Limited micronutrient data for gluten‐free bread products prevents accurate dietary analysis

Background:  Gluten containing staple foods including bread are an important source of B vitamins, folate, iron and calcium. In coeliac disease (CD), bread is commonly substituted with specialist gluten‐free (SGF) bread, most obtained on prescription (Kinsey, 2008). In the UK, mandatory fortification of bread‐flour with four nutrients; iron, thiamin, niacin and calcium, does not apply to GF bread flour. Several studies highlight low intakes of micronutrients in CD (Wild et al ., 2010); it is unclear whether this is a result of a lack of fortification, lack of compositional data for the SGF products or absence of nutrients. The aim of this preliminary study was to investigate the fortification of prescription SGF bread products and the availability of micronutrient compositional data. Methods:  Gluten‐free breads available on prescription were identified from the National Health Service Drug Tariff and the British National Formulary. Manufacturers were contacted by e‐mail/phone to obtain information on the fortification of SGF breads and data available for the micronutrient content of finished goods. Results:  Of 13 brands providing SGF breads on prescription, only four were fortified with some but not all of the four micronutrients recommended for bread flour. All four of these brands were fortified with folate. Table 1 illustrates the variability in micronutrient levels within and between brands. Unlike compositional data for ordinary gluten containing bread available from McCance and Widdowson, no manufacturer was able to provide a complete micronutrient profile (e.g. data on magnesium, zinc, selenium were not available). 1  Micronutrient data per 100 g of SGF white breads available on prescription: 4 of 13 brandsWhite Bread Data Source Calcium (mg) Folate (ug) Iron (mg) Thiamin (mg) Niacin (mg)Dietary Specials 1 loafa120a30 NA NA NA Ener‐G* 2 loaves b 240–247a76–83c1.88–2.39c0.33–0.39c2.35–2.39Glutafin/Select 3 loavesa120–120–380a30NA NA NA Juvela 2 loaves b 113–121c30c4.0–4.3c0.21c2.7(FSA, 2002) Avg 15 samples177252.20.241.6Bold italic = nutrient fortified. NA = Not available. *Excludes non‐fortified Yeast free rice loaf. a Levels of added nutrients on product label. b Levels on label but not fortified. C Levels available from company on request.Discussion:  Although a European standard exists that recommends that foods for special medical purposes contain nutrients at levels of the foods that they intend to replace, this study demonstrates that fortification of SGF bread products in the UK is limited and inconsistent. As is demonstrated in this preliminary study, the complete micronutrient content of SGF bread products is not available. This is not unexpected given that labelling legislation requires manufacturers to state only energy, macronutrient, fibre and sodium content unless a nutritional claim is made. The outcome of UK studies evaluating the nutritional adequacy of gluten‐free diets may therefore reflect inconsistent fortification plus the paucity of analytical data for micronutrients present in the natural ingredients, rather than a genuine absence. Conclusions:  To accurately assess the nutritional adequacy of gluten‐free diets, consideration needs to be given to the development of a comprehensive SGF product database comparable with McCance and Widdowson. The mandatory fortification of SGF bread products also warrants further consideration. References:  Food Standards Agency (2002) McCance and Widdowson's The Composition of Foods , Sixth summary edition. Cambridge: Royal Society of Chemistry. Kinsey, L., Burden, S.T. & Bannerman, E. (2008) A dietary survey to determine if patients with celiac disease are meeting current healthy eating guidelines and how their diet compares to that of the British general population. Eur. J. Clin. Nutr. 62 , 1333–1342. Wild, D., Robins, G.G., Burley, V.J. & Howdle, P.D. (2010) Evidence of high sugar intake and low fibre and mineral intake, in the gluten free diet. Aliment. Pharmacol. Ther. 32 , 573–581.