Early-Life Gluten Intake Linked to Increased Risk of Celiac Disease

By Will Boggs MD

June 24, 2019

NEW YORK (Reuters Health) - Higher intake of gluten early in life is associated with an increased risk of celiac disease (CD) and CD autoimmunity, according to new findings.

"We found that 1-year-olds in the highest third of gluten intake had a two-fold increased relative risk of developing celiac disease autoimmunity (CDA), a potential prodromal stage of celiac disease," said Dr. Karl Marild from the Norwegian Institute of Public Health, in Oslo, Norway, and Queen Silvia Children's Hospital, in Gothenburg, Sweden.

"For me, it was a surprising to find this magnitude of association given the ubiquitous nature of gluten in our diet," he told Reuters Health by email.

Gluten intake drives the pathology associated with celiac disease, but it remains unclear whether the amount of gluten intake predicts later CD or CDA.

To investigate, Dr. Marild's team used data from 1,875 participants in the prospective Diabetes Autoimmunity Study in the Young (DAISY). Compared with 1-year-olds in the lowest third of gluten intake, those in the highest third had a 96% increased risk of CD (P=0.09) and a significant 2.17-fold increased risk of CDA.

The association between gluten intake in 1-year-olds and future CDA and CD did not differ by the child's HLA genotype or family history of CD, the researchers report in The American Journal of Gastroenterology, online May 9.

The incidence of CD increased with the cumulative gluten intake throughout childhood (corresponding to a 15% increase in risk per standard deviation of cumulative gluten intake by age 6, P=0.04), whereas the cumulative gluten intake throughout childhood was not associated with CDA risk.

"While the strength of association was similar for the outcome celiac disease and celiac disease autoimmunity, only the latter reached statistical significance (possibly related to the fact that this outcome was more prevalent)," Dr. Marild said. "However, if our findings are corroborated, they may provide a somewhat better understanding on one significant aspect of the likely multifactorial etiology of this disease."

"It is important to stress that we do not recommend a change in pediatric feeding practices," he said. "Because this is an observational study, there are many possible explanations to our findings, including non-causal explanations related to bias."

"Our conclusions are subject to the caveat that this study was restricted to genetically at-risk children from Denver, U.S.," Dr. Marild cautioned. "We do not know the extent to which these results can be generalized to other populations. Previous data in this field of research are relatively scarce and have yielded inconsistent results."

SOURCE: https://bit.ly/2x5ICRo

Am J Gastroenterol 2019.