People without clinical diagnosis of intolerance or allergy have benefits from gluten-and casein-free diet

People without clinical diagnosis of intolerance or allergy have benefits from gluten-and casein-free diet | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article People without clinical diagnosis of intolerance or allergy have benefits from gluten-and casein-free diet Nathália de Freitas Penaforte, Marcelo Cairrão Araújo Rodrigues, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4790074/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction and Aim: The present study aimed to assess university professors and students regarding the variation in body mass and intestinal health resulting from a restricted dietary intervention in foods containing gluten and casein. Methods: This was a non-randomized, quasi-experimental clinical trial type study. Initially, 122 volunteers aged 20 to 55 years of both sexes were evaluated, but only 63 volunteers comprised the final sample. Participants were divided into two groups: No Gluten/Casein containing Food Restriction (CG, n= 42) and Gluten/Casein containing Food Restriction (EG, for 90 days, n= 21). Approval was obtained from the Ethics Committee on Human Research at the Health Sciences Center of the Federal University of Pernambuco under protocol number 5.671.846. It also presents the Brazilian Clinical Trials Registry (ReBEC) under number RBR-6htr5rg. Results: Scores from the Metabolic Screening Questionnaire (MSQ) in the intervention group for the thick domain showed a significant improvement compared to the NGC. Additionally, within-group comparisons showed reduced scores in the overall MSQ and domains of the digestive tract, mind, head, and emotions (p=<0.0001; p=0.0003; p=0.0434; p=0.0143; p=0.0318; respectively). Improvement in responses to the Bristol Scale was observed after gluten-and casein-free diet (GCFD). There was no reduction in body mass or Body Mass Index (BMI). Conclusion: These results confirm our hypothesis that GCFD seems to contribute to improve intestinal function in people without diagnosed intolerances/allergies to these components. Making it a pioneer in the outlined research design. Gluten-free diet Casein Metabolism Body Mass Index Digestive tract. Figures Figure 1 Figure 2 Figure 3 1. INTRODUCTION Gluten has been the subject of numerous studies demonstrating its association with an inflammatory state and intolerance in both animal [1] and human [2] studies over time. Gluten, a glycoprotein composed of gliadin and glutenin formed in the presence of water, is found in foods like wheat, barley, and rye—staples in the regular diet of most Western countries [3]. Literature posits an association between gluten-related diseases (including Celiac Disease - CD), wheat allergy, gluten intolerance (GI) or sensitivity (GS) in undiagnosed individuals, and metabolic and inflammatory processes [1,4]. However, the role of gluten in components of metabolic syndrome and related inflammatory responses remains unclear due to conflicting results [5]. Thus, a gap in the literature requires investigation. Like gluten, peptides from milk proteins like casein can induce immune responses and abnormal intestinal permeability, facilitating the absorption of incompletely broken peptides, leading to inflammation [6,7]. The scientific uncertainties and controversies provide a significant scope for studies identifying the relationship between potentially inflammatory foods and intestinal health. In a similar context, teachers and students, theoretically vulnerable to subclinical inflammation [8,9], typically have unregulated eating habits, often consuming industrialized and ultra-processed foods, increasing the likelihood of hypersensitivity [10,11,12]. These habits involve significant consumption of gluten- and casein-containing foods, contributing to overweight and obesity prevalent in this population [13,14,15], making them more susceptible to signs of intestinal dysbiosis associated with food hypersensitivity [10]. Despite the controversies, gluten and casein-containing foods favor increased intestinal mucosal permeability, altering the intestinal microbiota [2,16], resulting in metabolic and nutritional changes. We hypothesized that gluten-and casein-free diet (GCFD) improves intestinal health, and decreases body mass/BMI in individuals without a clinical diagnosis of intolerances/allergies. Thus, the study aims to evaluate the variation in body mass and intestinal health in university faculty and students following a restricted diet in gluten- and casein-containing foods. 2. MATERIALS AND METHODS 2.1. Procedures The study protocol adhered to ethical norms for research involving human subjects (Resolution 466/12 of the National Health Council) and was approved by the Ethics Committee on Human Research at the Health Sciences Center of the Federal University of Pernambuco under protocol number 5.671.846 and CAAE 57955822.2.0000.520. Meeting all ethical criteria. Data collection took place at the Neurodynamics laboratory at the Federal University of Pernambuco, located in the Department of Physiology and Pharmacology in the Center for Biosciences. There is also the Brazilian Clinical Trials Registry (ReBEC) under registration number RBR-6htr5rg registered on April 9, 2024. 2.2. Participants This study was an analytical, non-randomized, quasi-experimental clinical trial involving teaching professionals in a teaching or administrative role and undergraduate and postgraduate students aged 20 to 55 of both sexes in Recife, Brazil. Regarding the exclusion criteria, it was established that the following would not participate in the sample: i) individuals diagnosed with food allergies, such as celiac disease and cow's milk protein allergy (CMPA); ii) those who were undergoing pre-existing medical-nutritional monitoring; 3) those with a body mass index (BMI) ≤ 18.4 and ≥ 40. A total of 122 volunteers were assessed, with 63 meeting eligibility criteria for the final sample. Data collection occurred from September 2022 to April 2023. The final sample was divided into two groups: Control Group (with No Gluten/Casein containing Foods Restriction, (CG), n= 42) and experimental (Gluten/Casein containing Foods Restriction, (EG), n= 21). The experimental group underwent dietary intervention for 90 days, in which they were subject to Gluten and Casein containing foods Restriction (Fig 1). Volunteers were recruited through in-person invitations at schools/institutions. After a brief explanation of the research, volunteers signed the Human Ethics and Consent to Participate declarations and chose to join the control or experimental group, both composed of self-reported individuals without a diagnosis of gluten and/or casein allergy. Volunteers had the option to withdraw at any stage without prejudice. 2.3. Study Variables All participants completed questionnaires and underwent anthropometric data collection (body mass, height, and BMI). The control group maintained their regular diet for 90 days, while the experimental group was instructed to restrict gluten- and casein-containing foods for the same period. Afterward, both groups were reassessed with the same instruments. The independent variable included food consumption, while dependent variables comprised assessment of Metabolic Screening Questionnaire (MSQ) score, BMI and stool consistency. 2.3.1. Assessment of Body Mass Index Anthropometric data collection involved measuring height and body mass. Height measurement utilized an Avanutri® digital ultrasonic stadiometer with a range of 50 to 215 cm. Participants stood barefoot, with heels, buttocks, and the upper back against the wall, maintaining the head in the Frankfurt plane. Body mass measurement was conducted with participants barefoot and in light clothing, using a G.TECH® portable digital scale (GLASS200) with a maximum capacity of 200 kg and a precision of 50 g. All measurements were duplicated, with a third measurement taken when mass differed by more than 100 g and height by more than 0.5 cm. Measurements were collected in person, at the beginning and end of the study, by trained researchers of the same sex as the participant. These data were used to calculate BMI by dividing mass (kg) by height (m²). BMI cutoffs were established for underweight (≤ 18.4), normal weight (18.5-24.9), overweight (25-29.9), and obesity (≥ 30), following the distribution of the reference population's BMI as presented in the National Health Library - Ministry of Health [BVS/MS] (2009) (Box 1 and 3). 2.3.2. Assessment of Food Consumption The Food Frequency Questionnaire (FFQ) was administered by trained nutrition professionals at the beginning and end of the study to both groups in person. The FFQ, a valuable tool for analyzing habitual food consumption, can be applied qualitatively, semi-qualitatively, quantitatively, and semi-quantitatively [17]. Along with the FFQ, the MSQ [18] and Bristol Scale [19] were administered before and after the gluten- and casein-restricted diet. This approach ensured better control of potential repercussions from the restricted diet, as there was no proposed change in energy/nutritional content. Nutritional data were tabulated in electronic spreadsheets using Microsoft Excel® to determine the frequency of food consumption and the relative predominance of gluten- and casein-containing foods. 2.3.3. Assessment of Metabolic Tracking Questionnaire scores The MSQ from the Brazilian Institute of Functional Nutrition, composed of closed questions filled subjectively with information about the subject's Healthy Status in the last 30 days, weeks, and 48 hours, was used. The MSQ is a tool to investigate various signs and symptoms over specific periods, with the patient assigning scores. The total points serve as a parameter to begin screening for potential nutritional deficiencies, hypersensitivities, food intolerances, or other causes (food or environmental). The MSQ was applied by trained nutrition professionals in person at the beginning and end of the study in both groups. The MSQ comprises 14 blocks related to the body's important points: head, eyes, ears, skin, nose, mouth/throat, joints, lungs, heart, digestive tract, joints/muscles, energy/activity, mind, and emotions. Results were interpreted on a scoring scale from 0 to 4, where 0 indicates no or almost no symptoms, and 4 indicates frequent and severe symptoms. Scores in each section were analyzed, with 10 or more points indicating food hypersensitivity. The number of 4s in the questionnaire could also indicate hypersensitivity [18]. 2.3.4. Assessment of Stool Consistency The Bristol Scale [19], applied along with the MSQ and FFQ, assessed stool consistency by presenting seven images with precise descriptions of form and consistency. This scale was applied before and after the gluten- and casein-restricted diet, with participants choosing the image that most closely resembled their own stools. Results were recorded in the patient records. Subtypes 1 and 2 indicated constipation, subtypes 3 and 4 represented normal stools, and subtypes 5, 6, and 7 indicated diarrhea [20]. 2.4. Data Analysis Data obtained from the questionnaires were entered into a Microsoft Excel spreadsheet and subjected to statistical analysis using the Graphpad Prism version 9.0 program. The normality of distribution for continuous variables was assessed employing the Kolmogorov-Smirnov test. Parametrically distributed variables were expressed as mean and standard deviation values, while non-parametrically distributed variables were presented as median values and interquartile ranges. When comparing the variable between two groups at the same period, the unpaired t-test or Mann-Whitney test was employed for parametric and non-parametric analyses, respectively. When comparing a single variable before and after the restriction within each group, paired t-test or Wilcoxon rank sum test was employed for parametric and non-parametric analyses, respectively. Categorical variables were evaluated using the Pearson Chi-square test or Fisher's Exact test, where applicable. A significance level of 5% was employed for all statistical tests. It is worth mentioning that foods containing gluten and/or casein in their composition, as these were the focus of this research, were selected for the score calculation formula [21]. In these analyzes, as the data are non-parametric and not paired, parametric analysis was used by the Mann-Whitney test. The data are presented as the Median value, 95% Confidence Interval with lower and upper limits; and the p-value for each analysis. 3. RESULTS Initially, we will present the flowchart related to the acquisition of the final sample, followed by the characterization of the study sample (Figure 1). Subsequently, the total sample and the respective control and experimental groups will be characterized according to participant characteristics and clinical data at baseline (T0). Later, an intra and intergroup comparison will be performed after the intervention period or the final research time (T3). 3.1. Baseline comparisons At baseline, a general characterization and clinical data of the sample and the respective control and experimental groups were performed (Table 1). Table 1 - Clinical and sample characterization variables. Recife, Pernambuco, Brazil, 2023 T (n = 63) CG (n = 42) EG (n = 21) P value Description Age a 32,9 ± 11,6 30,6 ± 10,2 37,6 ± 13,2 0,0711 Height a 1,65 ± 0,08 1,66 ± 0,07 1,64 ± 0,09 0,2434 Weight a 69,1 ± 15,3 69,8 ±15,9 67,7 ±14,3 0,6872 BMI a 25,2 ± 5,5 25,2 ± 5,3 25,4 ± 6,0 0,8491 Sex n (%) n (%) n (%) Masculine 23 (37%) 16 (38%) 7 (33%) 0,7864 Feminine 40 (63%) 26 (62%) 14 (66%) Category n (%) n (%) n (%) Teacher 22 (35%) 11 (27%) 11 (52%) 0,0524 Student 41 (65%) 31 (73%) 10 (48%) Acting n (%) n (%) n (%) Exact sciences 12 (19%) 10 (24%) 2 (10%) 0,0052 Human 19 (30%) 6 (14%) 11 (52%) Health 34 (51%) 26 (62%) 8 (28%) Teaching network n (%) n (%) n (%) Public 49 (78%) 33 (78%) 16 (76%) Toilet 14 (22%) 9 (22%) 5 (24%) >0,9999 Lactose intolerance? n (%) n (%) n (%) No 39 (62%) 27 (64%) 12 (57%) 0,5339 Do not know 15 (24%) 10 (23%) 5 (24%) Yes 9 (14%) 5 (13%) 4 (19%) Are you allergic to casein? n (%) n (%) n (%) No 47 (75%) 35 (83%) 12 (57%) Do not know 16 (25%) 7 (17%) 9 (43%) 0,0244 Medical diagnosis of lactose intolerance? n (%) n (%) n (%) No 57 (90%) 38 (90%) 19 (90%) >0,9999 Yes 6 (10%) 4 (10%) 2 (10%) Do you have an allergy or intolerance to gluten? n (%) n (%) n (%) No 45 (66%) 32 (76%) 13 (62%) 0,3727 Do not know 16 (25%) 9 (21%) 7 (33%) Yes 2 (9%) 1 (3%) 1 (5%) Do you have a medical diagnosis of celiac disease? n (%) n (%) n (%) No 63 (100%) 42 (100%) 21 (100%) 0,4760 Did you have COVID-19? n (%) n (%) n (%) No 22 (35%) 17 (40%) 5 (24%) 0,3454 Do not know 5 (8%) 2 (7%) 3 (14%) Yes 36 (57%) 23 (53%) 13 (52%) Caption: BMI, Body mass index; T, total sample; CG, no gluten/casein containing food restriction group; EG, gluten/casein containing food restriction group. a - Kruskal-Wallis test with Dunn's post-hoc test - Data did not pass any normality test, but not corrected for multiple comparison. * - (CG vs T), # (EG vs T), δ (CG vs EG) The p-value presented in the table indicates the comparison between the Control and Experimental groups. Source: Own authorship, 2023. 3.2. Total sample data According to gender, women made up the largest percentage of the sample. In relation to the three major areas of specialization, the majority were not in the health sector, followed by the humanities and exact sciences. Furthermore, the majority represented the public educational institution (Table 1). Self-reports on allergy/intolerance to casein and/or lactose and/or gluten indicated a predominance of negative responses across the entire sample. Regarding SARS-CoV-2 infection, 57.4% responded positively based on self-report (Table 1). 3.3. Control and experimental group data The control (CG) and experimental (EG) groups were also compared at baseline (T0) to determine if both groups were similar or different before the proposed intervention. Both groups were similar for age, height, body mass, and BMI. In terms of participant gender, there was similarity between the groups, with females predominating in both (Table 1). When analyzing the distribution of participants between university teachers and students, it was observed that in the EG, there was a balance in this proportion, but in the CG, 73% were composed of students. Regarding areas of expertise, health predominated in the CG, and humanities in the EG. When analyzing the education network, the public network predominated, following the same result as the total sample and having a similar distribution in both groups (Table 1). Except for casein allergy (p=0.0244), no significance was found between the groups regarding responses to gluten and/or lactose allergy/intolerance (p>0.05), (Table 1). The self-declaration of the absence of gluten and lactose intolerance/allergy was in line with the lower frequency of medical diagnoses of lactose intolerance or celiac disease proven. Regarding SARS-CoV-2 infection, the majority responded positively in both groups (Table 1), with no significant difference between the groups and following a pattern similar to the total sample. 