Skip to main content
SpringerLink
Log in

Intake and sources of gluten in 20- to 75-year-old Danish adults: a national dietary survey

  • Original Contribution
  • Published:
European Journal of Nutrition Aims and scope Submit manuscript

Abstract

Purpose

Celiac disease, an immunological response triggered by gluten, affects ~1 % of the Western population. Information concerning gluten intake in the general population is scarce. We determined intake of gluten from wheat, barley, rye and oat in the Danish National Survey of Diet and Physical Activity 2005–2008. The study population comprised a random cross-sectional sample of 1494 adults 20–75 years, selected from the Danish Civil Registration System.

Methods

Protein content in wheat, rye, barley and oat was determined from the National Danish Food Composition Table and multiplied with the amount of cereal used in recipes. Amount of gluten was calculated as amount of cereal protein ×0.80 for wheat and oat, ×0.65 for rye and ×0.50 for barley. Dietary intake was recorded daily during seven consecutive days in pre-coded food diaries with open-answer possibilities.

Results

Mean total gluten intake was 10.4 ± 4.4 g/day (10th–90th percentiles; 5.4–16.2 g/day), in men 12.0 ± 4.6 g/day and 9.0 ± 3.4 g/day in women. It was higher among men than among women in all age groups (20–75 years; P < 0.0001); however, this difference was eliminated when adjusting for energy intake. Intake of different gluten sources tended to be higher in men than in women with the exception of gluten from barley. Total gluten intake decreased with increasing age (P < 0.0001) as did gluten intake from wheat (P < 0.0001), whereas intake of gluten from rye (P < 0.0001) and barley (P = 0.001) increased with increasing age, also when adjusted for energy intake or body weight.

Conclusion

This study presents representative population-based data on gluten intake in Danish adults. Total gluten intake decreased with increasing age.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Sollid LM, Jabri B (2013) Triggers and drivers of autoimmunity: lessons from coeliac disease. Nat Rev Immunol 13:294–302

    Article  CAS  Google Scholar 

  2. Hill ID, Dirks MH, Liptak GS, Colletti RB, Fasano A, Guandalini S, Hoffenberg EJ, Horvath K, Murray JA, Pivor M, Seidman EG (2005) Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 40:1–19

    Article  Google Scholar 

  3. American Gastroenterological Association (2001) American Gastroenterological Association medical position statement: celiac sprue. Gastroenterology 120:1522–1525

    Article  Google Scholar 

  4. Mäki M, Collin P (1997) Coeliac disease. Lancet 349:1755–1759

    Article  Google Scholar 

  5. Johnston SD, Watson RG, McMillan SA, Sloan J, Love AH (1997) Prevalence of coeliac disease in Northern Ireland. Lancet 350:1370

    Article  CAS  Google Scholar 

  6. Sanders DS, Patel D, Stephenson TJ, Ward AM, McCloskey EV, Hadjivassiliou M, Lobo AJ (2003) A primary care cross-sectional study of undiagnosed adult coeliac disease. Eur J Gastroenterol Hepatol 15:407–413

    Article  CAS  Google Scholar 

  7. West J, Logan RF, Hill PG, Lloyd A, Lewis S, Hubbard R, Reader R, Holmes GK, Khaw KT (2003) Seroprevalence, correlates, and characteristics of undetected coeliac disease in England. Gut 52:960–965

    Article  CAS  Google Scholar 

  8. Fasano A, Berti I, Gerarduzzi T, Not T, Colletti RB, Drago S, Elitsur Y, Green PH, Guandalini S, Hill ID, Pietzak M, Ventura A, Thorpe M, Kryszak D, Fornaroli F, Wasserman SS, Murray JA, Horvath K (2003) Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med 163:286–292

    Article  Google Scholar 

  9. Dube C, Rostom A, Sy R, Cranney A, Saloojee N, Garritty C, Sampson M, Zhang L, Yazdi F, Mamaladze V, Pan I, Macneil J, Mack D, Patel D, Moher D (2005) The prevalence of celiac disease in average-risk and at-risk Western European populations: a systematic review. Gastroenterology 128:S57–S67

