In the Journals

Gluten intake during childhood may increase risk for celiac disease

High gluten intake during the first 5 years of life may increase the risk for celiac disease, according to findings published in JAMA.

“Increased intake of gluten during the first 5 years of life is an independent risk factor for celiac disease autoimmunity and celiac disease in genetically predisposed children,” Daniel Agardh, MD, PhD, an adjunct senior lecturer at the Diabetes and Celiac Unit at Lund University in Sweden, told Infectious Diseases in Children. “It was reassuring that the results confirmed our previous findings for all participating countries in the [The Environmental Determinants of Diabetes in the Young] study.”

The researchers conducted a prospective birth cohort study in which they assessed 8,676 newborns carrying human leukocyte antigen (HLA) genotypes associated with type 1 diabetes and celiac disease from birth up to age 15 years. Children received follow-up at six clinical research centers located in Finland, Germany, Sweden and the United States.

Agardh and colleagues screened for celiac disease with tissue transglutaminase autoantibodies annually in 6,757 children beginning at age 2 years. The final follow-up occurred on Sept. 30, 2017.

Data on gluten intake were available for 6,605 children by the final follow-up date. Of these children, 18% (n = 1,216) developed celiac disease autoimmunity, and 7% (n = 447) developed celiac disease. The incidence for both outcomes peaked in children aged 2 to 3 years.

Agardh and colleagues reported that daily gluten intake was associated with higher risk for celiac disease autoimmunity for every 1 g per day increase in gluten consumption (HR = 1.30; 95% CI, 1.22-1.38). The absolute risk by age 3 years if children consumed the reference amount of gluten was 28.1%. The absolute risk increased to 34.2% if gluten intake was 1 g per day higher than the reference amount (absolute risk difference, 6.1%; 95% CI, 4.5%-7.7%).

Children who consumed gluten daily also had a higher risk for celiac disease for every 1 g per day increase in gluten consumption (HR = 1.5; 95% CI, 1.35-1.66). The absolute risk by age 3 years if the child consumed the reference amount of gluten was 20.7%. The absolute risk was 27.9% if gluten intake was 1 g per day higher than the reference amount (absolute risk difference, 7.2%; 95% CI, 6.1%-8.3%).

Pediatricians should be aware that this is an observational study of children at genetic risk and therefore causality cannot be made based on the findings,” Agardh said. “Thus, pediatricians should not advise parents to change their infant feeding habits until the study has been validated by others or tested in larger intervention studies.”

In a related editorial, Maureen M. Leonard, MD, MMSc, clinical director of the Center for Celiac Research and Treatment at the Massachusetts General Hospital for Children, and Alessio Fasano, MD, chair of the department of pediatric gastroenterology and nutrition at Massachusetts General Hospital, noted that the findings likely will not inspire new recommendations for the current practice of gluten introduction into a child’s diet unless they can be validated.

“These results are intriguing and, as the authors suggested, should inspire larger studies to further explore this finding,” they wrote. “However, the amount of gluten ingested during the first 5 years after birth cannot completely explain the increased prevalence of celiac disease.” – by Joe Gramigna

Disclosures: Agardh reports no relevant financial disclosures. Fasano reports grants from Mead Johnson Nutrition and serving as a consultant to Alba Therapeutics. Leonard reports serving as a consultant to Takeda and Glutenostics LLC, and personal fees from HealthMode. Please see the study for all other authors’ relevant financial disclosures.

High gluten intake during the first 5 years of life may increase the risk for celiac disease, according to findings published in JAMA.

“Increased intake of gluten during the first 5 years of life is an independent risk factor for celiac disease autoimmunity and celiac disease in genetically predisposed children,” Daniel Agardh, MD, PhD, an adjunct senior lecturer at the Diabetes and Celiac Unit at Lund University in Sweden, told Infectious Diseases in Children. “It was reassuring that the results confirmed our previous findings for all participating countries in the [The Environmental Determinants of Diabetes in the Young] study.”

The researchers conducted a prospective birth cohort study in which they assessed 8,676 newborns carrying human leukocyte antigen (HLA) genotypes associated with type 1 diabetes and celiac disease from birth up to age 15 years. Children received follow-up at six clinical research centers located in Finland, Germany, Sweden and the United States.

Agardh and colleagues screened for celiac disease with tissue transglutaminase autoantibodies annually in 6,757 children beginning at age 2 years. The final follow-up occurred on Sept. 30, 2017.

Data on gluten intake were available for 6,605 children by the final follow-up date. Of these children, 18% (n = 1,216) developed celiac disease autoimmunity, and 7% (n = 447) developed celiac disease. The incidence for both outcomes peaked in children aged 2 to 3 years.

Agardh and colleagues reported that daily gluten intake was associated with higher risk for celiac disease autoimmunity for every 1 g per day increase in gluten consumption (HR = 1.30; 95% CI, 1.22-1.38). The absolute risk by age 3 years if children consumed the reference amount of gluten was 28.1%. The absolute risk increased to 34.2% if gluten intake was 1 g per day higher than the reference amount (absolute risk difference, 6.1%; 95% CI, 4.5%-7.7%).

Children who consumed gluten daily also had a higher risk for celiac disease for every 1 g per day increase in gluten consumption (HR = 1.5; 95% CI, 1.35-1.66). The absolute risk by age 3 years if the child consumed the reference amount of gluten was 20.7%. The absolute risk was 27.9% if gluten intake was 1 g per day higher than the reference amount (absolute risk difference, 7.2%; 95% CI, 6.1%-8.3%).

Pediatricians should be aware that this is an observational study of children at genetic risk and therefore causality cannot be made based on the findings,” Agardh said. “Thus, pediatricians should not advise parents to change their infant feeding habits until the study has been validated by others or tested in larger intervention studies.”

PAGE BREAK

In a related editorial, Maureen M. Leonard, MD, MMSc, clinical director of the Center for Celiac Research and Treatment at the Massachusetts General Hospital for Children, and Alessio Fasano, MD, chair of the department of pediatric gastroenterology and nutrition at Massachusetts General Hospital, noted that the findings likely will not inspire new recommendations for the current practice of gluten introduction into a child’s diet unless they can be validated.

“These results are intriguing and, as the authors suggested, should inspire larger studies to further explore this finding,” they wrote. “However, the amount of gluten ingested during the first 5 years after birth cannot completely explain the increased prevalence of celiac disease.” – by Joe Gramigna

Disclosures: Agardh reports no relevant financial disclosures. Fasano reports grants from Mead Johnson Nutrition and serving as a consultant to Alba Therapeutics. Leonard reports serving as a consultant to Takeda and Glutenostics LLC, and personal fees from HealthMode. Please see the study for all other authors’ relevant financial disclosures.