Original article Dietary and symptom assessment in adults with self-reported non-coeliac gluten sensitivity Gry I. Skodje a, c, *, 1 , Ingunn H. Minelle b , Kjersti L. Rolfsen b , Marina Iacovou d , Knut E.A. Lundin c, e , Marit B. Veierød f , Christine Henriksen b a Department of Clinical Services, Oslo University Hospital Rikshospitalet, 0424, Oslo, Norway b Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, 0316, Oslo, Norway c K.G. Jebsen Coeliac Disease Research Centre, University of Oslo, 0424, Oslo, Norway d Department of Gastroenterology, Monash University, Melbourne, Victoria, Australia e Department of Gastroenterology, Oslo University Hospital Rikshospitalet, 0424, Oslo, Norway f Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, 0317, Oslo, Norway article info Article history: Received 9 February 2019 Accepted 20 February 2019 Keywords: Gluten-free diet FODMAP Non-coeliac gluten sensitivity summary Background & aims: The mechanisms behind non-coeliac gluten sensitivity (NCGS) are not fully un- derstood although clinical symptoms have shown to subside after wheat withdrawal. Self-prescription of a gluten-free diet (GFD) without medical supervision is common in NCGS subjects, resulting in dietary restrictions that can cause macro- and micronutrient deficiencies. The primary aim was to describe di- etary intake, including FODMAP, in subjects with self-reported gluten sensitivity on GFD in whom coeliac disease (CD) and wheat allergy were excluded. Secondary, clinical symptoms and health-related quality of life (HR-QoL) were examined. Methods: Baseline characteristics were obtained from 65 adults with self-reported NCGS on GFD recruited to a randomised placebo-controlled challenge trial at Oslo University Hospital. Dietary intake was obtained by a seven-day food record and symptoms recorded by questionnaires. Results: Mean proportions of energy were 43 E% from fat, 40 E% from carbohydrate and 17 E% from protein. Intakes of vitamin D, folic acid, calcium, iodine and iron were lower than recommended, mean (SD) 7.3 (5.8) mg, 235 (105) mg, 695 (309) mg, 81 (52) mg and 9.6 (7.5) mg, respectively. Mean (SD) intake of FODMAP was 11.6 g (8.7). Gastrointestinal symptoms as scored by 100 mm visual analogue scale (VAS) were all below 15 mm of which wind and bloating were the most expressed. Tiredness, concentration difficulties, fatigue and muscle/joint pain were scored highest among extra-intestinal symptoms. Gastrointestinal symptoms as scored by gastrointestinal symptom rating scale e irritable bowel syn- drome version (GSRS-IBS) were correlated with mild depression (r ¼ 0.43) and inversely correlated with five sub-domains of HR-QoL (0.29 < r < 0.26). Conclusion: Subjects with self-reported NCGS on GFD had high proportion of energy from fat and sub- optimal intakes of vitamin D, folic acid, calcium, iodine and iron. Despite GFD and moderate intake of FODMAP, the subjects reported various gastro- and extra-intestinal symptoms and reduced HR-QoL. The findings highlight the importance of dietary education and nutritional follow-up of subjects on GFD. © 2019 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved. 1. Introduction Non-coeliac gluten sensitivity (NCGS) is defined as a condition of gastrointestinal and extra-intestinal symptoms that improve as response to gluten-free diet (GFD) and where coeliac disease (CD) and wheat allergy are ruled out [1]. There are no strict, objective markers for the condition and prevalence from 0.6% to 6% have been reported [2,3]. The symptoms overlap with other Abbreviations: BDI-II, Beck depression inventory version 2; CD, coeliac disease; FODMAP, fermentable oligo-, di-, monosaccharides and polyols; GFD, gluten-free diet; GSRS-IBS, gastrointestinal symptom rating scale irritable bowel syndrome version; HR-QoL, health-related quality of life; IBS, irritable bowel syndrome; NCGS, non-coeliac gluten sensitivity; SF-36, short form-36; VAS, visual analogue scale. * Corresponding author. Department of Clinical Services, Oslo University Hospital Rikshospitalet, 0424, Oslo, Norway. E-mail address: gry.irene.skodje@nes-ak.kommune.no (G.I. Skodje). 1 New: Municipality of Nes, Akershus County, Hagaskogveien 19, 2150 Aarnes, Norway. Contents lists available at ScienceDirect Clinical Nutrition ESPEN journal homepage: http://www.clinicalnutritionespen.com https://doi.org/10.1016/j.clnesp.2019.02.012 2405-4577/© 2019 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved. Clinical Nutrition ESPEN xxx (xxxx) xxx Please cite this article as: Skodje GI et al., Dietary and symptom assessment in adults with self-reported non-coeliac gluten sensitivity, Clinical Nutrition ESPEN, https://doi.org/10.1016/j.clnesp.2019.02.012