3.4. Baseline comparison of between score of Metabolic Screening Questionnaire and intragroup When evaluating the overall classification, no difference was observed (p=0.3128) between the CG and EG at the initial time (T0). However, at T0, it is observed that between the CG and EG, there is a difference in the digestive tract domain (p=0.0245). Regarding the digestive tract domain, it is possible to verify that the EG has higher scores when compared to the CG at T0 (Table 2). In this study, the overall domain in both groups is composed of the sum of the scores of all domains that contribute equally. 3.5. Comparison between score of Metabolic Screening Questionnaire after the intervention period A decrease in the global classification (p=0.0001) and the domains was found in the EG after the intervention period: 1) digestive tract (p=0.0003); 2) mind (p=0.0434); 4) head (p=0.0143); 5) and emotions (p=0.0318). However, the CG also showed statistically different values in the global classification of MSQ (p=0.0049) and the following domains: 1) Digestive tract (p=0.0121); 2) and Head (p=0.0001). There was a decrease in value, projecting an improvement at the metabolic level in these points over the studied period. In the other evaluated domains of MSQ, no significant differences were found (p>0.05). When comparing the CG and EG at the end of the study (T3), the analysis of the global score and the domains of MSQ showed that the only difference found was for the nose domain, where the EG showed reduced values (Table 2). Table 2 - Intra and intergroup results of global organizations and MSQ application domains of the control and experimental group before and after period gluten-and casein-free diet. Recife, Pernambuco, Brazil, 2023 Variables CG (n = 42) T0 CG (n = 42) T3 P value a EG (n = 21) T0 EG (n = 21) T3 P value a P value CG x EG (T0) a P value CG x EG (T3) a MSQ Global 0,83 ± 0,55 0,68 ± 0,45* 0,0049 0,96 ± 0,56 0,58 ± 0,36* <0,0001 0,3128 0,6524 Digestive tract 0,82 ± 0,71 0,57 ± 0,66* 0,0121 0,85 ± 0,78 0,56 ± 0,63* 0,0003 0,0245 0,8563 Mind 0,81 ± 0,66 0,71 ± 0,67 0,3615 1,06 ± 1,04 0,71 ± 0,67* 0,0434 0,5395 0,8570 Head 1,15 ± 0,70 0,81 ± 0,53* <0,0001 1,42 ± 0,81 1,00 ± 0,67* 0,0143 0,2650 0,3475 Emotions 1,47 ± 1,22 1,29 ± 1,07 0,1827 1,30 ± 1,02 0,99 ± 0,87* 0,0318 0,7161 0,4111 Caption: CG, no gluten/casein containing food restriction group; EG, gluten/casein containing food restriction group; T0, baseline moment, before the intervention period; T3, final moment, after the intervention period. a - Wilcoxon test - Not approved in any normality test * - Existence of difference between groups Source: Own authorship, 2023. 3.6. Baseline and Final comparison of groups regarding the Bristol Scale Concerning self-reported characteristics related to evacuations, from the classification of the Bristol Scale, it was observed in a qualitative distribution that the EG provided responses for all types of fecal consistencies at the initial moment of the study (Figure 2). For the CG, the concentration of responses remained in types 3 and 4, with no representation in type 7 (Figure 3). It is noteworthy that volunteers could mark more than one option in their response. At the end of the intervention period, the reapplication of the Bristol Scale questionnaire showed that the EG provided more concentrated responses for Type 3 and Type 4 (Figure 2). However, there was no statistical difference (p=0.1611). Just as the CG showed a lack of statistical significance (p=0.6195). 3.7. Baseline and final comparison of groups regarding body mass index In Table 3, it can be observed that at baseline, there were no significant intra and intergroup differences. The intervention protocol with gluten and casein restriction for 90 days did not alter body mass or BMI (p=0.9389; p=0.7525, respectively) when compared to the CG. Anthropometric differences were also not observed within the groups after the experimental period. Table 3 - Intra and intergroup associations of body mass and BMI of the control and experimental groups before and after period gluten-and casein-free diet. Recife, Pernambuco, Brazil, 2023 Variables CG (n = 42) in T0 CG (n = 42) in T3 P value a EG (n = 21) in T0 EG (n = 21) in T3 P value a Valor p CG x EG(T0) a P value CG x EG(T3) a Body mass 69,7 ±15,9 70,3 ±15,9 0,1288 67,7 ± 14,3 67,7 ± 14,9 0,9389 0,6934 0,5750 BMI 25,2 ± 5,3 25,4 ± 5,4 0,0936 25,4 ± 6,0 25,2 ± 6,1 0,7525 0,8540 0,7206 Caption: CG, no gluten/casein containing food restriction group; EG, gluten/casein containing food restriction group; T0 = Baseline moment, before the proposed intervention; T3 = Final moment, after intervention period; BMI = Body mass index; b Wilcoxon test - Not approved in any normality test Source: Own authorship, 2023. 3.8. Baseline comparison of groups regarding dietary score The dietary scores, collected through FFQ, were calculated for each food group: 1) Global; 2) Milk and dairy products; 3) Breads and cookies; 4) Fats, sauces, and seasonings; 5) Sweets and desserts; 6) Soups and pastas; 7) and Beverages. In general, for all food groups, the CG and EG had equivalent scores at the beginning of the experiment, as shown in Table 3.9. Final comparison of groups regarding dietary score The dietary scores, collected through FFQ, were calculated for each food group: 1) Global; 2) Milk and dairy products; 3) Breads and cookies; 4) Fats, sauces, and seasonings; 5) Sweets and desserts; 6) Soups and pastas; 7) and Beverages. It is worth mentioning that foods containing gluten and/or casein in their composition, as these were the focus of this research, were selected for the score calculation formula used by other researchers [21]. After the 90-day period of gluten and casein restriction, it was observed that the EG showed a significant difference (p<0.05) in all evaluated food groups, except for group 7, referring to alcoholic beverages (Table 4). In the CG, it was possible to see that there were no differences over the studied time, as expected since there was no intervention (Table 4). In summary, the results indicate that there was no change in the eating pattern of the CG, only in the EG. Therefore, the results suggest that this group followed the guidelines proposed by the study. When comparing between groups after the intervention period, statistical significance (p<0.05) was observed in all food groups except group 7 (Table 6). This result confirms that indeed the EG followed the proposed guidelines (Table 5). Table 4 - Comparative score of food groups, using the FFQ, between the control and experimental groups at baseline moment, before intervention. Recife, Pernambuco, Brazil, 2023 Food group CG (n = 42) in T0 EG (n = 21) in T0 P value Median IQ Median IQ Global 0,1409 0,1084 - 0,1765 0,1425 0,0822 - 0,1974 0,7918 Milk and derivatives 0,1786 0,1281 - 0,2366 0,1449 0,0937 - 0,2710 0,5034 Breads and cookies 0,1224 0,0864 - 0,1684 0,1272 0,0816 - 0,1837 0,9510 Fat, sauce and seasoning 0,2143 0,0166 - 0,2310 0,0881 0,0166 - 0,2143 0,1919 Sweets and desserts 0,1246 0,0587 - 0,2107 0,1063 0,0222 - 0,2857 0,7143 Soups and pasta 0,0937 0,0404 - 0,1484 0,0881 0,0349 - 0,1190 0,4982 Drinks 0,0000 0,0000 - 0,0333 0,0000 0,0000 - 0,0333 0,7362 Caption: CG, no gluten/casein containing food restriction group; EG, gluten/casein containing food restriction group; T0 = Baseline moment, before intervention; FFQ, Food Frequency Questionnaire. Non-parametric test (Mann-Whitney test), values presented are the Median and IQ - Interquartile Range Source: Own authorship, 2023. Table 5 - Intragroup comparative score of the food groups, using the FFQ, of the control and experimental group before and after period gluten-and casein-free diet. Recife, Pernambuco, Brazil, 2023 Baseline moment (T0) Final moment (T3) CG (n = 42) CG (n = 42) P value Food group Median IQ Median IQ Global 0,1409 0,1084 - 0,1765 0,1378 0,1034 - 0,1729 0,8358 Milk and derivatives 0,1786 0,1281 - 0,2366 0,1911 0,1281 - 0,2510 0,8969 Breads and cookies 0,1224 0,0864 - 0,1684 0,0911 0,0492 - 0,1896 0,5441 Fat, sauce and seasoning 0,2143 0,0166 - 0,2310 0,2143 0,0166 - 0,2143 0,0759 Sweets and desserts 0,1246 0,0587 - 0,2107 0,1429 0,0587 - 0,2107 0,8919 Soups and pasta 0,0937 0,0404 - 0,1484 0,0881 0,0390 - 0,1260 0,6485 Drinks 0,0000 0,0000 - 0,0333 0,0000 0,0000 - 0,0333 0,3359 EG (n = 21) EG (n = 21) Food group Median IQ Median IQ P value Global 0,1425 0,0822 - 0,1974 0,0212* 0,0116 - 0,0523 < 0,0001 Milk and derivatives 0,1607 0,0982 - 0,2699 0,0000* 0,0000 - 0,0000 < 0,0001 Breads and cookies 0,1272 0,0816 - 0,1837 0,0204* 0,0000 - 0,0612 0,0003 Fat, sauce and seasoning 0,0881 0,0166 - 0,2143 0,0000* 0,0000 - 0,0000 0,0013 Sweets and desserts 0,1063 0,0222 - 0,2857 0,0111* 0,0000 - 0,0587 0,0025 Soups and pasta 0,0881 0,0349 - 0,1190 0,0460* 0,0083 - 0,0714 0,0244 Drinks 0,0000 0,0000 - 0,0333 0,0000 0,0000 - 0,0000 0,1250 Caption: CG, no gluten/casein containing food restriction group; EG, gluten/casein containing food restriction group; T0 = Baseline moment, before the intervention; T3 = Final moment, after intervention period; FFQ, Food Frequency Questionnaire. Paired non-parametric test (Wilcoxon matched-pairs test), values presented are the Median and IQ - Interquartile Range. * - Existence of difference between groups (p < 0.05) Source: Own authorship, 2023 Table 6 - Comparative score of food groups, using the FFQ, of the control and experimental groups at the final moment, after the intervention period. Recife, Pernambuco, Brazil, 2023 Food group CG (n = 42) in T3 EG (n = 21) in T3 P value Median IQ Median IQ Global 0,1378 0,1034 - 0,1729 0,0211* 0,0116 - 0,0523 <0,0001 Milk and derivatives 0,1911 0,1281 - 0,2510 0,0000* 0,0000 - 0,0000 <0,0001 Breads and cookies 0,0911 0,0492 - 0,1896 0,0204* 0,0000 - 0,0612 <0,0001 Fat, sauce and seasoning 0,2143 0,0166 - 0,2143 0,0000* 0,0000 - 0,0000 <0,0001 Sweets and desserts 0,1429 0,0587 - 0,2107 0,0111* 0,0000 - 0,0587 <0,0001 Soups and pasta 0,0881 0,0390 - 0,1260 0,0460* 0,0008 - 0,0714 0,0059 Drinks 0,0000 0,0000 - 0,0333 0,0000 0,0000 - 0,0000 0,0934 Caption: CG, no gluten/casein containing food restriction group; EG, gluten/casein containing food restriction group; T3 = Final moment, after intervention period; FFQ, Food Frequency Questionnaire. Unpaired non-parametric test (Mann-Whitney test), values presented are the Median and IQ - Interquartile Range. * - Existence of difference between groups (p < 0.05) Source: Own authorship, 2023. 4. DISCUSSION Based on the results of this study, it was possible to confirm the hypothesis that gluten- and casein-free dietary intervention seems to contribute to improving gut health and reducing possible hypersensitivity in individuals without a diagnosis of intolerance/allergies to these components. The sensitivity statement needs to be further investigated based on a more precise diagnosis [22], which was not the object of research in the present study. As for the hypothesis of changes in body mass and BMI, it was not possible to prove it. This result may be justified by the absence of a global energy reduction since there was no intervention or recommendation regarding the restriction of caloric intake from the habitual diet. However, this weight reduction can be found in long-term studies [23]. Although, adopting gluten-free diets has been linked to some nutritional deficiencies [24]. According to the Family Budget Survey (FBS), between 2008-2009 and 2017-2018, there was a reduction in the consumption of rice, beans, beef, bread, fruits, dairy products, processed meats, and sodas, but an increase in the consumption of sandwiches, signaling a worsening in the quality of the Brazilian diet [25]. In Brazil, the most consumed items, in order, are: cereals, milk, and fruits; Internationally, the three most consumed items are: cereals, vegetables, and milk. It can be said that the consumption patterns of both have some similarities, justified by globalization [26]. These data explain, in part, the high percentage of the presence of foods containing gluten and casein in the population's dietary habits [27,28], which may justify the dietary pattern of the public analyzed at the beginning of this research. This situation could be observed, in part, in students in the health sector at a public university in Recife, given the high consumption of simple carbohydrates, as well as other inadequacies that contributed to the association metabolic risk [29]. When mentioning hypersensitivity, in our findings, 19% of the volunteers in the EG group reported, through the applied questionnaire, being lactose intolerant, and another 24% reported having doubts about the possibility. However, when asked if they had undergone any type of test for confirmation and subsequent medical diagnosis of intolerance, only 9% of the entire sample in the EG had done so. Regarding gluten intolerance/allergy, the situation is the same as the previous one, 5% reported having it, and another 33% were unsure, but none of these reported a medical diagnosis of celiac disease or comproved hypersensibility. Thus without medical diagnosis, it can be inferred that a significant portion of the volunteers self-reported being intolerant, as well as suspected of "perceive hypersensitivity." This self-report is in line with the results conducted by other researchers, concluding that noticeable hesitation can be justified by the similarity between triggered symptoms [30]. This prevalence of sensitivity to gluten/wheat, for example, can be related to the technological process applied to the original wheat grain due to the loss of antioxidant compounds and the addition of inflammatory ingredients [31]. Regarding casein sensitivity, this may be associated with the possibility of the presence of β-casomorphin-7 (BCM-7), resulting from the hydrolysis of the A1 genetic variant of β-casein, which reflects intestinal discomfort and pro-inflammatory effects [32]. These reports may justify the symptomatic perception of these compounds, gluten, and casein. In the EG group, it was observed that there was a predominance of females, as well as a strong adherence to GCFD. Adherence to nutritional recommendations was identified from the results obtained through the application of the FFQ and their respective significance at the end of the study when compared intra- and inter-groups. However, even without a diagnosis of celiac disease or casein/lactose allergy, the effect of dietary intervention in the EG on the MSQ and intestinal changes by the Bristol Scale was evident. Although reports indicate that following a restrictive diet in this regard appears to be difficult to adhere to, taking as an example the gluten-restricted diet, which appears to have greater adherence in celiac patients [33]. However, there is controversy regarding adherence even in celiac patients, which may have persistent symptomatology as a mediator [34]. Furthermore, in this study, significant improvements were observed in symptomatological levels after GCFD, with a reduction in scores in the overall MSQ and in the domains of the digestive tract, mind, head, emotions, and nose. This can be explained by there being more than 50 toxic epitopes described in the gluten molecule related to cytotoxic, immunomodulatory activities and capable of altering intestinal permeability [35]. Regarding casein, there are also correlates of its contribution to immune response, intestinal permeability, and inflammation [6,7]. In addition, it is hypothesized that the A1 protein portion of β-casein is more inflammatory and detrimental to intestinal health when compared to the A2 protein portion of β-casein [36]. It is worth noting that the higher the representation of the score for the global classification of the MSQ, the greater the suspicion of hypersensitivity. Similarly, the greater the risk of developing intestinal dysbiosis and, consequently, the greater the influence of intestinal microbiota on the immune and neuroendocrine systems [12,37]. Through the findings of this study, it is verified that our intervention group initially presented similar characteristics, with a hypothesis of hypersensitivity and a risk of intestinal dysbiosis, which after GCFD resulted in a lower probability. Results in the Bristol Scale also could be observed after the intervention period by demonstrating an improvement in stool consistency, as this instrument can indicate or be associated with a higher prevalence of food hypersensitivity due to changes in stool consistency and the presence of symptoms related to dysbiosis [38,39,40]. Although there was no statistical difference of the Bristol Scale in EG, the qualitative analysis clearly shows a reduction after intervention. Since there was an increase of 7% for Type 3 and 12% for Type 4. What corroborates with the intestinal result, as improvements in the digestive tract domain were also detected by the MSQ after the GCFD (gluten and casein free restriction). Therefore, the