ESPEYB17 10. Type 1 Diabetes Mellitus (1) (14 abstracts)
10.4. 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
Aronsson CA , Lee H-S , Hårdaf Segerstad EM , Uusitalo U , Yang J , Koletzko S , Liu E , Kurppa K , Bingley PJ , Toppari J , Ziegler AG , She J-X , Hagopian WA , Rewers M , Akolkar B , Krischer JP , Virtanen SM , Norris JM , Agardh D & for the TEDDY Study Group
To read the full abstract: JAMA. 2019;322(6):514–523. doi: 10.1001/jama.2019.10329
Some children have a high genetic risk to develop type 1 diabetes (T1DM) and/or celiac disease. However, environmental factors may modify such risks. One arm of the TEDDY study assessed the influence of high gluten intakes on the development of celiac disease in genetically high risk children.
Between 2004 and 2010, 8676 newborns carrying HLA antigen genotypes associated with increased risks of T1DM and celiac disease were enrolled. Screening for celiac disease with tissue transglutaminase autoantibodies was performed annually in 6757 children from age 2 years. Data on gluten intake were available in 6605 children (98%), estimated using 3-day food records collected at ages 6, 9, and12 months and biannually thereafter up to age 5 years.
The children (49% females) were followed-up for median 9.0 years [interquartile range, 8.0–10.0]), and of these 1216 (18%) developed celiac disease autoimmunity and 447 (7%) developed celiac disease. The peak incidence for both outcomes was at age 2 to 3 years. Gluten intake was associated with higher risk of celiac disease autoimmunity (hazard ratio [HR], 1.30 per gram/day [95% CI, 1.22–1.38]). By age 3 years, the absolute risk of celiac disease autoimmunity in those with the reference gluten intake levels was 28.1%, and was 34.2% in those with 1 gram/day higher intakes (absolute risk difference: 6.1% [95% CI, 4.5%–7.7%]). For celiac disease itself, gluten intake was associated with a HR, 1.50 (95% CI, 1.35–1.66) higher risk per 1 gram/day; absolute risk of coeliac disease by age of 3 years was 20.7% in the reference intake group and 27.9% with 1 gram/day higher intakes (absolute risk difference: 7.2% [95% CI, 6.1%–8.3%]).
In conclusion, higher gluten intake during the first years of life was associated with a higher risk of celiac disease autoimmunity and also celiac disease among these genetically predisposed children of mixed ancestry/ethnicity in Australia.
For dietary recommendations in genetically high risk infants, the estimated cut point for gluten intake was estimated to be >2 gram/day of gluten at ~2 years of age, which is equivalent to one slice of white bread or one portion of pasta. However, it was found in this study that a reduction of gluten or even a gluten free diet in the first year of life has no major impact on the development of T1DM.
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ESPE Yearbook of Paediatric Endocrinology
ISSN 1662-4009 (Online)
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