Celiac.com 09/30/2019 - We know from recent studies that high gluten intake in infancy can raise risk for celiac disease, and we know that the amount of gluten eaten by infants at 18 months heavily influences their risk of developing type 1 diabetes later in life.

An earlier study conducted in Denmark suggested that a high maternal gluten consumption during pregnancy increased the risk of type 1 diabetes in the child.  

Until now, researchers have not looked at levels of gluten intake by both the mother during pregnancy and the child in early life, and how that influences risk of developing type 1 diabetes in childhood. 

Now, a new study shows that every 10 grams of extra gluten eaten at age 18 months is associated with a 46% increased risk of developing type 1 diabetes.

The researchers recently conducted a Norwegian population-based nationwide study of 86,306 people to examine the association between the mother's intake of gluten during pregnancy, child's gluten intake at age 18 months, and the risk of type 1 diabetes in the child.

The research team included Dr Nicolai Lund-Blix, and colleagues at Oslo University Hospital, and the Norwegian Institute of Public Health in Oslo, Norway. Their research was presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD) in Barcelona, Spain from September 16-20.

The outcome was clinical type 1 diabetes cases in the nationwide childhood diabetes registry. The team calculated increased risk using statistical modeling for maternal gluten intake during pregnancy and child's gluten intake at 18 months. 

The authors estimated grams per day of gluten intake based on a semi-quantitative food frequency questionnaire at week 22 of pregnancy, and from a questionnaire completed by the guardian when the child was 18 months old.

Researchers are not calling upon expectant mothers to reduce gluten content in the infant diet at this point in time.

According to the authors, "This study suggests that the child's gluten intake at 18 months of age, and not the maternal intake during pregnancy, could increase the risk of type 1 diabetes in the child."

Read more at: Diabetes Times
and at Celiac.com: High Childhood Gluten Intake Increases Risk of Celiac Disease and Celiac Autoimmunity

Celiac.com 07/04/2019 - There's been some data to suggest that gluten may play a role in diabetes, but there really isn't much data on the role of gluten in type 1 diabetes (T1D), so a team of researchers recently set out to test whether gluten plays a role in type 1 diabetes onset. Specifically, the team wanted to know if a gluten-free diet can decelerate the decline in beta-cell capacity in newly diagnosed non-celiac children with T1D.

The research team included Vít Neuman, Stepanka Pruhova, Michal Kulich, Stanislava Kolouskova, Jan Vosahlo, Martina Romanova, Lenka Petruzelkova, Barbora Obermannova, Ondrej Cinek, and Zdeněk Šumník. They are variously affiliated with Charles University in Prague, and the University of Chemistry and Technology in Prague, Czech Republic.

For their non-randomized self-selected intervention trial, the team recruited forty-six children, from about 6-13 years old. One group of 26 began a gluten-free diet, while 20 continued on a standard non-gluten-free diet. 

Main outcomes were the decline in C-peptide area under the curve (AUC) in mixed-meal tolerance tests and the differences in insulin dose, insulin dose adjusted A1c (IDAA1c) and HbA1c at 12 months. 

Data were analyzed as intention-to-treat by linear regression models adjusted for baseline parameters. The adherence to a gluten-free diet was tested by immunoreactive gluten in stool.

Average decrease in C-peptide AUC was 293 vs.484 pmol/L (p=0.3) at 6 months, and 567 vs. 919 pmol/L (p=0.1) at 12 months in the gluten-free diet and control group, respectively. 

The group that ate a gluten-free diet had a lower insulin dose by 0.22 U/kg/day, lower IDAA1c by 1.5, and lower average HbA1c by 7.5 mmol/mol (p=0.01) after 12 months. Daily carbohydrate intake between the groups was the same. Researchers found immunoreactive gluten in the stool of just 3 patients.

Children with type 1 diabetes who ate a gluten-free diet for their first year after diagnosis lower insulin demand and lower HbA1c, although C-peptide dynamics were similar for each group.

This is the first study to provide solid data on the connection between gluten intake and type 1 diabetes. The fact that children who follow a gluten-free diet need less insulin is intriguing.

Read more at Diabetes 2019 Jun; 68(Supplement 1).

