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Although the positive effects of a GFD on AITDs have been observed in studies, these effects may be influenced by confounding factors such as dietary changes, age, adherence to the diet, and the strictness of dietary compliance, all of which can affect the outcomes

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While an updated meta-analysis of 32 randomized trials including 24,389 patients showed SDD was associated with lower mortality, it should be noted that the vast majority of positive trials were published well over a decade ago and are in settings with low antimicrobial resistance [327]

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