absence of gluten and casein in the usual diet appears to improve intestinal health. Similarly, a gluten-free diet has shown possible therapeutic potential due to its contribution to changing the microbiota profile and modulating intestinal permeability [2,16]. This can be explained by gluten contributing to the intestinal inflammatory process by triggering immune, cellular, and humoral responses with consequent alteration in intestinal permeability [41,42]. Although the study did not evaluate inflammatory markers or microbiota profile, it is conjectured that the diet promoted an intestinal change with repercussions on intestinal health and the body as a whole. In addition, it is evident that casein may be associated with abnormal intestinal permeability due to the possibility of incomplete absorption of peptides, which can trigger an inflammatory process [43,44,45]. The set of findings above suggest that there is a relationship between emotional and gastrointestinal symptoms, and, in the presence of intestinal dysbiosis can be assessed through the MSQ and Bristol Scale [46,47]. These associations may be related to the results for the following MSQ domains: mind, head, and emotions. However, these considerations still require further evidence regarding GCFD. Based on the obtained results, it was possible to verify that the intervention with GCFD does not interfere with body mass and BMI. This finding reinforces the premise that the restriction of these compounds is not necessarily a strategy for reducing body weight, at least in the short term. This result is in agreement with the findings of another study that, after a gluten-free diet intervention in non-celiac, eutrophic women for three weeks, did not achieve significant reduction in body mass [48]. These results contradict studies that report an association between the exclusion of these components, gluten, and casein, with effectiveness in the weight loss process, as well as adherence to them. Excluding gluten from the diet may have beneficial effects on weight reduction, adiposity, insulin resistance, and inflammation [49]. It is important to mention that there is not enough evidence to support or dismiss the idea of inducing weight loss in healthy individuals [50]. However, the follow-up time may be a factor to be considered. Regarding cow's milk, which contains casein, when consumed in large quantities, it can trigger a process of metabolic inflammation and, thus, seem to hinder the weight loss process [51]. On the other hand, in the celiac population, for example, results related to BMI are observed [52]. Despite this, it is worth noting that there are currently no studies in the literature investigating GCFD in people without a diagnosis of allergy/intolerance to these components, preventing us from comparing our findings, especially considering it is a university population. In addition, it remains unknown, and its impact may differ in the presence of allergy. Furthermore, obese individuals also characterize an imbalanced microbiota [14,53], which makes them more vulnerable to the presence of signs and symptoms characteristic of intestinal dysbiosis associated with food hypersensitivity [10]. However, it is important to highlight the sample size and intervention time, which may not be sufficient, as limitations of the present study. Interestingly, based on the results obtained, at the beginning of the study, 52% of the EG self-reported being infected with SARS-CoV-2, while responding to the questionnaire, and another 14% did not know how to respond. We cannot affirm, but there are intriguing doubts about possible metabolic impacts related, as well as possible health consequences; equally, it is not known how relevant this information is. However, it remains undefined and difficult to identify which inflammatory or hemodynamic changes are secondary to infection [54,55]. From the consulted literature, this study is pioneering in the designed research plan aimed at analyzing the impact of gluten and casein restriction on the gastrointestinal tract, applied to the academic community. Our results may stimulate other experimental designs and further investigations. We recognize the limitations of the study, such as the sample size of the EG; in addition, we did not assess biochemical measures to investigate and associate various inflammatory markers or of diagnostic or hypersensibility and compare them with the CG before and after the intervention. A possible bias in our study is that our sample was voluntary without double-bind. That is, these individuals previously suspected some dysfunction and chose to participate in the proposed intervention. Other limitations are associated with unknown if the results observed in this study were due to: i) the combined removal of gluten and casein; ii) which potentially inflammatory compound presented itself more influentially individually, gluten or casein?; iii) or if foods containing these compounds in addition to these (gluten and casein). These foods still have other compounds that may intervene in combination in the final result, such as a high content of fats and simple carbohydrates, which requires further clarification in future research. Declarations Author Contribution N.F.P.: Conceptualization, Investigation, Methodology, Formal analysis, Project administration, Data curation, Writing - original draft, Writing - review and editing; M.C.A.R.: Conceptualization, Investigation, Methodology, Formal analysis, Supervision, Project administration, Writing - review and editing; A.L.G.: Investigation, Data curation, Formal analysis, Writing - review and editing; F.W.C.A.: Formal analysis, Investigation, Writing - review and editing; E.N.: Conceptualization, Investigation, Methodology, Formal analysis, Project administration, Supervision, Writing - original draft, Writing - review and editing, Project administration, Funding acquisition. Acknowledgement The authors would like to thank the funding granted by the National Council for Scientific and Technological Development (CNPq), the Coordination for the Improvement of Higher Education Personnel (CAPES), the Postgraduate Program in Nutrition (PPGN) and the Dean of Research and Innovation (Propesqi) of the Federal University. University of Pernambuco (UFPE). The authors would like to acknowledge the support received from the Laboratory of Neurodynamics and Laboratory of Biochemistry of Nutrition, Experimental Nutrition and Metabolic Programming. Data Availability Data is provided within the manuscript. Funding Declaration This work was supported by the National Council for Scientific and Technological Development (CNPq) [grant number: 135166/2022-5]. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4790074","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":339526820,"identity":"d2970986-0eed-4b7b-be28-140bbab32baf","order_by":0,"name":"Nathália de Freitas Penaforte","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEklEQVRIie3OsWvCQBTH8SfCZbnuL1yo/8KTgjGQ1n/lJJAuLXZ0KgEhXY72vxHHhECmFFfHFsHJpYs4CO0TtEhJdO1w3yH53fDhDsBm+58JgCc87HD/aWcw5h81ijYTOpIYQILQUF0mcEoknSW+My8/ttTvgJrw0OFo4JgN5rMQfJXVksBETtcQdhOvvO8aHQdGvk8xr2IIXnUtoSwSKAlbCT708GpbkMTHqfpKC6Cq/mE0Xwp3RzhIcLRxd5pJZ73CPP1uJotIKL5lyLfw2BOUgkl2hix7yiOMUq/koWOSVXzTz6tIBqbpYcOVux4/376pCQ8dkvNSfC7y2d21L+vJbwJPT60ELgHuL7HZbDbbsR+qpFaTnsDF6AAAAABJRU5ErkJggg==","orcid":"","institution":"Federal University of Pernambuco","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Nathália","middleName":"de Freitas","lastName":"Penaforte","suffix":""},{"id":339526821,"identity":"053acd6e-9a8a-4529-9dbf-6e6fa65529d7","order_by":1,"name":"Marcelo Cairrão Araújo Rodrigues","email":"","orcid":"","institution":"Federal University of Pernambuco","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Marcelo","middleName":"Cairrão Araújo","lastName":"Rodrigues","suffix":""},{"id":339526822,"identity":"103a59ba-3ddc-4a7c-80d7-71613d08243f","order_by":2,"name":"Arildo Lemes Guedes","email":"","orcid":"","institution":"Federal University of Pernambuco","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Arildo","middleName":"Lemes","lastName":"Guedes","suffix":""},{"id":339526823,"identity":"aa0ab13c-1044-4fe8-b61a-90bf94930079","order_by":3,"name":"Fernando Wesley Cavalcanti de Araújo","email":"","orcid":"","institution":"Federal University of Pernambuco","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Fernando","middleName":"Wesley Cavalcanti","lastName":"de Araújo","suffix":""},{"id":339526824,"identity":"e1eb9b82-edf4-4d82-8c8d-322cf0244deb","order_by":4,"name":"Elizabeth do Nascimento","email":"","orcid":"","institution":"Federal University of Pernambuco","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Elizabeth","middleName":"do","lastName":"Nascimento","suffix":""}],"badges":[],"createdAt":"2024-07-23 15:51:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4790074/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4790074/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":62529860,"identity":"a213e6a5-b91a-431d-9872-7d665d27d514","added_by":"auto","created_at":"2024-08-15 12:13:24","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":48555,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of the sample of evaluated participants.\u003c/p\u003e\n\u003cp\u003eSource: Own authorship, 2023.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4790074/v1/46990a0b1868aeb1fa0eb8ef.png"},{"id":62529191,"identity":"ea0d1447-bd85-4129-9e45-a4ae6a967d33","added_by":"auto","created_at":"2024-08-15 12:05:25","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":39253,"visible":true,"origin":"","legend":"\u003cp\u003ePercentage distribution of the Bristol Scale of the experimental group at T0 and T3. Recife, Pernambuco, Brazil, 2023\u003c/p\u003e\n\u003cp\u003eCaption: EG, gluten/casein containing food restriction group; T0 = Baseline moment, before the intervention period; T3 = Final moment, after the intervention period. Fisher's Exact test.\u003c/p\u003e\n\u003cp\u003eSource: Own authorship, 2023.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4790074/v1/30a4ce6c9d19c023f56da1b4.png"},{"id":62529188,"identity":"312bbdf4-6623-4a5e-aaf0-77e94855281d","added_by":"auto","created_at":"2024-08-15 12:05:24","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":39533,"visible":true,"origin":"","legend":"\u003cp\u003ePercentage distribution of the Bristol Scale of the control group at T0 and T3. Recife, Pernambuco, Brazil, 2023\u003c/p\u003e\n\u003cp\u003eLegend: CG, no gluten/casein containing food restriction group; T0 = Baseline moment, before the intervention period; T3 = Final moment, after the intervention period. Fisher's Exact test.\u003c/p\u003e\n\u003cp\u003eSource: Own authorship, 2023.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4790074/v1/e91db75cf72880802d2724aa.png"},{"id":87615052,"identity":"f3ea8943-db58-4680-a680-1d4cff3c48ea","added_by":"auto","created_at":"2025-07-26 00:31:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1740258,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4790074/v1/efe816f3-193d-4bbf-8331-562d816acccb.pdf"},{"id":62529190,"identity":"39373b7c-234b-4ad3-ba0a-ac1bfa9dce7d","added_by":"auto","created_at":"2024-08-15 12:05:25","extension":"jpg","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":214913,"visible":true,"origin":"","legend":"","description":"","filename":"GraphicalAbstractnew1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4790074/v1/ef8f3140dcd0644cb4a397da.jpg"}],"financialInterests":"No competing interests reported.","formattedTitle":"People without clinical diagnosis of intolerance or allergy have benefits from gluten-and casein-free diet","fulltext":[{"header":"1.\tINTRODUCTION","content":"\u003cp\u003eGluten has been the subject of numerous studies demonstrating its association with an inflammatory state and intolerance in both animal [1] and human [2] studies over time. Gluten, a glycoprotein composed of gliadin and glutenin formed in the presence of water, is found in foods like wheat, barley, and rye—staples in the regular diet of most Western countries [3]. Literature posits an association between gluten-related diseases (including Celiac Disease - CD), wheat allergy, gluten intolerance (GI) or sensitivity (GS) in undiagnosed individuals, and metabolic and inflammatory processes [1,4]. However, the role of gluten in components of metabolic syndrome and related inflammatory responses remains unclear due to conflicting results [5]. Thus, a gap in the literature requires investigation.\u003c/p\u003e\n\u003cp\u003eLike gluten, peptides from milk proteins like casein can induce immune responses and abnormal intestinal permeability, facilitating the absorption of incompletely broken peptides, leading to inflammation [6,7]. The scientific uncertainties and controversies provide a significant scope for studies identifying the relationship between potentially inflammatory foods and intestinal health.\u003c/p\u003e\n\u003cp\u003eIn a similar context, teachers and students, theoretically vulnerable to subclinical inflammation [8,9], typically have unregulated eating habits, often consuming industrialized and ultra-processed foods, increasing the likelihood of hypersensitivity [10,11,12]. These habits involve significant consumption of gluten- and casein-containing foods, contributing to overweight and obesity prevalent in this population [13,14,15], making them more susceptible to signs of intestinal dysbiosis associated with food hypersensitivity [10].\u003c/p\u003e\n\u003cp\u003eDespite the controversies, gluten and casein-containing foods favor increased intestinal mucosal permeability, altering the intestinal microbiota [2,16], resulting in metabolic and nutritional changes. We hypothesized that gluten-and casein-free diet (GCFD) improves intestinal health, and decreases body mass/BMI in individuals without a clinical diagnosis of intolerances/allergies. Thus, the study aims to evaluate the variation in body mass and intestinal health in university faculty and students following a restricted diet in gluten- and casein-containing foods.\u003c/p\u003e"},{"header":"2.\tMATERIALS AND METHODS","content":"\u003ch2\u003e2.1. Procedures\u003c/h2\u003e\n\u003cp\u003eThe study protocol adhered to ethical norms for research involving human subjects (Resolution 466/12 of the National Health Council) and was approved by the Ethics Committee on Human Research at the Health Sciences Center of the Federal University of Pernambuco under protocol number 5.671.846 and CAAE 57955822.2.0000.520. Meeting all ethical criteria. Data collection took place at the Neurodynamics laboratory at the Federal University of Pernambuco, located in the Department of Physiology and Pharmacology in the Center for Biosciences. There is also the Brazilian Clinical Trials Registry (ReBEC) under registration number RBR-6htr5rg registered on April 9, 2024.\u003c/p\u003e\n\u003ch2\u003e2.2. Participants\u003c/h2\u003e\n\u003cp\u003eThis study was an analytical, non-randomized, quasi-experimental clinical trial involving teaching professionals in a teaching or administrative role and undergraduate and postgraduate students aged 20 to 55 of both sexes in Recife, Brazil. Regarding the exclusion criteria, it was established that the following would not participate in the sample: i) individuals diagnosed with food allergies, such as celiac disease and cow\u0026apos;s milk protein allergy (CMPA); ii) those who were undergoing pre-existing medical-nutritional monitoring; 3) those with a body mass index (BMI) \u0026le; 18.4 and \u0026ge; 40.\u003c/p\u003e\n\u003cp\u003eA total of 122 volunteers were assessed, with 63 meeting eligibility criteria for the final sample. Data collection occurred from September 2022 to April 2023. The final sample was divided into two groups: Control Group (with No Gluten/Casein containing Foods Restriction, (CG), n= 42) and experimental (Gluten/Casein containing Foods Restriction, (EG), n= 21). The experimental group underwent dietary intervention for 90 days, in which they were subject to Gluten and Casein containing foods Restriction (Fig 1). Volunteers were recruited through in-person invitations at schools/institutions. After a brief explanation of the research, volunteers signed the Human Ethics and Consent to Participate declarations and chose to join the control or experimental group, both composed of self-reported individuals without a diagnosis of gluten and/or casein allergy. Volunteers had the option to withdraw at any stage without prejudice.\u003c/p\u003e\n\u003ch2\u003e2.3. Study Variables\u003c/h2\u003e\n\u003cp\u003eAll participants completed questionnaires and underwent anthropometric data collection (body mass, height, and BMI). The control group maintained their regular diet for 90 days, while the experimental group was instructed to restrict gluten- and casein-containing foods for the same period. Afterward, both groups were reassessed with the same instruments. The independent variable included food consumption, while dependent variables comprised assessment of Metabolic Screening Questionnaire (MSQ) score, BMI and stool consistency.