenesis of celiac disease. Front Med (Lausanne) 2017; 4: 137. doi: 10.3389/fmed.2017.00137
  6. Bascunan KA, Vespa MC, Araya M. Celiac disease: understanding the gluten-free diet. Eur J Nutr 2017; 56(2): 449–59. doi: 10.1007/s00394-016-1238-5
  7. Shewry P. What is gluten – why is it special? Front Nutr 2019; 6: 101. doi: 10.3389/fnut.2019.00101
  8. Newberry C, McKnight L, Sarav M, Pickett-Blakely O. Going gluten free: the history and nutritional implications of today’s most popular diet. Curr Gastroenterol Rep 2017; 19(11): 54. doi: 10.1007/s11894-017-0597-2
  9. Day L, Augustin MA, Batey IL, Wrigley CW. Wheat-gluten uses and industry needs. Trends Food Sci Technol 2006; 17(2): 82–90. doi: 10.1016/j.tifs.2005.10.003
  10. Kim HS, Patel KG, Orosz E, Kothari N, Demyen MF, Pyrsopoulos N, et al. Time trends in the prevalence of celiac disease and gluten-free diet in the US population: results from the national health and nutrition examination surveys 2009–2014. JAMA Intern Med 2016; 176(11): 1716–7. doi: 10.1001/jamainternmed.2016.5254
  11. Vici G, Belli L, Biondi M, Polzonetti V. Gluten free diet and nutrient deficiencies: a review. Clin Nutr 2016; 35(6): 1236–41. doi: 10.1016/j.clnu.2016.05.002
  12. Penagini F, Dilillo D, Meneghin F, Mameli C, Fabiano V, Zuccotti GV. Gluten-free diet in children: an approach to a nutritionally adequate and balanced diet. Nutrients 2013; 5(11): 4553–65. doi: 10.3390/nu5114553
  13. Jamieson JA, Weir M, Gougeon L. Canadian packaged gluten-free foods are less nutritious than their regular gluten-containing counterparts. PeerJ 2018; 6: e5875. doi: 10.7717/peerj.5875
  14. Fry L, Madden AM, Fallaize R. An investigation into the nutritional composition and cost of gluten-free versus regular food products in the UK. J Hum Nutr Diet 2018; 31(1): 108–20. doi: 10.1111/jhn.12502
  15. Shepherd SJ, Gibson PR. Nutritional inadequacies of the gluten-free diet in both recently-diagnosed and long-term patients with coeliac disease. J Hum Nutr Diet 2013; 26(4): 349–58. doi: 10.1111/jhn.12018
  16. Skodje GI, Minelle IH, Rolfsen KL, Iacovou M, Lundin KEA, Veierod MB, et al. Dietary and symptom assessment in adults with self-reported non-coeliac gluten sensitivity. Clin Nutr ESPEN 2019; 31: 88–94. doi: 10.1016/j.clnesp.2019.02.012
  17. Barber TM, Kabisch S, Pfeiffer AFH, Weickert MO. The health benefits of dietary fibre. Nutrients 2020; 12(10): 2–9. doi: 10.3390/nu12103209
  18. Veronese N, Solmi M, Caruso MG, Giannelli G, Osella AR, Evangelou E, et al. Dietary fiber and health outcomes: an umbrella review of systematic reviews and meta-analyses. Am J Clin Nutr 2018; 107(3): 436–44. doi: 10.1093/ajcn/nqx082
  19. Institute of Basic Medical Sciences University of Oslo, Norwegian Directorate of Health, Norwegian Food Safety Authority. Norway NORKOST National Food Consumption Survey 2010–2011. 2012.
  20. Norwegian Director of Health. Utviklingen i norsk kosthold 2019. Matforsyningsstatistikk og forbruksundersøkelser. 2019. Available from: https://www.helsedirektoratet.no/rapporter/utviklingen-i-norsk-kosthold/Utviklingen%20i%20norsk%20kosthold%202019%20%E2%80%93%20Fullversjon.pdf/_/attachment/inline/bf435664-65a3-4e30-96ed-24e4629807ad:689bbb7710259adfd5ff46802424938922e0e222/Utviklingen%20i%20norsk%20kosthold%202019%20%E2%80%93%20Fullversjon.pdf [cited 24 February 2021].
  21. Lee AR, Wolf RL, Lebwohl B, Ciaccio EJ, Green PHR. Persistent economic burden of the gluten free diet. Nutrients 2019; 11(2). doi: 10.3390/nu11020399
  22. Hartmann-Boyce J, Bianchi F, Piernas C, Payne Riches S, Frie K, et al. Grocery store interventions to change food purchasing behaviors: a systematic review of randomized controlled trials. Am J Clin Nutr 2018; 107(6): 1004–16. doi: 10.1093/ajcn/nqy045
  23. French SA. Pricing effects on food choices. J Nutr 2003; 133(3): 841S–3S. doi: 10.1093/jn/133.3.841S
  24. Norwegian Director of Health. Healthy Choices made easy, Available from: https://www.helsenorge.no/en/kosthold-og-ernaring/keyhole-healthy-food/ [cited 24 February 2021].
