High Gluten Intake Is a Risk Factor for Celiac Disease Among Predisposed Children

Children who are genetically predisposed to celiac disease and type 1 diabetes have an increased risk of celiac disease autoimmunity and celiac disease if they consume a higher amount of gluten during the first 5 years of life, according to a new study. The findings show that for every gram increase of gluten intake per day, there is a statistically significant increase in celiac disease autoimmunity and celiac disease.

To reach this conclusion, the researchers analyzed data on 6757 participants enrolled in The Environmental Determinants of Diabetes in the Young (TEDDY) study who underwent annual screening for celiac disease beginning at age 2 years. All participants were carriers of HLA antigen genotypes associated with type 1 diabetes and celiac disease.

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Gluten intake was evaluated based on 3-day food records at ages 6, 9, and 12 months and then biannually until the participant was 5 years of age. Gluten intake data were available on 6605 participants.

Among the 6605 participants, 1216 (18%) developed celiac disease autoimmunity and 447 (7%) developed celiac disease. The incidence for both was highest when the participants were aged 2 to 3 years.

Daily gluten intake was associated with an increased risk of celiac disease autoimmunity (hazard ratio [HR], 1.30; 95% CI, 1.22-1.38) and celiac disease (HR, 1.50; 95% CI, 1.35-1.66) for every 1 gram per day increase in gluten consumption.

By 3 years of age, a participant had an absolute risk of 28.1% for celiac disease autoimmunity if the reference amount of gluten was consumed and an absolute risk of 34.2% for celiac disease autoimmunity if gluten intake was 1 gram per day higher than the reference amount. 

By 3 years of age, a participant had an absolute risk of 20.7% for celiac disease if the reference amount of gluten was consumed and an absolute risk of 27.9% for celiac disease if gluten intake was 1 gram per day higher than the reference amount.

The absolute risk difference for celiac disease autoimmunity was 6.1%. The absolute risk of celiac disease had a similar pattern, with an absolute risk difference of 7.2%.

—Colleen Murphy

Reference:

Andrén Aronsson C, Lee H, Hård af Segerstad EM, et al. Association of gluten intake during the first 5 years of life with incidence of celiac disease autoimmunity and celiac disease among children at increased risk. JAMA. 2019;322(6):514-523. doi:10.1001/jama.2019.10329.