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Association of gluten intake during the first 5 years with incidence of celiac disease autoimmunity and celiac disease among children at increased risk

Research output: Contribution to journalArticle

  • Carin Andrén Aronsson
  • Hye-Seung Lee
  • Elin Hård Af Segerstad
  • Ulla Uusitalo
  • Jimin Yang
  • Sybille Koletzko
  • Edwin Liu
  • Kalle Kurppa
  • Polly Bingley
  • Jorma Toppari
  • Anette-G Ziegler
  • Jin-Xiong She
  • William Hagopian
  • Marian Rewers
  • Beena Akolkar
  • Jeffrey Krischer
  • Suvi M Virtanen
  • Jill M Norris
  • Daniel Agardh
Original languageEnglish
Pages (from-to)514-523
Number of pages10
JournalJAMA - Journal of the American Medical Association
Volume322
Issue number6
DOIs
DateAccepted/In press - 26 Jun 2019
DatePublished (current) - 13 Aug 2019

Abstract

Importance High gluten intake during childhood may confer risk of celiac disease.

Objectives To investigate if the amount of gluten intake is associated with celiac disease autoimmunity and celiac disease in genetically at-risk children.

Design, Setting, and Participants The participants in The Environmental Determinants of Diabetes in the Young (TEDDY), a prospective observational birth cohort study designed to identify environmental triggers of type 1 diabetes and celiac disease, were followed up at 6 clinical centers in Finland, Germany, Sweden, and the United States. Between 2004 and 2010, 8676 newborns carrying HLA antigen genotypes associated with type 1 diabetes and celiac disease were enrolled. Screening for celiac disease with tissue transglutaminase autoantibodies was performed annually in 6757 children from the age of 2 years. Data on gluten intake were available in 6605 children (98%) by September 30, 2017.

Exposures Gluten intake was estimated from 3-day food records collected at ages 6, 9, and 12 months and biannually thereafter until the age of 5 years.

Main Outcomes and Measures 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.

Results Of the 6605 children (49% females; median follow-up: 9.0 years [interquartile range, 8.0-10.0 years]), 1216 (18%) developed celiac disease autoimmunity and 447 (7%) developed celiac disease. The incidence for both outcomes peaked at the age of 2 to 3 years. Daily gluten intake was associated with higher risk of celiac disease autoimmunity for every 1-g/d increase in gluten consumption (hazard ratio [HR], 1.30 [95% CI, 1.22-1.38]; absolute risk by the age of 3 years 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%]). Daily gluten intake was associated with higher risk of celiac disease for every 1-g/d increase in gluten consumption (HR, 1.50 [95% CI, 1.35-1.66]; absolute risk by age of 3 years 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%]).

Conclusions and Relevance 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.

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    Rights statement: This is the author accepted manuscript (AAM). The final published version (version of record) is available online via American Medical Association at https://jamanetwork.com/journals/jama/fullarticle/2747670 . Please refer to any applicable terms of use of the publisher.

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