\u003c/p\u003e\n\u003ch3\u003e2.3.1. Assessment of Body Mass Index\u003c/h3\u003e\n\u003cp\u003eAnthropometric data collection involved measuring height and body mass. Height measurement utilized an Avanutri\u0026reg; digital ultrasonic stadiometer with a range of 50 to 215 cm. Participants stood barefoot, with heels, buttocks, and the upper back against the wall, maintaining the head in the Frankfurt plane. Body mass measurement was conducted with participants barefoot and in light clothing, using a G.TECH\u0026reg; portable digital scale (GLASS200) with a maximum capacity of 200 kg and a precision of 50 g. All measurements were duplicated, with a third measurement taken when mass differed by more than 100 g and height by more than 0.5 cm. Measurements were collected in person, at the beginning and end of the study, by trained researchers of the same sex as the participant. These data were used to calculate BMI by dividing mass (kg) by height (m\u0026sup2;). BMI cutoffs were established for underweight (\u0026le; 18.4), normal weight (18.5-24.9), overweight (25-29.9), and obesity (\u0026ge; 30), following the distribution of the reference population\u0026apos;s BMI as presented in the National Health Library - Ministry of Health [BVS/MS] (2009) (Box 1 and 3).\u003c/p\u003e\n\u003ch3\u003e2.3.2. Assessment of Food Consumption\u003c/h3\u003e\n\u003cp\u003eThe Food Frequency Questionnaire (FFQ) was administered by trained nutrition professionals at the beginning and end of the study to both groups in person. The FFQ, a valuable tool for analyzing habitual food consumption, can be applied qualitatively, semi-qualitatively, quantitatively, and semi-quantitatively [17]. Along with the FFQ, the MSQ [18] and Bristol Scale [19] were administered before and after the gluten- and casein-restricted diet. This approach ensured better control of potential repercussions from the restricted diet, as there was no proposed change in energy/nutritional content. Nutritional data were tabulated in electronic spreadsheets using Microsoft Excel\u0026reg; to determine the frequency of food consumption and the relative predominance of gluten- and casein-containing foods.\u003c/p\u003e\n\u003ch3\u003e2.3.3. Assessment of Metabolic Tracking Questionnaire scores\u003c/h3\u003e\n\u003cp\u003eThe MSQ from the Brazilian Institute of Functional Nutrition, composed of closed questions filled subjectively with information about the subject\u0026apos;s Healthy Status in the last 30 days, weeks, and 48 hours, was used. The MSQ is a tool to investigate various signs and symptoms over specific periods, with the patient assigning scores. The total points serve as a parameter to begin screening for potential nutritional deficiencies, hypersensitivities, food intolerances, or other causes (food or environmental). The MSQ was applied by trained nutrition professionals in person at the beginning and end of the study in both groups. The MSQ comprises 14 blocks related to the body\u0026apos;s important points: head, eyes, ears, skin, nose, mouth/throat, joints, lungs, heart, digestive tract, joints/muscles, energy/activity, mind, and emotions. Results were interpreted on a scoring scale from 0 to 4, where 0 indicates no or almost no symptoms, and 4 indicates frequent and severe symptoms. Scores in each section were analyzed, with 10 or more points indicating food hypersensitivity. The number of 4s in the questionnaire could also indicate hypersensitivity [18].\u003c/p\u003e\n\u003ch3\u003e2.3.4. Assessment of Stool Consistency\u003c/h3\u003e\n\u003cp\u003eThe Bristol Scale [19], applied along with the MSQ and FFQ, assessed stool consistency by presenting seven images with precise descriptions of form and consistency. This scale was applied before and after the gluten- and casein-restricted diet, with participants choosing the image that most closely resembled their own stools. Results were recorded in the patient records. Subtypes 1 and 2 indicated constipation, subtypes 3 and 4 represented normal stools, and subtypes 5, 6, and 7 indicated diarrhea [20].\u003c/p\u003e\n\u003ch2\u003e2.4. Data Analysis\u003c/h2\u003e\n\u003cp\u003eData obtained from the questionnaires were entered into a Microsoft Excel spreadsheet and subjected to statistical analysis using the Graphpad Prism version 9.0 program. The normality of distribution for continuous variables was assessed employing the Kolmogorov-Smirnov test. Parametrically distributed variables were expressed as mean and standard deviation values, while non-parametrically distributed variables were presented as median values and interquartile ranges.\u003c/p\u003e\n\u003cp\u003eWhen comparing the variable between two groups at the same period, the unpaired t-test or Mann-Whitney test was employed for parametric and non-parametric analyses, respectively. When comparing a single variable before and after the restriction within each group, paired t-test or Wilcoxon rank sum test was employed for parametric and non-parametric analyses, respectively. Categorical variables were evaluated using the Pearson Chi-square test or Fisher\u0026apos;s Exact test, where applicable. A significance level of 5% was employed for all statistical tests.\u003c/p\u003e\n\u003cp\u003eIt is worth mentioning that foods containing gluten and/or casein in their composition, as these were the focus of this research, were selected for the score calculation formula [21]. In these analyzes, as the data are non-parametric and not paired, parametric analysis was used by the Mann-Whitney test. The data are presented as the Median value, 95% Confidence Interval with lower and upper limits; and the p-value for each analysis.\u003c/p\u003e"},{"header":"3.\tRESULTS","content":"\u003cp\u003eInitially, we will present the flowchart related to the acquisition of the final sample, followed by the characterization of the study sample (Figure 1). Subsequently, the total sample and the respective control and experimental groups will be characterized according to participant characteristics and clinical data at baseline (T0). Later, an intra and intergroup comparison will be performed after the intervention period or the final research time (T3).\u003c/p\u003e\n\u003ch2\u003e3.1.\u0026nbsp;Baseline comparisons\u003c/h2\u003e\n\u003cp\u003eAt baseline, a general characterization and clinical data of the sample and the respective control and experimental groups were performed (Table 1).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"552\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1 -\u0026nbsp;\u003c/strong\u003eClinical and sample characterization variables. Recife, Pernambuco, Brazil, 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.89855072463768%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.03623188405797%\"\u003e\n \u003cp\u003e\u003cstrong\u003eT (n = 63)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCG (n = 42)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEG (n = 21)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.89855072463768%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDescription\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.03623188405797%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.89855072463768%\"\u003e\n \u003cp\u003eAge \u003cstrong\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.03623188405797%\"\u003e\n \u003cp\u003e32,9 \u0026plusmn; 11,6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e30,6 \u0026plusmn; 10,2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e37,6 \u0026plusmn; 13,2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e0,0711\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.89855072463768%\"\u003e\n \u003cp\u003eHeight \u003cstrong\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.03623188405797%\"\u003e\n \u003cp\u003e1,65 \u0026plusmn; 0,08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e1,66 \u0026plusmn; 0,07\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e1,64 \u0026plusmn; 0,09\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e0,2434\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.89855072463768%\"\u003e\n \u003cp\u003eWeight \u003cstrong\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.03623188405797%\"\u003e\n \u003cp\u003e69,1 \u0026plusmn; 15,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e69,8 \u0026plusmn;15,9\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e67,7 \u0026plusmn;14,3\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e0,6872\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.89855072463768%\"\u003e\n \u003cp\u003eBMI \u003cstrong\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.03623188405797%\"\u003e\n \u003cp\u003e25,2 \u0026plusmn; 5,5\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e25,2 \u0026plusmn; 5,3\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e25,4 \u0026plusmn; 6,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e0,8491\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.89855072463768%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.03623188405797%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.89855072463768%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n 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width=\"19.02173913043478%\" rowspan=\"2\"\u003e\n \u003cp\u003e0,7864\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.45190156599553%\"\u003e\n \u003cp\u003eFeminine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.568232662192393%\"\u003e\n \u003cp\u003e40 (63%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.48993288590604%\"\u003e\n \u003cp\u003e26 (62%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.48993288590604%\"\u003e\n \u003cp\u003e14 (66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.89855072463768%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.03623188405797%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n 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width=\"15.03623188405797%\"\u003e\n \u003cp\u003e22 (35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e11 (27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e11 (52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\" rowspan=\"2\"\u003e\n \u003cp\u003e0,0524\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.45190156599553%\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.568232662192393%\"\u003e\n \u003cp\u003e41 (65%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.48993288590604%\"\u003e\n \u003cp\u003e31 (73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.48993288590604%\"\u003e\n \u003cp\u003e10 (48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.89855072463768%\"\u003e\n 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width=\"34.45190156599553%\"\u003e\n \u003cp\u003eHuman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.568232662192393%\"\u003e\n \u003cp\u003e19 (30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.48993288590604%\"\u003e\n \u003cp\u003e6 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.48993288590604%\"\u003e\n \u003cp\u003e11 (52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.45190156599553%\"\u003e\n \u003cp\u003eHealth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.568232662192393%\"\u003e\n \u003cp\u003e34 (51%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.48993288590604%\"\u003e\n \u003cp\u003e26 (62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.48993288590604%\"\u003e\n \u003cp\u003e8 (28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.89855072463768%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n 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\u003ctd width=\"15.03623188405797%\"\u003e\n \u003cp\u003e14 (22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e9 (22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e5 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;0,9999\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.45190156599553%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.568232662192393%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.48993288590604%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.48993288590604%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.89855072463768%\"\u003e\n \u003cp\u003e\u003cstrong\u003eLactose intolerance?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.03623188405797%\"\u003e\n \u003cp\u003e\u003cstrong\u003en \u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u003cstrong\u003en \u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u003cstrong\u003en \u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.89855072463768%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.03623188405797%\"\u003e\n \u003cp\u003e39 (62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e27 (64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e12 (57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\" rowspan=\"3\"\u003e\n \u003cp\u003e0,5339\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.45190156599553%\"\u003e\n \u003cp\u003eDo not know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.568232662192393%\"\u003e\n \u003cp\u003e15 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.48993288590604%\"\u003e\n \u003cp\u003e10 (23%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.48993288590604%\"\u003e\n \u003cp\u003e5 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.45190156599553%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.568232662192393%\"\u003e\n \u003cp\u003e9 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.48993288590604%\"\u003e\n \u003cp\u003e5 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.48993288590604%\"\u003e\n \u003cp\u003e4 (19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.89855072463768%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.03623188405797%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.89855072463768%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAre you allergic to casein?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.03623188405797%\"\u003e\n \u003cp\u003e\u003cstrong\u003en \u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u003cstrong\u003en \u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u003cstrong\u003en \u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.89855072463768%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.03623188405797%\"\u003e\n \u003cp\u003e47 (75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e35 (83%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e12 (57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.89855072463768%\"\u003e\n \u003cp\u003eDo not know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.03623188405797%\"\u003e\n \u003cp\u003e16 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e7 (17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e9 (43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,0244\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.45190156599553%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.568232662192393%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.48993288590604%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.48993288590604%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.89855072463768%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedical diagnosis of lactose intolerance?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.03623188405797%\"\u003e\n \u003cp\u003e\u003cstrong\u003en \u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u003cstrong\u003en \u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u003cstrong\u003en \u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.89855072463768%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.03623188405797%\"\u003e\n \u003cp\u003e57 (90%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e38 (90%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e19 (90%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u0026gt;0,9999\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.45190156599553%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.568232662192393%\"\u003e\n \u003cp\u003e6 (10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.48993288590604%\"\u003e\n \u003cp\u003e4 (10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.48993288590604%\"\u003e\n \u003cp\u003e2 (10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.89855072463768%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.03623188405797%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.89855072463768%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDo you have an allergy or intolerance to gluten?