Folate content of gluten-free food purchases and dietary intake are low in children with coeliac disease

Abstract

The lack of mandated folate enrichment of gluten-free (GF) grains in Canada has been suspected to contribute to suboptimal folate intake among children suffering from Celiac disease (CD). Children with CD on the gluten-free diet (GFD) face nutrient imbalances (higher fat/sugar, lower folate) from processed GF foods. The study objective examined folate intake in children with CD and folate content of household food purchases. Households collected food receipts for 30 days to assess folate content. Folate-rich foods were defined as ≥60 µg dietary folate equivalent (DFE)/100g. Two 24-hour recalls assessed children’s intake. Households (n = 73) purchased >17,000 food items. Median child age was 10.5 y (IQR: 8.4–14.1). GF folate-rich foods represented <15% of all household food purchases and 69% of children had low folate intakes. Folate-rich foods consumed included legumes/GF-breakfast cereals. These represented 5% of GF-food purchases/intake. Few were fortified with folate. Findings highlight the need for mandated GF folate food fortification policy.

Keywords:

• Celiac
•  disease
• folate
• gluten-free
• children
• food purchases
• dietary intake

Acknowledgements

The authors would like to acknowledge Seema Rajani MSc, Kelsey Gordulik BSc RD, and Kelly Shih for their assistance with data collection and data entry. The children and families are gratefully acknowledged for their participation in this research. Funders had no role in the design, analysis, or writing of this article.

Author contributions

D.R.M., S.A. co-developed the research question and study design. D.R.M. supervised data collection/analysis, interpreted results, co-wrote the manuscript and approved final manuscript. D.R.M, A.L., S.C., H.M, and C.K., implemented the study. S.C. and D.R.M. were responsible for statistical analysis. S.C. and D.R.M. drafted the manuscript. S.A., A.L., S.C., C.K., H.M., J.D., R.N., M.M., H.B., J.T. and D.R.M. contributed to the interpretation of results and approved the final manuscript for publication.

Disclosure statement

No conflict of interest was reported by the author(s). The lead author affirms that this manuscript is an honest, accurate, and a transparent account of the study being reported. The reporting of this work is compliant with STROBE guidelines. The lead author affirms that no important aspects of the study have been omitted and that any discrepancies from the study as planned have been explained.

Additional information

Funding

This study was funded by the J. A Campbell Award (DRM) by the Canadian Celiac Association.