title: The effect of substituting alternative grains in the diet on the nutritional profile of the gluten-free diet.
abstract: BACKGROUND
  The only treatment for coeliac disease is lifelong adherence to a gluten-free diet. Several studies have reported nutritional deficiencies in individuals on a gluten-free diet. The present study aimed to determine whether the nutritional profile of gluten-free diet could be improved through the use of alternative grains.
  
  
  METHODS
  A retrospective review of diet history records by a celiac specialist dietitian were used to establish a 'standard' gluten-free dietary pattern. An 'alternative' gluten-free dietary pattern was developed that substituted naturally gluten-free grains or gluten-free products made from 'alternative' flours (oats, high fibre gluten-free bread and quinoa) in the standard pattern. A paired t-test was performed to identify statistical significance between the 'alternative' and standard gluten-free dietary pattern.
  
  
  RESULTS
  Analysis of standard pattern indicated that 38% of meals and snacks contained no grain or starch choice. Of those meals that contained a grain or starch component, rice was the grain chosen 44% of the time. The inclusion of alternative grains or grain products provided a higher nutrient profile compared to the standard gluten-free dietary pattern (P = 0.002). Several nutrients; protein (20.6 g versus 11 g), iron (18.4 mg versus 1.4 mg), calcium (182 mg versus 0 mg) and fibre (12.7 g versus 5 g) were significantly increased by changing the grain or starch component in the dietary pattern. The B vitamin content (riboflavin, niacin and folate) was improved, although this was not statistically significant (P = 0.125).
  
  
  CONCLUSIONS
  The inclusion of alternative grain-based products increased the nutrient profile of the gluten-free dietary pattern significantly.
authors.affiliation: Celiac Disease Center, Department of Medicine, Columbia University, New York, NY, USA. anne.lee@schar.com
authors.forename: A R
authors.initials: AR
authors.lastname: Lee
authors.forename: D L
authors.initials: DL
authors.lastname: Ng
authors.forename: E
authors.initials: E
authors.lastname: Dave
authors.forename: E J
authors.initials: EJ
authors.lastname: Ciaccio
authors.forename: P H R
authors.initials: PH
authors.lastname: Green
mesh_terms: D015930:Diet Records; D055050:Diet, Gluten-Free / Q000592:standards; D004040:Dietary Carbohydrates / Q000008:administration & dosage*; D002523:Edible Grain; D006801:Humans; D009753:Nutritive Value; D012189:Retrospective Studies; D013213:Starch / Q000008:administration & dosage*
chemical_list: D004040:Dietary Carbohydrates; D013213:Starch