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.03623188405797%\"\u003e\n \u003cp\u003e\u003cstrong\u003en \u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u003cstrong\u003en \u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u003cstrong\u003en \u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.89855072463768%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.03623188405797%\"\u003e\n \u003cp\u003e45 (66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e32 (76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e13 (62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\" rowspan=\"3\"\u003e\n \u003cp\u003e0,3727\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.45190156599553%\"\u003e\n \u003cp\u003eDo not know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.568232662192393%\"\u003e\n \u003cp\u003e16 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.48993288590604%\"\u003e\n \u003cp\u003e9 (21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.48993288590604%\"\u003e\n \u003cp\u003e7 (33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.45190156599553%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.568232662192393%\"\u003e\n \u003cp\u003e2 (9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.48993288590604%\"\u003e\n \u003cp\u003e1 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.48993288590604%\"\u003e\n \u003cp\u003e1 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.89855072463768%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.03623188405797%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.89855072463768%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDo you have a medical diagnosis of celiac disease?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.03623188405797%\"\u003e\n \u003cp\u003e\u003cstrong\u003en \u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u003cstrong\u003en \u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u003cstrong\u003en \u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.89855072463768%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.03623188405797%\"\u003e\n \u003cp\u003e63 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e42 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e21 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e0,4760\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.89855072463768%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.03623188405797%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.89855072463768%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDid you have COVID-19?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.03623188405797%\"\u003e\n \u003cp\u003e\u003cstrong\u003en \u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u003cstrong\u003en \u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u003cstrong\u003en \u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.89855072463768%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.03623188405797%\"\u003e\n \u003cp\u003e22 (35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e17 (40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\"\u003e\n \u003cp\u003e5 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.02173913043478%\" rowspan=\"3\"\u003e\n \u003cp\u003e0,3454\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.45190156599553%\"\u003e\n \u003cp\u003eDo not know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.568232662192393%\"\u003e\n \u003cp\u003e5 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.48993288590604%\"\u003e\n \u003cp\u003e2 (7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.48993288590604%\"\u003e\n \u003cp\u003e3 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.45190156599553%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.568232662192393%\"\u003e\n \u003cp\u003e36 (57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.48993288590604%\"\u003e\n \u003cp\u003e23 (53%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.48993288590604%\"\u003e\n \u003cp\u003e13 (52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"5\"\u003e\n \u003cp\u003eCaption: BMI, Body mass index; T, total sample; CG, no gluten/casein containing food restriction group; EG, gluten/casein containing food restriction group.\u003c/p\u003e\n \u003cp\u003ea - Kruskal-Wallis test with Dunn\u0026apos;s post-hoc test - Data did not pass any normality test, but not corrected for multiple comparison.\u003c/p\u003e\n \u003cp\u003e* - (CG vs T), # (EG vs T), \u0026delta; (CG vs EG)\u003c/p\u003e\n \u003cp\u003eThe p-value presented in the table indicates the comparison between the Control and Experimental groups. Source: Own authorship, 2023.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003e3.2.\u0026nbsp;Total sample data\u003c/h2\u003e\n\u003cp\u003eAccording to gender, women made up the largest percentage of the sample. In relation to the three major areas of specialization, the majority were not in the health sector, followed by the humanities and exact sciences. Furthermore, the majority represented the public educational institution (Table 1). Self-reports on allergy/intolerance to casein and/or lactose and/or gluten indicated a predominance of negative responses across the entire sample. Regarding SARS-CoV-2 infection, 57.4% responded positively based on self-report (Table 1).\u003c/p\u003e\n\u003ch2\u003e3.3.\u0026nbsp;Control and experimental group data\u003c/h2\u003e\n\u003cp\u003eThe control (CG) and experimental (EG) groups were also compared at baseline (T0) to determine if both groups were similar or different before the proposed intervention. Both groups were similar for age, height, body mass, and BMI. In terms of participant gender, there was similarity between the groups, with females predominating in both (Table 1).\u003c/p\u003e\n\u003cp\u003eWhen analyzing the distribution of participants between university teachers and students, it was observed that in the EG, there was a balance in this proportion, but in the CG, 73% were composed of students. Regarding areas of expertise, health predominated in the CG, and humanities in the EG. When analyzing the education network, the public network predominated, following the same result as the total sample and having a similar distribution in both groups (Table 1).\u003c/p\u003e\n\u003cp\u003eExcept for casein allergy (p=0.0244), no significance was found between the groups regarding responses to gluten and/or lactose allergy/intolerance (p\u0026gt;0.05), (Table 1). The self-declaration of the absence of gluten and lactose intolerance/allergy was in line with the lower frequency of medical diagnoses of lactose intolerance or celiac disease proven. Regarding SARS-CoV-2 infection, the majority responded positively in both groups (Table 1), with no significant difference between the groups and following a pattern similar to the total sample.\u003c/p\u003e\n\u003ch2\u003e3.4.\u0026nbsp;Baseline comparison of \u0026nbsp;between score of Metabolic Screening Questionnaire and intragroup\u003c/h2\u003e\n\u003cp\u003eWhen evaluating the overall classification, no difference was observed (p=0.3128) between the CG and EG at the initial time (T0). However, at T0, it is observed that between the CG and EG, there is a difference in the digestive tract domain (p=0.0245). Regarding the digestive tract domain, it is possible to verify that the EG has higher scores when compared to the CG at T0 (Table 2). In this study, the overall domain in both groups is composed of the sum of the scores of all domains that contribute equally.\u003c/p\u003e\n\u003ch2\u003e3.5.\u0026nbsp;Comparison between score of Metabolic Screening Questionnaire after the intervention period\u003c/h2\u003e\n\u003cp\u003eA decrease in the global classification (p=0.0001) and the domains was found in the EG after the intervention period: 1) digestive tract (p=0.0003); 2) mind (p=0.0434); 4) head (p=0.0143); 5) and emotions (p=0.0318). However, the CG also showed statistically different values in the global classification of MSQ (p=0.0049) and the following domains: 1) Digestive tract (p=0.0121); 2) and Head (p=0.0001). There was a decrease in value, projecting an improvement at the metabolic level in these points over the studied period. In the other evaluated domains of MSQ, no significant differences were found (p\u0026gt;0.05). When comparing the CG and EG at the end of the study (T3), the analysis of the global score and the domains of MSQ showed that the only difference found was for the nose domain, where the EG showed reduced values (Table 2).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"621\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"9\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2 -\u0026nbsp;\u003c/strong\u003eIntra and intergroup results of global organizations and MSQ application domains of the control and experimental group before and after period gluten-and casein-free diet. Recife, Pernambuco, Brazil, 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.466988727858293%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.594202898550725%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCG\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n = 42)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eT0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.882447665056361%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCG\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n = 42)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eT3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.856682769726248%\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.272141706924316%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEG\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n = 21)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eT0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.20450885668277%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEG\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n = 21)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eT3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.21256038647343%\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.75523349436393%\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCG\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ex EG\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(T0)\u003c/strong\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.75523349436393%\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCG\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ex EG\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(T3)\u003c/strong\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.466988727858293%\"\u003e\n \u003cp\u003eMSQ Global\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.594202898550725%\"\u003e\n \u003cp\u003e0,83 \u0026plusmn; 0,55\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.882447665056361%\"\u003e\n \u003cp\u003e0,68 \u0026plusmn; 0,45*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.856682769726248%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,0049\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.272141706924316%\"\u003e\n \u003cp\u003e0,96 \u0026plusmn; 0,56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.20450885668277%\"\u003e\n \u003cp\u003e0,58 \u0026plusmn; 0,36*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.21256038647343%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0,0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.75523349436393%\"\u003e\n \u003cp\u003e0,3128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.75523349436393%\"\u003e\n \u003cp\u003e0,6524\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.466988727858293%\"\u003e\n \u003cp\u003eDigestive tract\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.594202898550725%\"\u003e\n \u003cp\u003e0,82 \u0026plusmn; 0,71\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.882447665056361%\"\u003e\n \u003cp\u003e0,57 \u0026plusmn; 0,66*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.856682769726248%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,0121\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.272141706924316%\"\u003e\n \u003cp\u003e0,85 \u0026plusmn; 0,78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.20450885668277%\"\u003e\n \u003cp\u003e0,56 \u0026plusmn; 0,63*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.21256038647343%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,0003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.75523349436393%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,0245\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.75523349436393%\"\u003e\n \u003cp\u003e0,8563\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.466988727858293%\"\u003e\n \u003cp\u003eMind\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.594202898550725%\"\u003e\n \u003cp\u003e0,81 \u0026plusmn; 0,66\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.882447665056361%\"\u003e\n \u003cp\u003e0,71 \u0026plusmn; 0,67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.856682769726248%\"\u003e\n \u003cp\u003e0,3615\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.272141706924316%\"\u003e\n \u003cp\u003e1,06 \u0026plusmn; 1,04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.20450885668277%\"\u003e\n \u003cp\u003e0,71 \u0026plusmn; 0,67*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.21256038647343%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,0434\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.75523349436393%\"\u003e\n \u003cp\u003e0,5395\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.75523349436393%\"\u003e\n \u003cp\u003e0,8570\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.466988727858293%\"\u003e\n \u003cp\u003eHead\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.594202898550725%\"\u003e\n \u003cp\u003e1,15 \u0026plusmn; 0,70\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.882447665056361%\"\u003e\n \u003cp\u003e0,81 \u0026plusmn; 0,53*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.856682769726248%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0,0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.272141706924316%\"\u003e\n \u003cp\u003e1,42 \u0026plusmn; 0,81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.20450885668277%\"\u003e\n \u003cp\u003e1,00 \u0026plusmn; 0,67*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.21256038647343%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,0143\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.75523349436393%\"\u003e\n \u003cp\u003e0,2650\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.75523349436393%\"\u003e\n \u003cp\u003e0,3475\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.466988727858293%\"\u003e\n \u003cp\u003eEmotions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.594202898550725%\"\u003e\n \u003cp\u003e1,47 \u0026plusmn; 1,22\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.882447665056361%\"\u003e\n \u003cp\u003e1,29 \u0026plusmn; 1,07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.856682769726248%\"\u003e\n \u003cp\u003e0,1827\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.272141706924316%\"\u003e\n \u003cp\u003e1,30 \u0026plusmn; 1,02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.20450885668277%\"\u003e\n \u003cp\u003e0,99 \u0026plusmn; 0,87*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.21256038647343%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,0318\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.75523349436393%\"\u003e\n \u003cp\u003e0,7161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.75523349436393%\"\u003e\n \u003cp\u003e0,4111\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"9\"\u003e\n \u003cp\u003eCaption: CG, no gluten/casein containing food restriction group; EG, gluten/casein containing food restriction group; T0, baseline moment, before the intervention period; T3, final moment, after the intervention period.\u003c/p\u003e\n \u003cp\u003ea - Wilcoxon test - Not approved in any normality test\u003c/p\u003e\n \u003cp\u003e* - Existence of difference between groups\u003c/p\u003e\n \u003cp\u003eSource: Own authorship, 2023.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003e3.6.\u0026nbsp;Baseline and Final comparison of groups regarding the Bristol Scale\u003c/h2\u003e\n\u003cp\u003eConcerning self-reported characteristics related to evacuations, from the classification of the Bristol Scale, it was observed in a qualitative distribution that the EG provided responses for all types of fecal consistencies at the initial moment of the study (Figure 2). For the CG, the concentration of responses remained in types 3 and 4, with no representation in type 7 (Figure 3). It is noteworthy that volunteers could mark more than one option in their response.\u003c/p\u003e\n\u003cp\u003eAt the end of the intervention period, the reapplication of the Bristol Scale questionnaire showed that the EG provided more concentrated responses for Type 3 and Type 4 (Figure 2). However, there was no statistical difference (p=0.1611). Just as the CG showed a lack of statistical significance (p=0.6195).\u003c/p\u003e\n\u003ch2\u003e3.7.\u0026nbsp;Baseline and final comparison of groups regarding body mass index\u003c/h2\u003e\n\u003cp\u003eIn Table 3, it can be observed that at baseline, there were no significant intra and intergroup differences. The intervention protocol with gluten and casein restriction for 90 days did not alter body mass or BMI (p=0.9389; p=0.7525, respectively) when compared to the CG. Anthropometric differences were also not observed within the groups after the experimental period.