Gluten Intake Linked to Celiac Disease Among Genetically Predisposed Children

Children who are genetically predisposed to celiac disease are more susceptible to autoimmunity if they consume a high amount of gluten during the first five years of life, according to a new study published in JAMA.

“In people diagnosed with celiac disease, eating gluten damages the lining of the small intestine and prevents nutrient absorption. It’s estimated to affect about 1 in 100 people worldwide, and more than 2 million people might not even know they have it,” according to information obtained from the Celiac Disease Foundation and published in a CNN article about the study.

Researchers in this study evaluated 6,605 child participants of The Environmental Determinants of Diabetes in the Young (TEDDY) study, a prospective observational birth cohort aimed at identifying environmental triggers of type 1 diabetes and celiac disease. Subjects were followed up at six clinical centers in Finland, Germany, Sweden, and the US. Gluten intake was estimated using three-day food records which researchers collected at six, nine, and 12 months and subsequently, recorded biannually thereafter up until the subjects reached five-years-old.

The key endpoint of this was defined celiac disease autoimmunity, defined as positive tissue transglutaminase autoantibodies found in two consecutive serum samples. The study’s secondary endpoint was stipulated as celiac disease confirmed by intestinal biopsy or continually high tissue autoantibody levels.

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According to the results of the study, over a median follow-up of nine years, 1,216 (18%) of study subjects developed celiac disease autoimmunity and 447 (7%) developed celiac disease. The occurrence for both outcomes peaked between the ages of two and three years old. Moreover, the study found that daily gluten intake was correlated with a higher risk of celiac disease autoimmunity for every one gram per day (1-g/d) increase in gluten consumption (HR=1.30 95% CI, 1.22 to 1.38). Furthermore, in absolute risk by the age of three years if the reference amount of gluten was consumed showed a 28%; absolute risk if gluten intake was 1-g/d higher than the reference amount, 34%; absolute risk difference, 6.1% (95% CI, 4.5% to 7.7%]). Overall, daily gluten intake was linked with an augmented risk of developing celiac disease for every 1-g/d increase in gluten consumption (HR=1.50; 95% CI, 1.35 to 1.66]; absolute risk by age of three years if the reference amount of gluten was consumed, 20.7%; absolute risk if gluten intake was 1-g/d higher than the reference amount, and 28%; absolute risk difference, 7.2% [95% CI, 6.1%-8.3%]), respectively.

The CNN article further quoted Carin Andrén Aronsson, study manager at the Unit for Diabetes & Celiac Disease at Lund University in Sweden, who said that there is no “safe limit” of gluten for children predisposed to celiac disease.

Source: JAMA, CNN