    Article  Google Scholar 

  10. Ludvigsson JF, Rubio-Tapia A, van Dyke CT, Melton LJ III, Zinsmeister AR, Lahr BD, Murray JA (2013) Increasing incidence of celiac disease in a North American population. Am J Gastroenterol 108:818–824

    Article  Google Scholar 

  11. Dydensborg S, Toftedal P, Biaggi M, Lillevang ST, Hansen DG, Husby S (2012) Increasing prevalence of coeliac disease in Denmark: a linkage study combining national registries. Acta Paediatr 101:179–184

    Article  Google Scholar 

  12. Catassi C, Kryszak D, Bhatti B, Sturgeon C, Helzlsouer K, Clipp SL, Gelfond D, Puppa E, Sferruzza A, Fasano A (2010) Natural history of celiac disease autoimmunity in a USA cohort followed since 1974. Ann Med 42:530–538

    Article  Google Scholar 

  13. Rewers M (2005) Epidemiology of celiac disease: what are the prevalence, incidence, and progression of celiac disease? Gastroenterology 128:S47–S51

    Article  Google Scholar 

  14. Myleus A, Ivarsson A, Webb C, Danielsson L, Hernell O, Hogberg L, Karlsson E, Lagerqvist C, Norstrom F, Rosen A, Sandstrom O, Stenhammar L, Stenlund H, Wall S, Carlsson A (2009) Celiac disease revealed in 3 % of Swedish 12-year-olds born during an epidemic. J Pediatr Gastroenterol Nutr 49:170–176

    Article  Google Scholar 

  15. Antvorskov JC, Josefsen K, Engkilde K, Funda DP, Buschard K (2014) Dietary gluten and the development of type 1 diabetes. Diabetologia 57:1770–1780

    Article  CAS  Google Scholar 

  16. Cohn A, Sofia AM, Kupfer SS (2014) Type 1 diabetes and celiac disease: clinical overlap and new insights into disease pathogenesis. Curr Diab Rep 14:517

    Article  Google Scholar 

  17. Goldstein NS (2004) Non-gluten sensitivity-related small bowel villous flattening with increased intraepithelial lymphocytes: not all that flattens is celiac sprue. Am J Clin Pathol 121:546–550

    Article  Google Scholar 

  18. Blomfeldt TO, Kuktaite R, Johansson E, Hedenqvist MS (2011) Mechanical properties and network structure of wheat gluten foams. Biomacromolecules 12:1707–1715

    Article  CAS  Google Scholar 

  19. Vader LW, Stepniak DT, Bunnik EM, Kooy YM, de Haan W, Drijfhout JW, Van Veelen PA, Koning F (2003) Characterization of cereal toxicity for celiac disease patients based on protein homology in grains. Gastroenterology 125:1105–1113

    Article  CAS  Google Scholar 

  20. Janatuinen EK, Pikkarainen PH, Kemppainen TA, Kosma VM, Jarvinen RM, Uusitupa MI, Julkunen RJ (1995) A comparison of diets with and without oats in adults with celiac disease. N Engl J Med 333:1033–1037

    Article  CAS  Google Scholar 

  21. Kemppainen T, Janatuinen E, Holm K, Kosma VM, Heikkinen M, Maki M, Laurila K, Uusitupa M, Julkunen R (2007) No observed local immunological response at cell level after five years of oats in adult coeliac disease. Scand J Gastroenterol 42:54–59

    Article  Google Scholar 

  22. Arentz-Hansen H, Fleckenstein B, Molberg O, Scott H, Koning F, Jung G, Roepstorff P, Lundin KE, Sollid LM (2004) The molecular basis for oat intolerance in patients with celiac disease. PLoS Med 1:e1

    Article  Google Scholar 

  23. van Overbeek FM, Uil-Dieterman IG, Mol IW, Kohler-Brands L, Heymans HS, Mulder CJ (1997) The daily gluten intake in relatives of patients with coeliac disease compared with that of the general Dutch population. Eur J Gastroenterol Hepatol 9:1097–1099

