Bottom Line: Consuming more gluten during the first five years of life was associated with increased risk of celiac disease and celiac disease autoimmunity (the presence of antibodies in the blood) among genetically predisposed children. It remains unclear whether the amount of gluten consumed can trigger celiac disease. This observational study included 6,605 children born between 2004 and 2010 in Finland, Germany, Sweden and the United States who had a genetic predisposition for celiac disease. Gluten intake was estimated from food records collected at ages 6, 9, and 12 months and then biannually until the age of 5. Of the 6,605 children, 18% developed celiac disease autoimmunity and 7% developed celiac disease. The incidence of both outcomes peaked at 2 to 3 years old. The authors report that for every 1-gram per day increase in gluten consumption there was an associated higher risk of celiac disease and celiac disease autoimmunity. If gluten intake was one gram per day higher than the average at age 2 (corresponding to a half slice of white bread), the absolute risk differences for celiac disease autoimmunity and celiac disease were 6% and 7% higher, respectively, by age 3. A limitation of the study is the uncertainty of the accuracy of the reported gluten intake. The authors suggest a randomized clinical trial be done of different amounts of gluten during early childhood in genetically at-risk children.
Authors: Daniel Agardh, M.D., Ph.D., Lund University, Malmo, Sweden and coauthors
(doi:10.1001/jama.2019.10329)
Editor's Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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Media advisory: To contact corresponding author Daniel Agardh, M.D., Ph.D., email daniel.agardh@med.lu.se. The full study and editorial are linked to this news release.
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JAMA