Genetically Susceptible Children with High Gluten Intake During the First 5 Years Face Increased Risk of Celiac Disease and Celiac Autoimmunity

Celiac.com 11/26/2019 - High gluten intake during childhood may confer risk of celiac disease, and celiac autoimmunity. A team of researchers recently set out to determine if the amount of gluten consumed during the first 5 years of life is associated with celiac disease autoimmunity and celiac disease in genetically at-risk children.

The research team included Carin Andrén Aronsson, PhD; Hye-Seung Lee, PhD; Elin M. Hård af Segerstad, MSc; Ulla Uusitalo, PhD; Jimin Yang, PhD; Sibylle Koletzko, MD, PhD; Edwin Liu, MD, PhD; Kalle Kurppa, MD, PhD; Polly J. Bingley, MD; Jorma Toppari, MD, PhD; Anette G. Ziegler, MD; Jin-Xiong She, PhD; William A. Hagopian, MD, PhD; Marian Rewers, MD, PhD; Beena Akolkar, PhD; Jeffrey P. Krischer, PhD; Suvi M. Virtanen, MD, PhD; Jill M. Norris, MPH, PhD; Daniel Agardh, MD, PhD; in association with the TEDDY Study Group.

Celiac.com Sponsor (A12):
The participants in The Environmental Determinants of Diabetes in the Young (TEDDY), a prospective observational birth cohort study designed to identify environmental triggers of type 1 diabetes and celiac disease, were followed up at 6 clinical centers in Finland, Germany, Sweden, and the United States. 

The team enrolled 8,676 newborns carrying HLA antigen genotypes associated with type 1 diabetes and celiac disease between 2004 and 2010. They conducted annual screening for celiac disease with tissue transglutaminase autoantibodies in 6,757 children from the age of 2 years. Data on gluten intake were available in 6,605 children (98%) by September 30, 2017.

Gluten intake was estimated from 3-day food records collected at ages 6, 9, and 12 months and biannually thereafter until the age of 5 years.

The data show that higher gluten intake is associated with a statistically significant increase in celiac disease autoimmunity (absolute risk difference, 6.1%) and celiac disease (absolute risk difference, 7.2%) for every gram increase of gluten intake per day.

The primary outcome was celiac disease autoimmunity, defined as positive tissue transglutaminase autoantibodies found in 2 consecutive serum samples. The secondary outcome was celiac disease confirmed by intestinal biopsy or persistently high tissue transglutaminase autoantibody levels.

Every increase in gluten consumption was associated with higher risk of celiac disease. Absolute risk was 20.7% by age of 3 years if the reference amount of gluten was consumed, compared with an absolute risk of 27.9% when gluten intake was 1-gram per day higher than the reference amount, for an absolute risk difference of 6.1%.

High gluten consumption during the first 5 years of life increases the risk of celiac disease autoimmunity and celiac disease in genetically predisposed children.

The main takeaway here is that genetically predisposed children consuming just 1 gram per day over baseline can face increased risk levels celiac disease, or celiac disease autoimmunity. That's something to keep an eye on. Stay tuned for more on this and related stories.

Read more, including more detailed results in JAMA. 2019;322(6):514-523. doi:10.1001/jama.2019.10329

The researchers are variously affiliated with the Department of Clinical Sciences, Lund University, Malmö, Sweden; the Health Informatics Institute, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa; the Dr von Hauner Children’s Hospital, Ludwig Maximilians University, Munich, Germany; University of Warmia and Mazuri, Olsztyn, Poland; the Digestive Health Institute, University of Colorado Denver, Children’s Hospital Colorado, Denver; the Tampere Centre for Child Health Research, University of Tampere, Tampere University Hospital, Tampere, Finland; the School of Clinical Sciences, University of Bristol, Bristol, England; the Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland; the Department of Pediatrics, Turku University Hospital, Turku, Finland; the Institute of Diabetes Research, Helmholtz Zentrum München, Klinikum rechts der Isar, Technische Universität München, and Forschergruppe Diabetes eV, Neuherberg, Germany; the Center for Biotechnology and Genomic Medicine, Augusta University, Augusta, Georgia; the Pacific Northwest Diabetes Research Institute, Seattle, Washington; the Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora; the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland; the National Institute for Health and Welfare, Department of Public Health Solutions, Helsinki, Finland; the Faculty of Social Sciences/Health Sciences, University of Tampere, Tampere, Finland; Research Center for Child Health, Tampere University, University Hospital, Science Center of Pirkanmaa Hospital District, Tampere, Finland; and the Colorado School of Public Health, Department of Epidemiology, University of Colorado, Aurora.