Celiac.com 04/18/2019 - Cases of type 1 diabetes have been on the rise in western countries, which suggests an environmental role in the development of the disease. Still, after decades of study, researchers have yet to nail down the factors driving the increase, and so they have no clear way to prevent new cases.

A potential association that deserves closer scrutiny is one of environmental causes as a driver of diabetes, including dietary factors, such as gluten. At the moment, there is a great deal of focus on maternal and childhood dietary factors. 

To remedy the current impasse, researchers Maija E Miettinen and Suvi M Virtanen of the National Institute for Health and Welfare in Helsinki, Finland, cite the need for comprehensive prospective studies with carefully collected data to define and confirm associations. Only with such data can effective solutions be devised and tested.

In a linked article, also in the BMJ, Antvorskov and colleagues investigated the association between maternal gluten intake during pregnancy and risk of type 1 diabetes in offspring. 

The authors analyzed data from the large Danish National Birth Cohort, covering about a third of all pregnancies in Denmark during the recruitment period of 1996-2002, in which more than 70,000 pregnant women reported their diet with a food frequency questionnaire.

That analysis revealed that risk of type 1 diabetes in offspring increased proportionally with maternal gluten intake during pregnancy per 10 grams per day increase of gluten. 

Compared to women with the lowest gluten intake of under 7 grams per day, those with the highest gluten intake, who consumed 20 or more grams a day, had double the risk for type 1 diabetes development in their children.  Basically, higher gluten intake during pregnancy meant higher diabetes risk for the children.

However, that’s one study with good data. The authors stress the urgency to understand what is driving alarmingly fast-rising diabetes rates. People’s health, well-being, and lives are at stake. For that, further study is needed, and soon.

Read more at BMJ 2018; 362 

Celiac.com 03/07/2019 - Researchers don’t have much good data on the distribution of the related alleles in the type 1 diabetes Iranian population. In an effort to generate better data, a team of researchers recently set out to assess the frequency of HLA DQ2 and DQ8 haplotypes in patients with type 1 diabetes, with and without celiac disease, and to compare them to the healthy population.

The research team included Ali Moheb-Alian, Flora Forouzesh, Amir Sadeghia, Kamran Rostami, Elham Aghamohammadi, Mohammad Rostami-Nejad, Mostafa Rezaei-Tavirani, and Mohammad Reza Zali.

The team looked at 70 type 1 diabetes patients who did not have celiac disease, 60 type 1 diabetes cases with celiac disease, and compared them with 150 healthy individuals. 

They collected ten milliliter Gheparinized blood samples, extracted genomic DNA, and genotyped alleles in Real-time PCR using SYBR Green as a low-resolution method. 

They found HLA-DQ2 genotypes in 51% of type 1 diabetes patients without celiac disease, and HLA-DQ8 in 23% of such patients. Just over twenty percent of those patients carried both alleles, while 5% carried neither allele. More than 70% of type 1 diabetes patients with celiac disease had DQ2, while nearly 12% carried DQ8.

Compared to  diabetes patients without celiac disease and the control group, 14% carry both alleles, and 3% carrying neither allele. The frequencies of DQ2 and DQ8 alleles in Iranian healthy population were 19 and 5% respectively.

The similarities in genetic background for celiac disease and type 1 diabetes show that HLA-typing can be serve as a helpful tool for spotting celiac disease in people with type one diabetes.

Read more in the Journal of Diabetes and its Complicationshttps://doi.org/10.1016/j.jdiacomp.2018.10.001

The researchers are variously affiliated with the Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran; the Department of Genetics, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran; the Department of Gastroenterology MidCentral District Health Board, Palmerston North Hospital, New Zealand; the Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran; and the Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Celiac.com 10/29/2018 - Researchers Emma L. Smith with UCB Pharma Ltd., Slough, United Kingdom, and Mark Peakman from the Department of Immunobiology, King’s College London, London, United Kingdom recently set out to catalog clinical advances in peptide immunotherapy for Type 1 diabetes.

Autoimmune and allergic diseases occur when a person’s body has an incorrect immune response to an antigen from the person’s own body, or to an innocuous antigen from outside the body. This triggers a pathogenic T-cell response which causes damage to certain tissues and organs. In Type 1 diabetes, this process results in the destruction of the insulin-secreting β cells, which leads to permanent need for recombinant insulin to make up for the loss. 

