Gluten Intake in Toddlers Not Tied to Risk of Progression to Type 1 Diabetes

By Will Boggs MD

March 08, 2019

NEW YORK (Reuters Health) - Gluten intake is not associated with islet autoimmunity or progression to type 1 diabetes in high-risk older infants and toddlers, according to results from the DAISY study.

"Over the past few years gluten-free diets have received a lot of media attention as the cure for a range of diseases and conditions, which could lead people in vulnerable groups to make dietary changes based on sometimes unreliable information," Dr. Nicolai A. Lund-Blix from the Norwegian Institute of Public Health and Oslo University Hospital, in Norway, told Reuters Health by email.

"The key message from our results is, therefore, of great importance to children and families of children at high risk of type 1 diabetes," said Dr. Lund-Blix, also at the University of Colorado Anschutz Medical Campus in Aurora. "There is no rationale to reduce the amount of gluten during childhood and adolescence in the high-risk population to prevent development of type 1 diabetes."

The Diabetes Autoimmunity Study in the Young (DAISY) study showed that the timing of the introduction of cereals (but not specifically gluten) was associated with the risk of islet autoimmunity in high-risk children, but found no association between age at introduction of foods containing wheat and barley and type 1 diabetes.

In the current study, Dr. Lund-Blix and colleagues investigated the association of age at introduction of gluten and gluten intake in early childhood and throughout childhood and adolescence with the development of islet autoimmunity and progression to type 1 diabetes in 1,916 high-risk children.

In these children, whose average gluten intake between the ages of 1 and 2 years was 11.4 g, there was no association between the amount of gluten intake and the development of islet autoimmunity or progression from islet autoimmunity to type 1 diabetes, the team reports in Diabetes Care, online February 22.

There was also no association between the cumulative amount of gluten intake during follow-up and either endpoint.

Compared with gluten introduction at 4 to 5.9 months of age, those who started eating gluten before 4 months of age had an 8.69-fold increased adjusted risk of progressing from islet autoimmunity to type 1 diabetes, a statistically significant result.

"Our finding of gluten introduction before 4 months of age as a potential risk factor for progression to type 1 diabetes supports the general infant feeding recommendations from the American Academy of Pediatrics and the World Health Organization (WHO) since they already state that introduction of solid foods, which includes gluten containing foods, at this early age should be avoided," Dr. Lund-Blix said.

Dr. Ulla M. Uusitalo from Morsani College of Medicine, University of South Florida, in Tampa, recently reported results from the TEDDY study showing a lower risk of islet autoimmunity with gluten exposure before 4 months of age and an increased risk of islet autoimmunity with gluten exposure after 9 months of age.

"The DAISY data was collected between 1993-2006, while the early feeding data, for example, in TEDDY was collected between 2005-2011. Geographical study locations vary," she told Reuters Health by email. "Changes in infant feeding practices over time could also have an effect. Human milk microbiota can vary due to changes in mother's diet or due to other environmental factors. This may result in changes, via 'vertical transfer,' in infant's gut microbiota, which again may affect the immunological responses to food."

"It is also good to keep in mind that the study population, like many other longitudinal cohorts studying the etiology of type 1 diabetes, was not representing the general population but a genetically at high-risk group," she said.

"As the authors pointed out, the finding about early introduction of gluten and its association with increasing risk of progression to type 1 diabetes was based on low numbers of children (n=7) introduced to gluten in the timeframe of interest and should, therefore, be interpreted cautiously," Dr. Uusitalo said. "The findings will not influence the current recommendations about introduction of gluten."


Diabetes Care 2019.