International Journal of Celiac Disease, 2015, Vol. 3, No. 3, 102-107 Available online at http://pubs.sciepub.com/ijcd/3/3/3 © Science and Education Publishing DOI:10.12691/ijcd-3-3-3 Following Gluten Free Diet: Less Available, Higher Cost and Poor Nutritional Profile of Gluten-Free School Snacks Amaya Oyarzún 1 , Talya Nakash 1 , Jimena Ayala 1 , Yalda Lucero 2 , Magdalena Araya 1,* 1 Human Nutrition, Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile 2 Department of Pediatrics, Faculty of Medicine, University of Chile, Santiago, Chile *Corresponding author: maraya@inta.uchile.cl Received May 10, 2015; Revised May 23, 2015; Accepted Jun 25, 2015 Abstract Background. Celiac disease has a high prevalence globally and to date the only effective treatment is a strict gluten-free diet for life. Diet compliance is difficult due to current unhealthy eating habits and increasing overweight/obesity, especially for school age children. Objectives. To assess availability, cost and nutritional adequacy of gluten-free school snacks. Methods. Five store categories (large, regular-size and wholesale supermarkets, health food stores and corner shops) were assessed in districts representing low, middle and high socioeconomic levels. Three categories of school snacks were surveyed: dairy products (milk boxes, yogurts), cereals (in bulk, cereal bars) and baked goods (various cookies). Portions and prices were standardized and the closest gluten-containing products were matched for comparison. Availability, cost and nutritional quality (total calories, total fat, carbohydrates and sodium) were then evaluated. Results. A total of 1562 products were assessed. Gluten-free products were less available, with significant differences among the socioeconomic levels for cereals and baked goods (P<0.05). Also, they were more expensive than gluten-containing products. Except for cereal calories and sodium in the upper socioeconomic level, less than one third of the products available met FAO/WHO recommendations. Products meeting all 4 characteristics (total calories, total fat, carbohydrates and sodium) analyzed were 7.8%, 7.3% and 7.3% in the upper, middle and low socioeconomic level, respectively. Conclusions. Gluten-free dairy products, cereals and baked snacks available as snacks for school-age celiac children are fewer, with less variety and more expensive than gluten containing counterparts; the majority of them not meeting current nutritional recommendations. Keywords: celiac disease, nutritional adequacy, availability, cost, gluten-free school snacks Cite This Article: Amaya Oyarzún, Talya Nakash, Jimena Ayala, Yalda Lucero, and Magdalena Araya, “Following Gluten Free Diet: Less Available, Higher Cost and Poor Nutritional Profile of Gluten-Free School Snacks.” International Journal of Celiac Disease, vol. 3, no. 3 (2015): 102-107. doi: 10.12691/ijcd-3-3-3. 1. Introduction Celiac disease (CD) is a condition observed only in humans. It results from the interaction of genes and the environment (gluten), with participation of the immune system and host microbiota. A complex and only partially understood damage to the small intestinal mucosa develops, which includes an inflammatory disease and autoimmune phenomena [1,2,3]. Today is known that its frequency is close to 1% in most of the assessed countries [4]. Increasing attention is currently given to the difficulties that pose maintaining a gluten-free diet, the only efficacious treatment of CD [5]. Compliance to a gluten-free diet results in symptom remission, histological and functional recovery of the small intestinal mucosa, and decreased risk of complications [6]. Although a gluten-free diet benefits celiac patients in many ways [7], evidence shows that expenditures increase in those who follow it [8,9]. Data also show that following strict gluten- free diet deteriorates significantly quality of life, an area that is poorly managed, mainly in less developed countries. Gluten is widely used in food processing and gluten contamination during the process of industrialized food production is of frequent occurrence [10]. Because these foods have poor elasticity due to the absence of gluten, other specific components are added, often resulting in increased content of fat and starch, i.e., higher in calories in comparison with their gluten-containing counterparts [11,12]. Given the changes of eating habits that modern life has introduced in western societies favoring the consumption of highly-processed foods, compliance to a strict gluten- free diet is increasingly more difficult. Most studies in this respect refer to US and European populations, but data about the situation in other areas of the world is scant, especially in those where bread and wheat based flour consumption is high. Availability and cost of gluten-free products is relevant because it may favor or hinder compliance to treatment, and lower compliance is