The best way to restore immune homeostasis and prevent further tissue damage is to reduce or cease the pathogenic T-cell response by using antigen-specific peptide immunotherapy. Smith and Peakman found that recent clinical advances with peptide therapy approaches in both Type 1 diabetes and other diseases are beginning to show encouraging results. New treatments that target peptides specific to certain cell types are also moving from the development stages into clinical use. 

Drug developers still face numerous hurdles in reaching full clinical use, including determining optimal dose and dosing frequency, but peptide immunotherapy for Type 1 diabetes is clearly becoming a very active field of drug development.

Read their full report: Front Immunol. 2018; 9: 392.Published online 2018 Feb 28. doi:  10.3389/fimmu.2018.00392PMCID: PMC5836708PMID: 29541078

Celiac.com 10/22/2018 - A team of researchers recently set out to determine if there is any association between prenatal gluten exposure and offspring risk of type 1 diabetes in humans.

The research team first designed a national prospective cohort study using the national health information registries in Denmark. They looked at data on pregnant Danish women enrolled into the Danish National Birth Cohort, between January 1996 and October 2002, and assessed maternal gluten intake, based on maternal consumption of gluten containing foods, as reported in a 360 item food frequency questionnaire at week 25 of pregnancy.

The team gathered information on type 1 diabetes occurrence in the participants’ children, from 1 January 1996 to 31 May 2016 by linking to the Danish Registry of Childhood and Adolescent Diabetes.

Overall, their study included data on 101,042 pregnancies in 91,745 women, of whom 70,188 filled out the food frequency questionnaire. Once they corrected the figures to account for multiple pregnancies, pregnancies ending in abortions, stillbirths, lack of information regarding the pregnancy, and pregnancies with implausibly high or low energy intake, they included 67,565 pregnancies and 63,529 women.

Gluten intake averaged 13.0 grams per day, ranging from under 7 grams per day to more than 20 grams per day. There were 247 children with type 1 diabetes among the group, for an incidence rate of 0.37%, with an average follow-up of 15.6 years.

Risk of type 1 diabetes in offspring increased proportionally with maternal gluten intake during pregnancy per 10 grams per day increase of gluten. Compared to women with the lowest gluten intake of under 7 grams per day, those with the highest gluten intake who consumed 20 or more grams a day had double the risk for type 1 diabetes development in their children.

These numbers indicate that high gluten intake by mothers during pregnancy may increase the risk of their children developing type 1 diabetes. However, the team is calling for further study to confirm the findings, preferably in an intervention setting.

Read more in BMJ 2018;362:k3547. doi: https://doi.org/10.1136/bmj.k3547

The research team included Julie C Antvorskov, assistant professor, Thorhallur I Halldorsson, professor in food science and nutrition, Knud Josefsen, senior researcher, Jannet Svensson, associate professor5, Charlotta Granström, statistician, Bart O Roep, professor, Trine H Olesen, research assistant, Laufey Hrolfsdottir, director, Karsten Buschard, professor, and Sjudur F Olsen, adjunct professor of nutrition.

They are variously affiliated with the Bartholin Institute, Rigshospitalet in Copenhagen, Denmark; the Centre for Foetal Programming, Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark; the Unit for Nutrition Research, Landspitali University Hospital, Reykjavik, Iceland; the Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland; the Copenhagen Diabetes Research Center (CPH-DIRECT), Department of Children and Adolescents, Copenhagen University Hospital Herlev, Herlev, Denmark; the Department of Diabetes Immunology, Diabetes and Metabolism Research Institute at the Beckman Diabetes Research Institute, City of Hope, Duarte, CA, USA; the Departments of Immunohematology and Blood Transfusion, Leiden University Medical Centre, Leiden, Netherlands; the Department of Education, Science, and Quality, Akureyri Hospital, Akureyri, Iceland; and the Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

Celiac.com 10/19/2018 - Work to develop a vaccine for celiac disease could soon lead to a vaccine for diabetes.

After successful phase 1 studies of Nexvax2, their peptide-based therapeutic vaccine for celiac disease, ImmusanT has seen a significant investment from venture philanthropy organization JDRF T1D. ImmusanT's peptide therapy program for celiac disease may provide lessons for a similar therapeutic treatment for Type 1 diabetes.