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"626\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"9\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3 -\u0026nbsp;\u003c/strong\u003eIntra and intergroup associations of body mass and BMI of the control and experimental groups before and after period gluten-and casein-free diet. Recife, Pernambuco, Brazil, 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.34185303514377%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.501597444089457%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCG (n = 42)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ein T0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.543130990415335%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCG (n = 42)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ein T3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.987220447284345%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.86261980830671%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEG (n = 21)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ein T0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.182108626198083%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEG (n = 21)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ein T3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34185303514377%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.619808306709265%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eValor p\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCG x EG(T0)\u003c/strong\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.619808306709265%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCG x EG(T3)\u003c/strong\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.34185303514377%\"\u003e\n \u003cp\u003eBody mass\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.501597444089457%\"\u003e\n \u003cp\u003e69,7 \u0026plusmn;15,9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.543130990415335%\"\u003e\n \u003cp\u003e70,3 \u0026plusmn;15,9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.987220447284345%\"\u003e\n \u003cp\u003e0,1288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.86261980830671%\"\u003e\n \u003cp\u003e67,7 \u0026plusmn; 14,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.182108626198083%\"\u003e\n \u003cp\u003e67,7 \u0026plusmn; 14,9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34185303514377%\"\u003e\n \u003cp\u003e0,9389\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.619808306709265%\"\u003e\n \u003cp\u003e0,6934\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.619808306709265%\"\u003e\n \u003cp\u003e0,5750\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.34185303514377%\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.501597444089457%\"\u003e\n \u003cp\u003e25,2 \u0026plusmn; 5,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.543130990415335%\"\u003e\n \u003cp\u003e25,4 \u0026plusmn; 5,4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.987220447284345%\"\u003e\n \u003cp\u003e0,0936\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.86261980830671%\"\u003e\n \u003cp\u003e25,4 \u0026plusmn; 6,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.182108626198083%\"\u003e\n \u003cp\u003e25,2 \u0026plusmn; 6,1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34185303514377%\"\u003e\n \u003cp\u003e0,7525\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.619808306709265%\"\u003e\n \u003cp\u003e0,8540\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.619808306709265%\"\u003e\n \u003cp\u003e0,7206\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"9\"\u003e\n \u003cp\u003eCaption: CG, no gluten/casein containing food restriction group; EG, gluten/casein containing food restriction group; T0 = Baseline moment, before the proposed intervention; T3 = Final moment, after intervention period; BMI = Body mass index;\u003c/p\u003e\n \u003cp\u003eb Wilcoxon test - Not approved in any normality test\u003c/p\u003e\n \u003cp\u003eSource: Own authorship, 2023.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003e3.8.\u0026nbsp;Baseline comparison of groups regarding dietary score\u003c/h2\u003e\n\u003cp\u003eThe dietary scores, collected through FFQ, were calculated for each food group: 1) Global; 2) Milk and dairy products; 3) Breads and cookies; 4) Fats, sauces, and seasonings; 5) Sweets and desserts; 6) Soups and pastas; 7) and Beverages. In general, for all food groups, the CG and EG had equivalent scores at the beginning of the experiment, as shown in Table\u003c/p\u003e\n\u003ch2\u003e3.9.\u0026nbsp;Final comparison of groups regarding dietary score\u003c/h2\u003e\n\u003cp\u003eThe dietary scores, collected through FFQ, were calculated for each food group: 1) Global; 2) Milk and dairy products; 3) Breads and cookies; 4) Fats, sauces, and seasonings; 5) Sweets and desserts; 6) Soups and pastas; 7) and Beverages. It is worth mentioning that foods containing gluten and/or casein in their composition, as these were the focus of this research, were selected for the score calculation formula used by other researchers [21].\u003c/p\u003e\n\u003cp\u003eAfter the 90-day period of gluten and casein restriction, it was observed that the EG showed a significant difference (p\u0026lt;0.05) in all evaluated food groups, except for group 7, referring to alcoholic beverages (Table 4). In the CG, it was possible to see that there were no differences over the studied time, as expected since there was no intervention (Table 4). In summary, the results indicate that there was no change in the eating pattern of the CG, only in the EG. Therefore, the results suggest that this group followed the guidelines proposed by the study. When comparing between groups after the intervention period, statistical significance (p\u0026lt;0.05) was observed in all food groups except group 7 (Table 6). This result confirms that indeed the EG followed the proposed guidelines (Table 5).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"609\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 4 -\u0026nbsp;\u003c/strong\u003eComparative score of food groups, using the FFQ, between the control and experimental groups at baseline moment, before intervention. Recife, Pernambuco, Brazil, 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.37704918032787%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eFood group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.16393442622951%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eCG\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n = 42) in T0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.16393442622951%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eEG\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n = 21) in T0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.295081967213115%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.37704918032787%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.459016393442623%\" valign=\"bottom\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.704918032786885%\" valign=\"bottom\"\u003e\n \u003cp\u003eIQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.459016393442623%\" valign=\"bottom\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.704918032786885%\" valign=\"bottom\"\u003e\n \u003cp\u003eIQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.295081967213115%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.37704918032787%\" valign=\"bottom\"\u003e\n \u003cp\u003eGlobal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.459016393442623%\" valign=\"top\"\u003e\n \u003cp\u003e0,1409\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.704918032786885%\" valign=\"top\"\u003e\n \u003cp\u003e0,1084 - 0,1765\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.459016393442623%\" valign=\"top\"\u003e\n \u003cp\u003e0,1425\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.704918032786885%\" valign=\"top\"\u003e\n \u003cp\u003e0,0822 - 0,1974\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.295081967213115%\" valign=\"top\"\u003e\n \u003cp\u003e0,7918\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.37704918032787%\" valign=\"bottom\"\u003e\n \u003cp\u003eMilk and derivatives\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.459016393442623%\" valign=\"top\"\u003e\n \u003cp\u003e0,1786\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.704918032786885%\" valign=\"top\"\u003e\n \u003cp\u003e0,1281 - 0,2366\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.459016393442623%\" valign=\"top\"\u003e\n \u003cp\u003e0,1449\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.704918032786885%\" valign=\"top\"\u003e\n \u003cp\u003e0,0937 - 0,2710\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.295081967213115%\" valign=\"top\"\u003e\n \u003cp\u003e0,5034\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.37704918032787%\" valign=\"bottom\"\u003e\n \u003cp\u003eBreads and cookies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.459016393442623%\" valign=\"top\"\u003e\n \u003cp\u003e0,1224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.704918032786885%\" valign=\"top\"\u003e\n \u003cp\u003e0,0864 - 0,1684\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.459016393442623%\" valign=\"top\"\u003e\n \u003cp\u003e0,1272\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.704918032786885%\" valign=\"top\"\u003e\n \u003cp\u003e0,0816 - 0,1837\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.295081967213115%\" valign=\"top\"\u003e\n \u003cp\u003e0,9510\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.37704918032787%\" valign=\"bottom\"\u003e\n \u003cp\u003eFat, sauce and seasoning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.459016393442623%\" valign=\"top\"\u003e\n \u003cp\u003e0,2143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.704918032786885%\" valign=\"top\"\u003e\n \u003cp\u003e0,0166 - 0,2310\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.459016393442623%\" valign=\"top\"\u003e\n \u003cp\u003e0,0881\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.704918032786885%\" valign=\"top\"\u003e\n \u003cp\u003e0,0166 - 0,2143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.295081967213115%\" valign=\"top\"\u003e\n \u003cp\u003e0,1919\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.37704918032787%\" valign=\"bottom\"\u003e\n \u003cp\u003eSweets and desserts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.459016393442623%\" valign=\"top\"\u003e\n \u003cp\u003e0,1246\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.704918032786885%\" valign=\"top\"\u003e\n \u003cp\u003e0,0587 - 0,2107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.459016393442623%\" valign=\"top\"\u003e\n \u003cp\u003e0,1063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.704918032786885%\" valign=\"top\"\u003e\n \u003cp\u003e0,0222 - 0,2857\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.295081967213115%\" valign=\"top\"\u003e\n \u003cp\u003e0,7143\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.37704918032787%\" valign=\"bottom\"\u003e\n \u003cp\u003eSoups and pasta\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.459016393442623%\" valign=\"top\"\u003e\n \u003cp\u003e0,0937\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.704918032786885%\" valign=\"top\"\u003e\n \u003cp\u003e0,0404 - 0,1484\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.459016393442623%\" valign=\"top\"\u003e\n \u003cp\u003e0,0881\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.704918032786885%\" valign=\"top\"\u003e\n \u003cp\u003e0,0349 - 0,1190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.295081967213115%\" valign=\"top\"\u003e\n \u003cp\u003e0,4982\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.37704918032787%\" valign=\"bottom\"\u003e\n \u003cp\u003eDrinks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.459016393442623%\" valign=\"top\"\u003e\n \u003cp\u003e0,0000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.704918032786885%\" valign=\"top\"\u003e\n \u003cp\u003e0,0000 - 0,0333\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.459016393442623%\" valign=\"top\"\u003e\n \u003cp\u003e0,0000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.704918032786885%\" valign=\"top\"\u003e\n \u003cp\u003e0,0000 - 0,0333\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.295081967213115%\" valign=\"top\"\u003e\n \u003cp\u003e0,7362\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\" valign=\"bottom\"\u003e\n \u003cp\u003eCaption: CG, no gluten/casein containing food restriction group; EG, gluten/casein containing food restriction group; T0 = Baseline moment, before intervention; FFQ, Food Frequency Questionnaire. Non-parametric test (Mann-Whitney test), values presented are the Median and IQ - Interquartile Range\u003c/p\u003e\n \u003cp\u003eSource: Own authorship, 2023.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"630\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 5 -\u0026nbsp;\u003c/strong\u003eIntragroup comparative score of the food groups, using the FFQ, of the control and experimental group before and after period gluten-and casein-free diet. Recife, Pernambuco, Brazil, 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.624405705229794%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.061806656101425%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline moment (T0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.4770206022187%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eFinal moment (T3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.836767036450079%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.624405705229794%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.061806656101425%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eCG (n = 42)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.4770206022187%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eCG (n = 42)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.836767036450079%\" rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.545454545454547%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eFood group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.545454545454545%\" valign=\"bottom\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.09090909090909%\" valign=\"bottom\"\u003e\n \u003cp\u003eIQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.545454545454545%\" valign=\"bottom\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.272727272727273%\" valign=\"bottom\"\u003e\n \u003cp\u003eIQ\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.624405705229794%\" valign=\"bottom\"\u003e\n \u003cp\u003eGlobal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\" valign=\"top\"\u003e\n \u003cp\u003e0,1409\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.38351822503962%\" valign=\"top\"\u003e\n \u003cp\u003e0,1084 - 0,1765\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\" valign=\"top\"\u003e\n \u003cp\u003e0,1378\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.798732171156892%\" valign=\"top\"\u003e\n \u003cp\u003e0,1034 - 0,1729\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.836767036450079%\" valign=\"top\"\u003e\n \u003cp\u003e0,8358\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.624405705229794%\" valign=\"bottom\"\u003e\n \u003cp\u003eMilk and derivatives\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\" valign=\"top\"\u003e\n \u003cp\u003e0,1786\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.38351822503962%\" valign=\"top\"\u003e\n \u003cp\u003e0,1281 - 0,2366\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\" valign=\"top\"\u003e\n \u003cp\u003e0,1911\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.798732171156892%\" valign=\"top\"\u003e\n \u003cp\u003e0,1281 - 0,2510\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.836767036450079%\" valign=\"top\"\u003e\n \u003cp\u003e0,8969\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.624405705229794%\" valign=\"bottom\"\u003e\n \u003cp\u003eBreads and cookies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\" valign=\"top\"\u003e\n \u003cp\u003e0,1224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.38351822503962%\" valign=\"top\"\u003e\n \u003cp\u003e0,0864 - 0,1684\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\" valign=\"top\"\u003e\n \u003cp\u003e0,0911\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.798732171156892%\" valign=\"top\"\u003e\n \u003cp\u003e0,0492 - 0,1896\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.836767036450079%\" valign=\"top\"\u003e\n \u003cp\u003e0,5441\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.624405705229794%\" valign=\"bottom\"\u003e\n \u003cp\u003eFat, sauce and seasoning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\" valign=\"top\"\u003e\n \u003cp\u003e0,2143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.38351822503962%\" valign=\"top\"\u003e\n \u003cp\u003e0,0166 - 