  25. Missbach B, Schwingshackl L, Billmann A, Mystek A, Hickelsberger M, Bauer G, et al. Gluten-free food database: the nutritional quality and cost of packaged gluten-free foods. PeerJ 2015; 3:e1337. doi: 10.7717/peerj.1337
  26. Miranda J, Lasa A, Bustamante MA, Churruca I, Simon E. Nutritional differences between a gluten-free diet and a diet containing equivalent products with gluten. Plant Foods Hum Nutr 2014; 69(2): 182–7. doi: 10.1007/s11130-014-0410-4
  27. Wu JH, Neal B, Trevena H, Crino M, Stuart-Smith W, Faulkner-Hogg K, et al. Are gluten-free foods healthier than non-gluten-free foods? An evaluation of supermarket products in Australia. Br J Nutr 2015; 114(3): 448–54. doi: 10.1017/S0007114515002056
  28. Stephen AM, Champ MM, Cloran SJ, Fleith M, van Lieshout L, Mejborn H, et al. Dietary fibre in Europe: current state of knowledge on definitions, sources, recommendations, intakes and relationships to health. Nutr Res Rev 2017; 30(2): 149–90. doi: 10.1017/S095442241700004X
  29. Kulai T, Rashid M. Assessment of nutritional adequacy of packaged gluten-free food products. Can J Diet Pract Res 2014; 75(4): 186–90. doi: 10.3148/cjdpr-2014-022
  30. Tres A, Tarnovska N, Varona E, Quintanilla-Casas B, Vichi S, Gibert A, et al. Determination and comparison of the lipid profile and sodium content of gluten-free and gluten-containing breads from the Spanish market. Plant Foods Hum Nutr 2020; 75(3): 344–54. doi: 10.1007/s11130-020-00828-w
  31. El Khoury D, Balfour-Ducharme S, Joye IJ. A review on the gluten-free diet: technological and nutritional challenges. Nutrients 2018; 10(10): 2–8. doi: 10.3390/nu10101410
  32. Nordic Cooperations Nordic Nouncil of Ministers. Nordic nutrition recommendations 2012: integrating nutrition and physical activity. 2012.
  33. Mozaffarian D, Micha R, Wallace S. Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and meta-analysis of randomized controlled trials. PLoS Med 2010; 7(3): e1000252. doi: 10.1371/journal.pmed.1000252
  34. Emilsson L, Lebwohl B, Sundstrom J, Ludvigsson JF. Cardiovascular disease in patients with coeliac disease: a systematic review and meta-analysis. Dig Liver Dis 2015; 47(10): 847–52. doi: 10.1016/j.dld.2015.06.004
  35. Strazzullo P, D’Elia L, Kandala NB, Cappuccio FP. Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies. BMJ 2009; 339: b4567. doi: 10.1136/bmj.b4567
  36. Collaborators GBDD. Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2019; 393(10184): 1958–72. doi: 10.1016/S0140-6736(19)30041-8
  37. World Health Organization. Guideline: sodium intake for adults and children. Geneva: World Health Organization; 2012.
  38. Norwegian Director of Health. The salt partnership 2015–2018 progress and achievements. 2019.
  39. Burden M, Mooney PD, Blanshard RJ, White WL, Cambray-Deakin DR, Sanders DS. Cost and availability of gluten-free food in the UK: in store and online. Postgrad Med J 2015; 91(1081): 622–6. doi: 10.1136/postgradmedj-2015-133395
  40. NAV.Grunn- og hjelpestønad. 2020. Available from: https://www.nav.no/no/nav-og-samfunn/kontakt-nav/oversikt-over-satser/grunn-og-hjelpestonad_kap [cited 5 October 2020].
  41. Agriculture and Agri-food Canada. ‘Gluten Free’ claims in the marketplace. 2014. Available from: https://www5.agr.gc.ca/eng/industry-markets-and-trade/canadian-agri-food-sector-intelligence/processed-food-and-beverages/trends-and-market-opportunities-for-the-food-processing-sector/gluten-free-claims-in-the-marketplace/?id=1397673574797 [cited 5 October 2020].
Published
2021-03-26
How to Cite
Myhrstad M. C., Slydahl M., Hellmann M., Garnweidner-Holme L., Lundin K. E. A., Henriksen C., & Telle-Hansen V. H. (2021). Nutritional quality and costs of gluten-free products: a case-control study of food products on the Norwegian marked. Food & Nutrition Research, 65. https://doi.org/10.29219/fnr.v65.6121
Issue
Vol 65 (2021)
Section
Original Articles
Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors retain copyright of their work, with first publication rights granted to SNF Swedish Nutrition Foundation. Read the full Copyright- and Licensing Statement.

 

 

Crossref
Scopus
Google Scholar
Europe PMC

Most read articles by the same author(s)