The investment will support ImmusanT as it attempts to develop a vaccine to prevent Type 1 diabetes, based on the early success of its peptide immunotherapy program for celiac disease, the two entities announced in a press release.

ImmusanT’s celiac peptide therapy program works by identifying antigens that trigger an inflammatory responses in people with autoimmune diseases. Once identified, the peptide therapy is used to neutralize the autoimmune response. This celiac disease program goes back to 1998, when Anderson first began his efforts to find and identify the peptides. 

The findings were published in 2010, and the company was founded shortly afterward by Leslie Williams, BS, RN, MBA, director, president and CEO of ImmusanT. 

From there, ImmusanT conducted five phase 1 trials for its celiac therapy. Those trials have proven very promising, and the latest investment into a similar drug for diabetes is proof of that promise. In the case of celiac disease, the drug works by “targeting T cells in patients. Those T cells that are engaged as peptides are distributed throughout the body after the injection, and we see evidence that the T cells are being activated about 2 hours later,” Robert Anderson, BMedSc, MB, ChB, PhD, FRACP, chief scientific officer for ImmusanT, told Endocrine Today. “We found that if we gradually increase the dose in patients building up to a maintenance dose level, they become non-reactive to those peptides.”

With much of the early research targeted towards demonstrating the drug’s safety, and getting the right dose and dose regimen, the development of a version targeted at diabetes, says Anderson, “should be more streamlined due to the lessons learned during the celiac disease program.

That’s partly because the team knows “a lot more going into Type 1 diabetes about how peptide therapy works and how to optimize it than we did when we started celiac disease, where it was a blank slate.”

This is really exciting news. A vaccine for celiac disease is exciting, to be sure, but a viable vaccine for diabetes would be a major development in disease prevention. Stay tuned for more news as the story develops. 

Read more at Healio.com

Celiac.com 02/28/2018 - In an effort to discover more genes that trigger type 1 diabetes, a team of researchers recently conducted a large, prospective study of children at risk for type 1 diabetes. The end goal is to reveal more targets for treating or even preventing the disease.

The research team included A Sharma, X Liu, D Hadley, W Hagopian, WM Chen, S Onengut-Gumuscu, C Törn, AK Steck, BI Frohnert, M Rewers, AG Ziegler, Å Lernmark, J Toppari, JP Krischer, B Akolkar, SS Rich, JX She; and TEDDY Study Group.

The team identified six new chromosomal regions in young people who have already developed type 1 diabetes, or who have started making antibodies against their insulin-producing cells, often a step toward full-blown diabetes that requires lifelong insulin therapy. Their analysis of 5,806 individuals, which is published in the Journal of Autoimmunity, also confirms three regions already associated with one of those related conditions.

The team observed two top autoantibodies. The first, called IAA, acts directly against insulin. The second, called GADA, acts against the enzyme glutamate decarboxylase, which regulates the insulin-producing beta cells in the pancreas. According to Dr. She, about 90 percent of patients with type 1 diabetes start with one of the autoantibodies, and many patients eventually end up with both. The second autoantibody may surface in a few days or even years later.

They began this study with 176,586 SNPs, or single nucleotide polymorphisms. Nucleotides are basic building blocks of our genetic information. According to Sharma, the SNPs evaluated by TEDDY scientists were already linked with other autoimmune conditions like rheumatoid arthritis or celiac disease, but not type 1 diabetes.

The researchers figured out which of these SNPs are different in TEDDY participants with type 1 diabetes versus those with Islet cell autoantibodies versus those with neither. Previous research has shown that the genes associated with IA and actual type 1 diabetes can differ. Dr. She says that even though clinicians regard Islet cell autoantibodies (IA) as a red flag for type 1 diabetes, not every child with IA goes on to develop diabetes, though multiple autoantibodies definitely increase that risk.

The team notes that it is possible that the genes that promote IA development may differ from those that lead to full-blown disease progression.

She says that this is the first study of gene identification for any disease to use this sort of longitudinal information. She add that this and other studies by the TEDDY research group help to clarify the search for important non-HLA genes by adding the "time to disease" perspective.