0,2310\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\" valign=\"top\"\u003e\n \u003cp\u003e0,2143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.798732171156892%\" valign=\"top\"\u003e\n \u003cp\u003e0,0166 - 0,2143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.836767036450079%\" valign=\"top\"\u003e\n \u003cp\u003e0,0759\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.624405705229794%\" valign=\"bottom\"\u003e\n \u003cp\u003eSweets and desserts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\" valign=\"top\"\u003e\n \u003cp\u003e0,1246\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.38351822503962%\" valign=\"top\"\u003e\n \u003cp\u003e0,0587 - 0,2107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\" valign=\"top\"\u003e\n \u003cp\u003e0,1429\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.798732171156892%\" valign=\"top\"\u003e\n \u003cp\u003e0,0587 - 0,2107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.836767036450079%\" valign=\"top\"\u003e\n \u003cp\u003e0,8919\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.624405705229794%\" valign=\"bottom\"\u003e\n \u003cp\u003eSoups and pasta\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\" valign=\"top\"\u003e\n \u003cp\u003e0,0937\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.38351822503962%\" valign=\"top\"\u003e\n \u003cp\u003e0,0404 - 0,1484\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\" valign=\"top\"\u003e\n \u003cp\u003e0,0881\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.798732171156892%\" valign=\"top\"\u003e\n \u003cp\u003e0,0390 - 0,1260\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.836767036450079%\" valign=\"top\"\u003e\n \u003cp\u003e0,6485\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.624405705229794%\" valign=\"bottom\"\u003e\n \u003cp\u003eDrinks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\" valign=\"top\"\u003e\n \u003cp\u003e0,0000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.38351822503962%\" valign=\"top\"\u003e\n \u003cp\u003e0,0000 - 0,0333\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\" valign=\"top\"\u003e\n \u003cp\u003e0,0000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.798732171156892%\" valign=\"top\"\u003e\n \u003cp\u003e0,0000 - 0,0333\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.836767036450079%\" valign=\"top\"\u003e\n \u003cp\u003e0,3359\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.624405705229794%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.38351822503962%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.798732171156892%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.836767036450079%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.624405705229794%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.061806656101425%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eEG (n = 21)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.4770206022187%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eEG \u0026nbsp;(n = 21)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.836767036450079%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.624405705229794%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eFood group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\" valign=\"bottom\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.38351822503962%\" valign=\"bottom\"\u003e\n \u003cp\u003eIQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\" valign=\"bottom\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.798732171156892%\" valign=\"bottom\"\u003e\n \u003cp\u003eIQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.836767036450079%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.624405705229794%\" valign=\"bottom\"\u003e\n \u003cp\u003eGlobal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\"\u003e\n \u003cp\u003e0,1425\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.38351822503962%\"\u003e\n \u003cp\u003e0,0822 - 0,1974\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\"\u003e\n \u003cp\u003e0,0212*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.798732171156892%\"\u003e\n \u003cp\u003e0,0116 - 0,0523\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.836767036450079%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0,0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.624405705229794%\" valign=\"bottom\"\u003e\n \u003cp\u003eMilk and derivatives\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\"\u003e\n \u003cp\u003e0,1607\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.38351822503962%\"\u003e\n \u003cp\u003e0,0982 - 0,2699\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\"\u003e\n \u003cp\u003e0,0000*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.798732171156892%\"\u003e\n \u003cp\u003e0,0000 - 0,0000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.836767036450079%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0,0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.624405705229794%\" valign=\"bottom\"\u003e\n \u003cp\u003eBreads and cookies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\"\u003e\n \u003cp\u003e0,1272\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.38351822503962%\"\u003e\n \u003cp\u003e0,0816 - 0,1837\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\"\u003e\n \u003cp\u003e0,0204*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.798732171156892%\"\u003e\n \u003cp\u003e0,0000 - 0,0612\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.836767036450079%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,0003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.624405705229794%\" valign=\"bottom\"\u003e\n \u003cp\u003eFat, sauce and seasoning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\"\u003e\n \u003cp\u003e0,0881\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.38351822503962%\"\u003e\n \u003cp\u003e0,0166 - 0,2143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\"\u003e\n \u003cp\u003e0,0000*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.798732171156892%\"\u003e\n \u003cp\u003e0,0000 - 0,0000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.836767036450079%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,0013\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.624405705229794%\" valign=\"bottom\"\u003e\n \u003cp\u003eSweets and desserts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\"\u003e\n \u003cp\u003e0,1063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.38351822503962%\"\u003e\n \u003cp\u003e0,0222 - 0,2857\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\"\u003e\n \u003cp\u003e0,0111*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.798732171156892%\"\u003e\n \u003cp\u003e0,0000 - 0,0587\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.836767036450079%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,0025\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.624405705229794%\" valign=\"bottom\"\u003e\n \u003cp\u003eSoups and pasta\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\"\u003e\n \u003cp\u003e0,0881\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.38351822503962%\"\u003e\n \u003cp\u003e0,0349 - 0,1190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\"\u003e\n \u003cp\u003e0,0460*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.798732171156892%\"\u003e\n \u003cp\u003e0,0083 - 0,0714\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.836767036450079%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,0244\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.624405705229794%\" valign=\"bottom\"\u003e\n \u003cp\u003eDrinks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\"\u003e\n \u003cp\u003e0,0000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.38351822503962%\"\u003e\n \u003cp\u003e0,0000 - 0,0333\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.678288431061807%\"\u003e\n \u003cp\u003e0,0000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.798732171156892%\"\u003e\n \u003cp\u003e0,0000 - 0,0000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.836767036450079%\"\u003e\n \u003cp\u003e0,1250\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\" valign=\"bottom\"\u003e\n \u003cp\u003eCaption: CG, no gluten/casein containing food restriction group; EG, gluten/casein containing food restriction group; T0 = Baseline moment, before the intervention; T3 = Final moment, after intervention period; FFQ, Food Frequency Questionnaire.\u003c/p\u003e\n \u003cp\u003ePaired non-parametric test (Wilcoxon matched-pairs test), values presented are the Median and IQ - Interquartile Range.\u003c/p\u003e\n \u003cp\u003e* - Existence of difference between groups (p \u0026lt; 0.05)\u003c/p\u003e\n \u003cp\u003eSource: Own authorship, 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"622\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 6 -\u0026nbsp;\u003c/strong\u003eComparative score of food groups, using the FFQ, of the control and experimental groups at the final moment, after the intervention period. Recife, Pernambuco, Brazil, 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.375201288244767%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eFood group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.884057971014492%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eCG\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n = 42) in T3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.434782608695652%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eEG\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n = 21) in T3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.305958132045088%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.375201288244767%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\" valign=\"bottom\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.840579710144926%\" valign=\"bottom\"\u003e\n \u003cp\u003eIQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\" valign=\"bottom\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.391304347826086%\" valign=\"bottom\"\u003e\n \u003cp\u003eIQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.305958132045088%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.375201288244767%\" valign=\"bottom\"\u003e\n \u003cp\u003eGlobal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\" valign=\"bottom\"\u003e\n \u003cp\u003e0,1378\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.840579710144926%\" valign=\"bottom\"\u003e\n \u003cp\u003e0,1034 - 0,1729\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\" valign=\"bottom\"\u003e\n \u003cp\u003e0,0211*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.391304347826086%\" valign=\"bottom\"\u003e\n \u003cp\u003e0,0116 - 0,0523\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.305958132045088%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0,0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.375201288244767%\" valign=\"bottom\"\u003e\n \u003cp\u003eMilk and derivatives\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\" valign=\"bottom\"\u003e\n \u003cp\u003e0,1911\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.840579710144926%\" valign=\"bottom\"\u003e\n \u003cp\u003e0,1281 - 0,2510\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\" valign=\"bottom\"\u003e\n \u003cp\u003e0,0000*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.391304347826086%\" valign=\"bottom\"\u003e\n \u003cp\u003e0,0000 - 0,0000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.305958132045088%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0,0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.375201288244767%\" valign=\"bottom\"\u003e\n \u003cp\u003eBreads and cookies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\" valign=\"bottom\"\u003e\n \u003cp\u003e0,0911\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.840579710144926%\" valign=\"bottom\"\u003e\n \u003cp\u003e0,0492 - 0,1896\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\" valign=\"bottom\"\u003e\n \u003cp\u003e0,0204*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.391304347826086%\" valign=\"bottom\"\u003e\n \u003cp\u003e0,0000 - 0,0612\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.305958132045088%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0,0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.375201288244767%\" valign=\"bottom\"\u003e\n \u003cp\u003eFat, sauce and seasoning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\" valign=\"bottom\"\u003e\n \u003cp\u003e0,2143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.840579710144926%\" valign=\"bottom\"\u003e\n \u003cp\u003e0,0166 - 0,2143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\" valign=\"bottom\"\u003e\n \u003cp\u003e0,0000*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.391304347826086%\" valign=\"bottom\"\u003e\n \u003cp\u003e0,0000 - 0,0000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.305958132045088%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0,0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.375201288244767%\" valign=\"bottom\"\u003e\n \u003cp\u003eSweets and desserts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\" valign=\"bottom\"\u003e\n \u003cp\u003e0,1429\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.840579710144926%\" valign=\"bottom\"\u003e\n \u003cp\u003e0,0587 - 0,2107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\" valign=\"bottom\"\u003e\n \u003cp\u003e0,0111*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.391304347826086%\" valign=\"bottom\"\u003e\n \u003cp\u003e0,0000 - 0,0587\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.305958132045088%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0,0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.375201288244767%\" valign=\"bottom\"\u003e\n \u003cp\u003eSoups and pasta\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\" valign=\"bottom\"\u003e\n \u003cp\u003e0,0881\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.840579710144926%\" valign=\"bottom\"\u003e\n \u003cp\u003e0,0390 - 0,1260\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\" valign=\"bottom\"\u003e\n \u003cp\u003e0,0460*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.391304347826086%\" valign=\"bottom\"\u003e\n \u003cp\u003e0,0008 - 0,0714\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.305958132045088%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,0059\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.375201288244767%\" valign=\"bottom\"\u003e\n \u003cp\u003eDrinks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\" valign=\"bottom\"\u003e\n \u003cp\u003e0,0000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.840579710144926%\" valign=\"bottom\"\u003e\n \u003cp\u003e0,0000 - 0,0333\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\" valign=\"bottom\"\u003e\n \u003cp\u003e0,0000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.391304347826086%\" valign=\"bottom\"\u003e\n \u003cp\u003e0,0000 - 0,0000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.305958132045088%\" valign=\"bottom\"\u003e\n \u003cp\u003e0,0934\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\" valign=\"bottom\"\u003e\n \u003cp\u003eCaption: CG, no gluten/casein containing food restriction group; EG, gluten/casein containing food restriction group; T3 = Final moment, after intervention period; FFQ, Food Frequency Questionnaire. Unpaired non-parametric test (Mann-Whitney test), values presented are the Median and IQ - Interquartile Range.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e* - Existence of difference between groups (p \u0026lt; 0.05)\u003c/p\u003e\n \u003cp\u003eSource: Own authorship, 2023.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003eBased on the results of this study, it was possible to confirm the hypothesis that gluten- and casein-free dietary intervention seems to contribute to improving gut health and reducing possible hypersensitivity in individuals without a diagnosis of intolerance/allergies to these components. The sensitivity statement needs to be further investigated based on a more precise diagnosis [22], which was not the object of research in the present study. As for the hypothesis of changes in body mass and BMI, it was not possible to prove it. This result may be justified by the absence of a global energy reduction since there was no intervention or recommendation regarding the restriction of caloric intake from the habitual diet. However, this weight reduction can be found in long-term studies [23]. Although, adopting gluten-free diets has been linked to some nutritional deficiencies [24].