TY - JOUR
T1 - Safety of Adding Oats to a Gluten-Free Diet for Patients With Celiac Disease
T2 - Systematic Review and Meta-analysis of Clinical and Observational Studies
AU - Pinto-Sánchez, María Inés
AU - Causada-Calo, Natalia
AU - Bercik, Premysl
AU - Ford, Alexander C.
AU - Murray, Joseph A.
AU - Armstrong, David
AU - Semrad, Carol
AU - Kupfer, Sonia S.
AU - Alaedini, Armin
AU - Moayyedi, Paul
AU - Leffler, Daniel A.
AU - Verdú, Elena F.
AU - Green, Peter
N1 - Publisher Copyright:
© 2017 AGA Institute
PY - 2017/8
Y1 - 2017/8
N2 - Background & Aims Patients with celiac disease should maintain a gluten-free diet (GFD), excluding wheat, rye, and barley. Oats might increase the nutritional value of a GFD, but their inclusion is controversial. We performed a systematic review and meta-analysis to evaluate the safety of oats as part of a GFD in patients with celiac disease. Methods We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE databases for clinical trials and observational studies of the effects of including oats in GFD of patients with celiac disease. The studies reported patients’ symptoms, results from serology tests, and findings from histologic analyses. We used the GRADE approach to assess the quality of evidence. Results We identified 433 studies; 28 were eligible for analysis. Of these, 6 were randomized and 2 were not randomized controlled trials comprising a total of 661 patients—the remaining studies were observational. All randomized controlled trials used pure/uncontaminated oats. Oat consumption for 12 months did not affect symptoms (standardized mean difference: reduction in symptom scores in patients who did and did not consume oats, −0.22; 95% CI, −0.56 to 0.13; P =.22), histologic scores (relative risk for histologic findings in patients who consumed oats, 0.24; 95% CI, 0.01–4.8; P =.35), intraepithelial lymphocyte counts (standardized mean difference, 0.21; 95% CI, reduction of 1.44 to increase in 1.86), or results from serologic tests. Subgroup analyses of adults vs children did not reveal differences. The overall quality of evidence was low. Conclusions In a systematic review and meta-analysis, we found no evidence that addition of oats to a GFD affects symptoms, histology, immunity, or serologic features of patients with celiac disease. However, there were few studies for many endpoints, as well as limited geographic distribution and low quality of evidence. Rigorous double-blind, placebo-controlled, randomized controlled trials, using commonly available oats sourced from different regions, are needed.
AB - Background & Aims Patients with celiac disease should maintain a gluten-free diet (GFD), excluding wheat, rye, and barley. Oats might increase the nutritional value of a GFD, but their inclusion is controversial. We performed a systematic review and meta-analysis to evaluate the safety of oats as part of a GFD in patients with celiac disease. Methods We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE databases for clinical trials and observational studies of the effects of including oats in GFD of patients with celiac disease. The studies reported patients’ symptoms, results from serology tests, and findings from histologic analyses. We used the GRADE approach to assess the quality of evidence. Results We identified 433 studies; 28 were eligible for analysis. Of these, 6 were randomized and 2 were not randomized controlled trials comprising a total of 661 patients—the remaining studies were observational. All randomized controlled trials used pure/uncontaminated oats. Oat consumption for 12 months did not affect symptoms (standardized mean difference: reduction in symptom scores in patients who did and did not consume oats, −0.22; 95% CI, −0.56 to 0.13; P =.22), histologic scores (relative risk for histologic findings in patients who consumed oats, 0.24; 95% CI, 0.01–4.8; P =.35), intraepithelial lymphocyte counts (standardized mean difference, 0.21; 95% CI, reduction of 1.44 to increase in 1.86), or results from serologic tests. Subgroup analyses of adults vs children did not reveal differences. The overall quality of evidence was low. Conclusions In a systematic review and meta-analysis, we found no evidence that addition of oats to a GFD affects symptoms, histology, immunity, or serologic features of patients with celiac disease. However, there were few studies for many endpoints, as well as limited geographic distribution and low quality of evidence. Rigorous double-blind, placebo-controlled, randomized controlled trials, using commonly available oats sourced from different regions, are needed.
KW - Gluten Sensitivity
KW - Histology
KW - Nutrition
KW - Symptoms
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U2 - 10.1053/j.gastro.2017.04.009
DO - 10.1053/j.gastro.2017.04.009
M3 - Article
C2 - 28431885
AN - SCOPUS:85021182354
SN - 0016-5085
VL - 153
SP - 395-409.e3
JO - Gastroenterology
JF - Gastroenterology
IS - 2
ER -