    Article  Google Scholar 

  24. Pedersen CB (2011) The Danish Civil Registration System. Scand J Public Health 39:22–25

    Article  Google Scholar 

  25. Pedersen AN, Fagt S, Groth MV, Christensen T, Biltoft-Jensen A, Matthiessen J, Andersen NL, Kørup K, Hartkopp H, Ygil KH, Hinsch H-J, Saxholt E, and Trolle E. Dietary habits in Denmark 2003–2008. Main results. 2010. National Food Institute, Technical University of Denmark

  26. Goldberg GR, Black AE, Jebb SA, Cole TJ, Murgatroyd PR, Coward WA, Prentice AM (1991) Critical evaluation of energy intake data using fundamental principles of energy physiology: 1. Derivation of cut-off limits to identify under-recording. Eur J Clin Nutr 45:569–581

    CAS  Google Scholar 

  27. Black AE (2000) Critical evaluation of energy intake using the Goldberg cut-off for energy intake: basal metabolic rate. A practical guide to its calculation, use and limitations. Int J Obes Relat Metab Disord 24:1119–1130

    Article  CAS  Google Scholar 

  28. Biltoft-Jensen A, Matthiessen J, Rasmussen LB, Fagt S, Groth MV, Hels O (2009) Validation of the Danish 7-day pre-coded food diary among adults: energy intake v. energy expenditure and recording length. Br J Nutr 102:1838–1846

    Article  CAS  Google Scholar 

  29. Hoppe C, Trolle E, Gondolf UH, Husby S (2013) Gluten intake in 6-36-month-old Danish infants and children based on a national survey. J Nutr Sci 2:1–7

    Article  Google Scholar 

  30. Saxholt E, Christensen AT, Møller A, Hartkopp H, Ygil KH, Hels OH (2008) Danish Food Composition Databank, revision 7. Division of Nutrition, National Food Institute, Technical University of Denmark

  31. Wieser H, Seilmeier W, Belitz HD (1980) Comparative investigations of partial amino acid sequences of prolamines and glutelins from cereals. II. Fractionation of glutelins (author’s transl). Z Lebensm Unters Forsch 171:430–436

    Article  CAS  Google Scholar 

  32. Gellrich C, Schieberle P, Weiser H (2003) Biochemical characterization and quantification of the storage protein (secalin) types in rye flour. Cereal Chem 80:102–109

    Article  CAS  Google Scholar 

  33. Ellis HJ, Freedman AR, Ciclitira PJ (1990) Detection and estimation of the barley prolamin content of beer and malt to assess their suitability for patients with celiac-disease. Clin Chim Acta 189:123–130

    Article  CAS  Google Scholar 

  34. Livingstone MB, Black AE (2003) Markers of the validity of reported energy intake. J Nutr 133(Suppl 3):895S–920S

    CAS  Google Scholar 

  35. Bingham SA, Gill C, Welch A, Cassidy A, Runswick SA, Oakes S, Lubin R, Thurnham DI, Key TJ, Roe L, Khaw KT, Day NE (1997) Validation of dietary assessment methods in the UK arm of EPIC using weighed records, and 24-hour urinary nitrogen and potassium and serum vitamin C and carotenoids as biomarkers. Int J Epidemiol 26(Suppl 1):S137–S151

    Article  Google Scholar 

  36. Knudsen VK, Gille MB, Nielsen TH, Christensen T, Fagt S, Biltoft-Jensen A (2011) Relative validity of the pre-coded food diary used in the Danish National Survey of Diet and Physical Activity. Public Health Nutr 14:2110–2116

    Article  Google Scholar 

  37. Tolonen H, Laatikainen T, Helakorpi S, Talala K, Martelin T, Prattala R (2010) Marital status, educational level and household income explain part of the excess mortality of survey non-respondents. Eur J Epidemiol 25:69–76

