Gluten Intake and Development of Celiac Disease -Two Studies

  • NA Lund-Blix et al. Am J Gastroenterol 2019; 114: 1299-1306.
  • K Marild et al. Am J Gastroenterol 2019; 114: 1307-14.

Thanks to Ben Gold for these references.

In the first study, the authors used an observational prospective nationwide cohort study, the Norwegian Mother and Child Cohort Study (MoBa) with 67,608 children born between 2000-2009 and with a mean followup of 11.5 years.

Key findings:

  • Celiac disease (CD) was diagnosed in 738 children (1.1%)
  • The adjusted relative risk of CD was 1.1 per standard deviation increase in daily gluten amount at age 18 months.
  • Compared to children in the lowest quartile of gluten ingestion, those in the upper quartile had an adjusted relative risk of 1.29.
  • Timing of gluten introduction, ≥6 months or before 4 months, was also an independent risk factor for CD. In those before 4 months the aRR was 1.45 and for those ≥6 months the aRR was 1.34

In the second study, the authors used the prospective Diabetes Autoimmunity Study in the Young cohort with 1875 at-risk children.

Key findings:

  • Children in the highest tertile of gluten intake between ages of 1 and 2 had a 2-fold greater hazard of developing CD autoimmunity (positive tTG antibodies) (aHR 2.17) than those in the lowest tertile.
  • The risk of CDA increased by 5% per daily gram increase in gluten intake in 1 year olds.

My take: Taken together, these studies indicate that higher gluten exposure (between 1-2 years) is associated with a modestly-higher risk of CD; in addition, early (<4 months) and late exposure (>6 months) may increase the risk as well.

Related blog posts:

Spoiler alert: This case study by A Fasano et al. NEJM 2020; 382: 180-9. describes a presentation of celiac disease and Addision’s disease. I recently had a teenager present with similar symptoms who had Addison’s alone (clues were fatigue, low sodium and hyperpigmentation)

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