Source:

• J Autoimmun. 2018 Jan 5. pii: S0896-8411(17)30739-4. doi: 10.1016/j.jaut.2017.12.008.

The researchers are variously affiliated with the Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA; Division of Biostatistics and Data Science, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, US; the Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA; the Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom; the Pacific Northwest Research Institute, Seattle, WA, USA; the Center for Public Health Genomics, University of Virginia, Charlottesville, VA, USA; the Department of Clinical Sciences, Lund University/CRC, Malmö, Sweden; the Barbara Davis Center for Childhood Diabetes, University of Colorado, Denver, Aurora, CO, USA; the Institute of Diabetes Research, Helmholtz Zentrum München, Munich-Neuherberg, Germany; Klinikum rechts der Isar, Technische Universität München, Munich-Neuherberg, Germany; Forschergruppe Diabetes e.V., Munich-Neuherberg, Germany; the Department of Pediatrics, Turku University Hospital, Turku, Finland; the National Institutes of Diabetes and Digestive and Kidney Disorders, National Institutes of Health, Bethesda, MD, USA; and the Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA.

Celiac.com 07/05/2017 - Numerous researchers have documented a connection between celiac disease and type 1 diabetes.

One team of researchers recently set out to examine international differences in celiac disease rates and clinical characteristics of youth with coexisting type 1 diabetes and celiac disease compared with type 1 diabetes only.

The research team included Maria E. Craig, Nicole Prinz, Claire T. Boyle, Fiona M. Campbell, Timothy W. Jones, Sabine E. Hofer, Jill H.Simmons, Naomi Holman, Elaine Tham, Elke Fröhlich-Reiterer, Stephanie DuBose, Helen Thornton, Bruce King, David M. Maahs, Reinhard W. Holl and Justin T. Warner.

To analyze the relationship between outcomes, including HbA1c, height-standard deviation score [sDS], overweight/obesity, and type 1 diabetes with celiac disease versus type 1 diabetes alone, adjusting for sex, age, and diabetes duration, the team created multivariable linear and logistic regression models.

The analysis included 52,721 people under 18 years of age with a clinic visit between April 2013 and March 2014. The team used the following data sources: the Prospective Diabetes Follow-up registry (Germany/Austria); the T1D Exchange Clinic Network (T1DX) (U.S.); the National Paediatric Diabetes Audit (U.K. [England/Wales]); and the Australasian Diabetes Data Network (ADDN) (Australia).

The researchers found biopsy-confirmed celiac disease in 1,835 young people, or 3.5%. These patients were diagnosed on average at age 8.1 years, with a range of 5.3 to 11.2 years.

Most young people (37%) with diabetes upon celiac disease diagnosis had it for less than one year. Eighteen percent with diabetes had it for 1-2 years at celiac diagnosis, 23% had diabetes between 3 and 5 years at celiac diagnosis, while 17% had diabetes for more than 5 years at celiac diagnosis. Celiac disease rates ranged from 1.9% in the T1DX to 7.7% in the ADDN and were higher in girls than boys (4.3% vs. 2.7%, P < 0.001).

Children with coexisting celiac disease were diagnosed with diabetes at 5.4 years on average, compared with those with type 1 diabetes only, who were diagnosed at 7.0 years of age, on average. Also, fewer children with both conditions were non-white, 15 vs. 18%.

Height-SDS was lower in those with celiac disease (0.36 vs. 0.48) and fewer were overweight/obese (34 vs. 37%, adjusted P < 0.001), whereas average HbA1c values were comparable: 8.3 ± 1.5% (67 ± 17 mmol/mol) versus 8.4 ± 1.6% (68 ± 17 mmol/mol).

This study clearly documented that celiac disease is not uncommon in young people with type 1 diabetes. Differences in disease rates may be due to variations in screening and diagnostic practices, and/or risk levels.

Although the groups showed similar glycemic control, the research team encourages close monitoring of growth and nutrition in this population, due to the lower height-SDS.

Source:

• Diabetes Care 2017 May; dc162508.