    Article  Google Scholar 

  38. Vriezinga SL, Auricchio R, Bravi E, Castillejo G, Chmielewska A, Crespo EP, Kolacek S, Koletzko S, Korponay-Szabo IR, Mummert E, Polanco I, Putter H, Ribes-Koninckx C, Shamir R, Szajewska H, Werkstetter K, Greco L, Gyimesi J, Hartman C, Hogen EC, Hopman E, Ivarsson A, Koltai T, Koning F, Martinez-Ojinaga E, te Marvelde C, Pavic A, Romanos J, Stoopman E, Villanacci V, Wijmenga C, Troncone R, Mearin ML (2014) Randomized feeding intervention in infants at high risk for celiac disease. N Engl J Med 371:1304–1315

    Article  CAS  Google Scholar 

  39. Lionetti E, Castellaneta S, Francavilla R, Pulvirenti A, Tonutti E, Amarri S, Barbato M, Barbera C, Barera G, Bellantoni A, Castellano E, Guariso G, Limongelli MG, Pellegrino S, Polloni C, Ughi C, Zuin G, Fasano A, Catassi C (2014) Introduction of gluten, HLA status, and the risk of celiac disease in children. N Engl J Med 371:1295–1303

    Article  Google Scholar 

  40. Szajewska H, Shamir R, Chmielewska A, Piescik-Lech M, Auricchio R, Ivarsson A, Kolacek S, Koletzko S, Korponay-Szabo I, Mearin ML, Ribes-Koninckx C, Troncone R (2015) Systematic review with meta-analysis: early infant feeding and coeliac disease—update 2015. Aliment Pharmacol Ther 41:1038–1054

    Article  CAS  Google Scholar 

  41. Hogg-Kollars S, Al DD, Tait K, Rostami K (2014) Type 1 diabetes mellitus and gluten induced disorders. Gastroenterol Hepatol Bed Bench 7:189–197

    Google Scholar 

Download references

Acknowledgments

The authors wish to thank Data Warehouse Manager Karsten Kørup and Data Scanning Manager Hanne-Jette Hinsch as well as Majken Ege and Karin Hess Ygil (Division of Nutrition, National Food Institute, Technical University of Denmark) for contributing to the data processing. The authors express their gratitude to all the participating children and parents in DANSDA. The authors conceived the study (C.H., S.H.), designed the analyses of this study (C.H.) and were responsible for the design and collection of data from the Danish National Survey of Diet and Physical Activity (S.F., J.M., E.T.) and responsible for data interpretation and processing (T.C.). C.H. was responsible for analyses of data and writing the manuscript. All authors participated in the discussion of the results and revision of the manuscript. This study was supported by the Danish Strategic Research Council (Project No. 09-06-5149), and the Danish National Survey of Diet and Physical Activity (DANSDA) was financed by the Ministry of Food, Agriculture and Fisheries.

Author information

Authors and Affiliations

  1. Division of Nutrition, National Food Institute, Technical University of Denmark, Mørkhøj Bygade 19, 2860, Søborg, Denmark

    Camilla Hoppe, Jeppe Matthiessen, Tue Christensen, Ellen Trolle & Sisse Fagt

  2. Faculty of Health and Medical Sciences, Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark

    Rikke Gøbel & Mia Linda Madsen

  3. Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark

    Mette Kristensen

  4. Food and Nutrition Science, Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden

    Mads Vendelbo Lind

  5. Hans Christian Andersen Children’s Hospital, Odense University Hospital/University of Southern Denmark, Odense, Denmark

    Mads Vendelbo Lind & Steffen Husby

Authors
  1. Camilla Hoppe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rikke Gøbel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mette Kristensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mads Vendelbo Lind
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jeppe Matthiessen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tue Christensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ellen Trolle
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sisse Fagt
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mia Linda Madsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Steffen Husby
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tue Christensen.

Ethics declarations

Conflict of interest

None of the authors have declared any conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hoppe, C., Gøbel, R., Kristensen, M. et al. Intake and sources of gluten in 20- to 75-year-old Danish adults: a national dietary survey. Eur J Nutr 56, 107–117 (2017). https://doi.org/10.1007/s00394-015-1062-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00394-015-1062-3

Keywords

Search

Navigation