Children with a high-gluten diet during the first five years of their life may be more likely to develop celiac disease down the road, new research suggests.
The study, published in JAMA, used data from The Environmental Determinants of Diabetes in the Young (TEDDY). TEDDY is a prospective, observational birth cohort study that sought to determine environmental factors associated with the development of celiac disease as well as type 1 diabetes. The multi-center study spanned Finland, Germany, Sweden, and the U.S. Newborns carrying HLA antigen genotypes who were born between 2004 and 2010 were included in the study; 6,757 underwent celiac disease screening annually from ages two through five. Three-day food records were used to estimate gluten intake at ages six, nine, and 12 months, and biannually from then until age five.
“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,” wrote the authors.
Gluten intake data were available for 6,605 children (49% were female), with a median follow-up of nine years (interquartile range, eight to 10 years). Of the total cohort, 1,216 children (18%) developed celiac disease autoimmunity, and 447 (7%) developed celiac disease. Both outcomes were most frequent between ages two and three years. Every 1 gram increase in daily gluten consumption increased the risk of celiac disease autoimmunity (hazard ratio [HR], 1.30 [95% CI, 1.22-1.38]; absolute risk by age three if the reference amount of gluten was consumed, 28.1%; absolute risk if gluten intake was 1-g/d higher than the reference amount, 34.2%; absolute risk difference, 6.1% [95% CI, 4.5%-7.7%]), and was associated with a higher risk of celiac disease (HR, 1.50 [95% CI, 1.35-1.66]; absolute risk by age three if the reference amount of gluten was consumed, 20.7%; absolute risk if gluten intake was 1-g/d higher than the reference amount, 27.9%; absolute risk difference, 7.2% [95% CI, 6.1%-8.3%]).
The authors wrote in sum, “Higher gluten intake during the first 5 years of life was associated with increased risk of celiac disease autoimmunity and celiac disease among genetically predisposed children.”