The researchers in this study are variously affiliated with the Children’s Hospital at Westmead, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia; Charles Perkins Centre Westmead, University of Sydney, Sydney, New South Wales, Australia; Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany; German Center for Diabetes Research, Munich-Neuherberg, Germany; Jaeb Center for Health Research, Tampa, FL; Leeds Children’s Hospital, Leeds, U.K.; The University of Western Australia, Perth, Western Australia, Australia; Telethon Kids Institute, Perth, Australia; Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria; Vanderbilt University Medical Center, Nashville, TN; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K.; Women’s and Children’s Hospital, Adelaide, South Australia, Australia; Department of Pediatrics, Medical University of Graz, Graz, Austria; St. Helens and Knowsley Teaching Hospitals NHS Trust, St. Helens, U.K.; John Hunter Children’s Hospital, Hunter Medical Research Institute, University of Newcastle, Callaghan, New South Wales, Australia; Lucile Salter Packard Children's Hospital Stanford, Stanford University Medical Center, Palo Alto, CA; and the Children's Hospital for Wales, Cardiff, U.K.

Celiac.com 04/18/2017 - Even though gluten-free diets are more popular than ever, researchers still don't have much good data on gluten intake and long-term health.

A team of researchers recently set out to assess three large cohort studies, the Nurses' Health Study (NHS, n=69,276), the NHSII (n=88,610), and the Health Professionals Follow-Up Study (HPFS, n=41,908), and to estimate gluten intake using a validated food-frequency questionnaire collected every 2-4 years. The research team included Geng Zong, of the Harvard T.H. Chan School of Public Health, Boston, MA; Benjamin Lebwohl, Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY; Frank Hu, Laura Sampson, Lauren Dougherty, Walter Willett, Andrew Chan, and Qi Sun, of the Harvard T.H. Chan School of Public Health in Boston, MA.

The team defined incidental Type 2 diabetes as physician diagnosed diabetes, and confirmed with supplementary information. Their results showed that average gluten intake, give or take standard deviation, was 5.83±2.23, 6.77±2.50, and 7.06±2.76 grams/day in NHS, NHSII, and HPFS, respectively. That gluten intake cam, mainly from carbohydrate sources, especially refined grains, starch, and cereal fiber (Spearman correlation coefficients > 0.6).

The team confirmed 15,947 Type 2 diabetes cases over 4.24 million years of follow-up time. In all three groups, the team observed an inverse connection between gluten consumption and Type 2 diabetes risk. The multivariate adjustment (table), and hazard ratio (HR, 95% confidence intervals [95%CI]) comparing extreme quintiles were 0.80 (0.76, 0.84; P<0.001).

The connection dissipated slightly after adjusting for cereal fiber (HR [95%CI]= 0.87 [0.81, 0.93]), but not for other carbohydrate components.

For study participants under 65 years of age, and without major chronic diseases, changes in gluten intake were not associated with weight gain in multivariate adjusted model. Overall, the 4-year weight change (95%CI) was 0.08 (-0.06, 0.22; P=0.25) in NHS, -0.05 (-0.18, 0.08; P=0.43) in NHSII, and 0.36 (-0.24, 0.96; P=0.24) HPFS for each 5 grams increase in gluten intake.

These findings suggest that gluten intake likely doesn't cause or promote Type 2 diabetes or excess weight gain.

Reducing dietary gluten is unlikely to help prevent Type 2 diabetes, and may actually reduce consumption of cereal fiber or whole grains that help to lower overall diabetes risk.

Source:

• AHA EPI

Celiac.com 02/22/2017 - Type 1 diabetes mellitus (T1DM) and celiac disease (celiac disease) are autoimmune diseases that share similar genetic patterns. T1DM treatment is based on diet, physical activity and insulin therapy, whereas celiac disease treatment is based on a gluten-free diet.

A research team recently set out to evaluate the quality of life (QoL) of individuals with the association of T1DM and celiac disease, to characterize their nutritional status and to compare it with those with only one disease and to healthier control subjects. The research team included JG Nunes-Silva, VS Nunes, RP Schwartz, S1 Mlss Trecco, D Evazian, ML Correa-Giannella, M Nery, and MS Queiroz. The are variously affiliated with the Nutrition and Dietetics Division, Central Institute of Clinics Hospital, the Lipids Laboratory (LIM-10), Endocrinology and Metabolism Division of Hospital das Clinicas, Faculty of Medical Sciences, the Radiology Institute of Clinics Hospital, the Cellular and Molecular Endocrinology Laboratory (LIM-18), and the Endocrinology Division, Internal Medicine Department, all at the University of São Paulo Medical School, São Paulo, Brazil.