\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;According to the Family Budget Survey (FBS), between 2008-2009 and 2017-2018, there was a reduction in the consumption of rice, beans, beef, bread, fruits, dairy products, processed meats, and sodas, but an increase in the consumption of sandwiches, signaling a worsening in the quality of the Brazilian diet [25]. In Brazil, the most consumed items, in order, are: cereals, milk, and fruits; Internationally, the three most consumed items are: cereals, vegetables, and milk. It can be said that the consumption patterns of both have some similarities, justified by globalization [26]. These data explain, in part, the high percentage of the presence of foods containing gluten and casein in the population's dietary habits [27,28], which may justify the dietary pattern of the public analyzed at the beginning of this research. This situation could be observed, in part, in students in the health sector at a public university in Recife, given the high consumption of simple carbohydrates, as well as other inadequacies that contributed to the association metabolic risk [29].\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; When mentioning hypersensitivity, in our findings, 19% of the volunteers in the EG group reported, through the applied questionnaire, being lactose intolerant, and another 24% reported having doubts about the possibility. However, when asked if they had undergone any type of test for confirmation and subsequent medical diagnosis of intolerance, only 9% of the entire sample in the EG had done so. Regarding gluten intolerance/allergy, the situation is the same as the previous one, 5% reported having it, and another 33% were unsure, but none of these reported a medical diagnosis of celiac disease or comproved hypersensibility. Thus without medical diagnosis, it can be inferred that a significant portion of the volunteers self-reported being intolerant, as well as suspected of \"perceive hypersensitivity.\" This self-report is in line with the results conducted by other researchers, concluding that noticeable hesitation can be justified by the similarity between triggered symptoms [30].\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; This prevalence of sensitivity to gluten/wheat, for example, can be related to the technological process applied to the original wheat grain due to the loss of antioxidant compounds and the addition of inflammatory ingredients [31]. Regarding casein sensitivity, this may be associated with the possibility of the presence of β-casomorphin-7 (BCM-7), resulting from the hydrolysis of the A1 genetic variant of β-casein, which reflects intestinal discomfort and pro-inflammatory effects [32]. These reports may justify the symptomatic perception of these compounds, gluten, and casein.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;In the EG group, it was observed that there was a predominance of females, as well as a strong adherence to GCFD. Adherence to nutritional recommendations was identified from the results obtained through the application of the FFQ and their respective significance at the end of the study when compared intra- and inter-groups. However, even without a diagnosis of celiac disease or casein/lactose allergy, the effect of dietary intervention in the EG on the MSQ and intestinal changes by the Bristol Scale was evident.\u0026nbsp;Although reports indicate that following a restrictive diet in this regard appears to be difficult to adhere to, taking as an example the gluten-restricted diet, which appears to have greater adherence in celiac patients \u0026nbsp;[33]. However, there is controversy regarding adherence even in celiac patients, which may have persistent symptomatology as a mediator [34].\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Furthermore, in this study, significant improvements were observed in symptomatological levels after GCFD, with a reduction in scores in the overall MSQ and in the domains of the digestive tract, mind, head, emotions, and nose. This can be explained by there being more than 50 toxic epitopes described in the gluten molecule related to cytotoxic, immunomodulatory activities and capable of altering intestinal permeability [35]. Regarding casein, there are also correlates of its contribution to immune response, intestinal permeability, and inflammation [6,7]. In addition, it is hypothesized that the A1 protein portion of β-casein is more inflammatory and detrimental to intestinal health when compared to the A2 protein portion of β-casein [36].\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; It is worth noting that the higher the representation of the score for the global classification of the MSQ, the greater the suspicion of hypersensitivity. Similarly, the greater the risk of developing intestinal dysbiosis and, consequently, the greater the influence of intestinal microbiota on the immune and neuroendocrine systems [12,37]. Through the findings of this study, it is verified that our intervention group initially presented similar characteristics, with a hypothesis of hypersensitivity and a risk of intestinal dysbiosis, which after GCFD resulted in a lower probability.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Results in the Bristol Scale also could be observed after the intervention period by demonstrating an improvement in stool consistency, as this instrument can indicate or be associated with a higher prevalence of food hypersensitivity due to changes in stool consistency and the presence of symptoms related to dysbiosis [38,39,40]. Although there was no statistical difference of the Bristol Scale in EG, the qualitative analysis clearly shows a reduction after intervention. Since there was an increase of 7% for Type 3 and 12% for Type 4. What corroborates with the intestinal result, as improvements in the digestive tract domain were also detected by the MSQ after the GCFD (gluten and casein free restriction). Therefore, the absence of gluten and casein in the usual diet appears to improve intestinal health.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Similarly, a gluten-free diet has shown possible therapeutic potential due to its contribution to changing the microbiota profile and modulating intestinal permeability [2,16]. This can be explained by gluten contributing to the intestinal inflammatory process by triggering immune, cellular, and humoral responses with consequent alteration in intestinal permeability [41,42]. Although the study did not evaluate inflammatory markers or microbiota profile, it is conjectured that the diet promoted an intestinal change with repercussions on intestinal health and the body as a whole.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;In addition, it is evident that casein may be associated with abnormal intestinal permeability due to the possibility of incomplete absorption of peptides, which can trigger an inflammatory process [43,44,45]. The set of findings above suggest that there is a relationship between emotional and gastrointestinal symptoms, and, in the presence of intestinal dysbiosis can be assessed through the MSQ and Bristol Scale [46,47]. These associations may be related to the results for the following MSQ domains: mind, head, and emotions. However, these considerations still require further evidence regarding GCFD.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Based on the obtained results, it was possible to verify that the intervention with GCFD does not interfere with body mass and BMI. This finding reinforces the premise that the restriction of these compounds is not necessarily a strategy for reducing body weight, at least in the short term. This result is in agreement with the findings of another study that, after a gluten-free diet intervention in non-celiac, eutrophic women for three weeks, did not achieve significant reduction in body mass [48]. These results contradict studies that report an association between the exclusion of these components, gluten, and casein, with effectiveness in the weight loss process, as well as adherence to them. Excluding gluten from the diet may have beneficial effects on weight reduction, adiposity, insulin resistance, and inflammation [49]. It is important to mention that there is not enough evidence to support or dismiss the idea of inducing weight loss in healthy individuals [50]. However, the follow-up time may be a factor to be considered. Regarding cow's milk, which contains casein, when consumed in large quantities, it can trigger a process of metabolic inflammation and, thus, seem to hinder the weight loss process [51].\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;On the other hand, in the celiac population, for example, results related to BMI are observed [52]. Despite this, it is worth noting that there are currently no studies in the literature investigating GCFD in people without a diagnosis of allergy/intolerance to these components, preventing us from comparing our findings, especially considering it is a university population. In addition, it remains unknown, and its impact may differ in the presence of allergy. Furthermore, obese individuals also characterize an imbalanced microbiota [14,53], which makes them more vulnerable to the presence of signs and symptoms characteristic of intestinal dysbiosis associated with food hypersensitivity [10].\u0026nbsp;However, it is important to highlight the sample size and intervention time, which may not be sufficient, as limitations of the present study.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Interestingly, based on the results obtained, at the beginning of the study, 52% of the EG self-reported being infected with SARS-CoV-2, while responding to the questionnaire, and another 14% did not know how to respond. We cannot affirm, but there are intriguing doubts about possible metabolic impacts related, as well as possible health consequences; equally, it is not known how relevant this information is. However, it remains undefined and difficult to identify which inflammatory or hemodynamic changes are secondary to infection [54,55].\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;From the consulted literature, this study is pioneering in the designed research plan aimed at analyzing the impact of gluten and casein restriction on the gastrointestinal tract, applied to the academic community. Our results may stimulate other experimental designs and further investigations. We recognize the limitations of the study, such as the sample size of the EG; in addition, we did not assess biochemical measures to investigate and associate various inflammatory markers or of diagnostic or hypersensibility and compare them with the CG before and after the intervention. A possible bias in our study is that our sample was voluntary without double-bind. That is, these individuals previously suspected some dysfunction and chose to participate in the proposed intervention.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Other limitations are associated with unknown if the results observed in this study were due to: i) the combined removal of gluten and casein; ii) which potentially inflammatory compound presented itself more influentially individually, gluten or casein?; iii) or if foods containing these compounds in addition to these (gluten and casein). These foods still have other compounds that may intervene in combination in the final result, such as a high content of fats and simple carbohydrates, which requires further clarification in future research.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eN.F.P.: Conceptualization, Investigation, Methodology, Formal analysis, Project administration, Data curation, Writing - original draft, Writing - review and editing; M.C.A.R.: Conceptualization, Investigation, Methodology, Formal analysis, Supervision, Project administration, Writing - review and editing; A.L.G.: Investigation, Data curation, Formal analysis, Writing - review and editing; F.W.C.A.: Formal analysis, Investigation, Writing - review and editing; E.N.: Conceptualization, Investigation, Methodology, Formal analysis, Project administration, Supervision, Writing - original draft, Writing - review and editing, Project administration, Funding acquisition.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to thank the funding granted by the National Council for Scientific and Technological Development (CNPq), the Coordination for the Improvement of Higher Education Personnel (CAPES), the Postgraduate Program in Nutrition (PPGN) and the Dean of Research and Innovation (Propesqi) of the Federal University. University of Pernambuco (UFPE). The authors would like to acknowledge the support received from the Laboratory of Neurodynamics and Laboratory of Biochemistry of Nutrition, Experimental Nutrition and Metabolic Programming.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData is provided within the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eThis work was supported by the National Council for Scientific and Technological Development (CNPq) [grant number: 135166/2022-5]. This work was supported by the Coordena\u0026ccedil;\u0026atilde;o de Aperfei\u0026ccedil;oamento de Pessoal de N\u0026iacute;vel Superior- Brasil (CAPES), Finance Code/Grant number 001, Postgraduate Program in Nutrition (PPGN) and Dean of Research and Innovation (Propesqi) at the Federal University of Pernambuco.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eFreire RH. Efeitos metab\u0026oacute;licos e inflamat\u0026oacute;rios do gl\u0026uacute;ten de trigo: papel da prote\u0026iacute;na na obesidade, 2015. http://hdl.handle.net/1843/BUBD-A2FGKV [accessed 13 October 2023].\u003c/li\u003e\n\u003cli\u003eBonder MJ, Tigchelaar EF, Cai X, Trynka G, Cenit MC, et al. The influence of a short-term gluten-free diet on the human gut microbiome. Genome medicine 8. 2016;1-11. doi: 10.1186/s13073-016-0295-y.\u003c/li\u003e\n\u003cli\u003eMart\u0026iacute;n SM, Vilar G, Yurrutia C, Caba\u0026ntilde;as C. 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Microbiota intestinal e risco cardiometab\u0026oacute;lico: mecanismos e modula\u0026ccedil;\u0026atilde;o diet\u0026eacute;tica. Arquivos Brasileiros de Endocrinologia \u0026amp; Metabologia 58. 2014;317-327. doi: 10.1590/0004-2730000002940.\u003c/li\u003e\n\u003cli\u003eStefan N, Birkenfeld AL, Schulze MB. Global pandemics interconnected\u0026mdash;obesity, impaired metabolic health and COVID-19. Nature Reviews Endocrinology 17.3. 2021;135-149. doi: 10.1038/ s41574-020-00462-1.\u003c/li\u003e\n\u003cli\u003ede Paula MN. S\u0026iacute;ndrome p\u0026oacute;s-Covid-19: aspectos cognitivos e neurol\u0026oacute;gicos.\u0026quot; Cadernos de Psicologia. 2022;10-10. doi: 10.9788/CP2022.2-01.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Gluten-free diet, Casein, Metabolism, Body Mass Index, Digestive tract.","lastPublishedDoi":"10.21203/rs.3.rs-4790074/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4790074/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction and Aim:\u003c/strong\u003e The present study aimed to assess university professors and students regarding the variation in body mass and intestinal health resulting from a restricted dietary intervention in foods containing gluten and casein. \u003cstrong\u003eMethods: \u003c/strong\u003eThis was a non-randomized, quasi-experimental clinical trial type study. Initially, 122 volunteers aged 20 to 55 years of both sexes were evaluated, but only 63 volunteers comprised the final sample. Participants were divided into two groups: No Gluten/Casein containing Food Restriction (CG, n= 42) and Gluten/Casein containing Food Restriction (EG, for 90 days, n= 21). Approval was obtained from the Ethics Committee on Human Research at the Health Sciences Center of the Federal University of Pernambuco under protocol number 5.671.846. It also presents the Brazilian Clinical Trials Registry (ReBEC) under number RBR-6htr5rg.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eScores from the Metabolic Screening Questionnaire (MSQ) in the intervention group for the thick domain showed a significant improvement compared to the NGC. Additionally, within-group comparisons showed reduced scores in the overall MSQ and domains of the digestive tract, mind, head, and emotions (p=\u0026lt;0.0001; p=0.0003; p=0.0434; p=0.0143; p=0.0318; respectively). Improvement in responses to the Bristol Scale was observed after gluten-and casein-free diet (GCFD). There was no reduction in body mass or Body Mass Index (BMI).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e These results confirm our hypothesis that GCFD seems to contribute to improve intestinal function in people without diagnosed intolerances/allergies to these components. Making it a pioneer in the outlined research design.\u003c/p\u003e","manuscriptTitle":"People without clinical diagnosis of intolerance or allergy have benefits from gluten-and casein-free diet","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-15 12:05:19","doi":"10.21203/rs.3.rs-4790074/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"97e8e4c3-70ba-43d9-9fcf-560559d4b8d4","owner":[],"postedDate":"August 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-26T00:23:18+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-15 12:05:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4790074","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4790074","identity":"rs-4790074","version":["v1"]},"buildId":"rHA-KDH7Qsr4HCuvH75dn","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}