The researchers evaluated sixty patients controlled by sex, age and body mass index (BMI). Patients were further divided into the following groups based on previous diagnosis: DMCD group (T1DM and celiac disease); DM group (T1DM); celiac disease group (celiac disease); or HC (healthy control subjects). They used the SF-36 questionnaire to assess psychological well-being, and compared the results with glycemic control, presence of complications related to diabetes, and adhesion to gluten-free diet (GFD).

Using BMI, waist circumference, bio-impedance, general laboratory tests and whole-body densitometry, they determined nutritional status and body mass composition.

Both the DMCD and DM groups had similar times of diagnosis, but the duration of celiac disease was significantly higher in the celiac disease group compared with DMCD. The SF-36 analysis revealed statistically significant differences between DM and HC groups in two domains: general health (P=0.042) and energy/vitality (P=0.012).

QoL was also correlated with compliance to a GFD, and scores were similar in both groups: DMCD and celiac disease. Forty percent of individuals in the celiac disease group had visceral fat area above 100 cm2, compared with just 20% in the other groups.

So, are people with both Type 1 diabetes and celiac disease automatically doomed to worse health? It seems not. To be sure, they are generally less healthy than control subjects, but the study found that the DMCD group had similar scores to DM, celiac disease and HC on QoL, as well as on their nutritional status and bone metabolism. The researchers conclude from this that the association of T1DM and celiac disease did not deteriorate the health status of the individuals with both Type 1 diabetes and celiac disease.

So, it seems that having both Type 1 diabetes and celiac disease dose not automatically mean having worse health, nutrition and well-being.

Source:

• Nutr Diabetes. 2017 Jan 9;7(1):e239. doi: 10.1038/nutd.2016.43.

Celiac.com 02/01/2017 - More and more evidence shows a connection between gut inflammation and type 1 diabetes (T1D). A team of researchers recently set out to assess gut inflammatory profiles and microbiota in patients with T1D, and to compare them with healthy controls (CTRL) and with celiac disease patients as gut inflammatory disease controls.

The research team included Silvia Pellegrini, Valeria Sordi, Andrea Mario Bolla, Diego Saita Roberto Ferrarese, Filippo Canducci, Massimo Clementi, Francesca Invernizzi, Alberto Mariani, Riccardo Bonfanti, Graziano Barera, Pier Alberto Testoni, Claudio Doglioni, Emanuele Bosi, and Lorenzo Piemonti. They are affiliated with the Diabetes Research Institute at the IRCCS San Raffaele Scientific Institute in Milan, Italy.

The team evaluated inflammatory status and microbiome composition in biopsies of the duodenal mucosa from 19 patients with T1D, 19 with celiac disease, and 16 healthy control subjects, recruited at San Raffaele Scientific Institute, in Milan, Italy, between 2009 and 2015. They assessed inflammation by gene expression study and immunohistochemistry and used 16S rRNA gene sequencing to analyze microbiome composition.

Compared to CTRL and celiac disease patients, the team found an increased expression of CCL13, CCL19, CCL22, CCR2, COX2, IL4R, CD68, PTX3, TNFα and VEGFA genes in T1D patients. The immunohistochemical analysis confirmed T1D specific inflammatory status was mainly marked by increased monocyte/macrophage lineage infiltration, compared to healthy and celiac disease control tissues.

The T1D duodenal mucosal microbiome also proved to be different from the control groups. This was mainly marked by increased Firmicutes, and Firmicutes/Bacteroidetes ratio and a reduction in Proteobacteria and Bacteroidetes.

The expression of genes specific for T1D inflammation was associated with the excess of specific bacteria in duodenum. This study shows that patients with T1D show specific abnormalities in gut inflammation and microbiota.

Greater knowledge of the complex pathogenesis of T1D will likely provide new directions for therapies targeting the gut. Look for more studies in this area in the near future, as scientists look to nail down specific treatments to prevent gut inflammation.

Source:

• The Journal of Clinical Endocrinology & Metabolism. DOI: https://doi.org/10.1210/jc.2016-3222