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Gluten Intake in Early Childhood and Risk of Celiac Disease in Childhood

A Nationwide Cohort Study

Lund-Blix, Nicolai A. PhD1,2,3,4; Mårild, Karl MD, PhD1,5; Tapia, German PhD1; Norris, Jill M. MD, PhD3; Stene, Lars C. PhD1; Størdal, Ketil MD, PhD1,6

American Journal of Gastroenterology: August 2019 - Volume 114 - Issue 8 - p 1299–1306
doi: 10.14309/ajg.0000000000000331
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OBJECTIVES: Celiac disease (CD) may occur in genetically predisposed individuals exposed to gluten, but it is unclear whether the amount of gluten influences the risk of disease. We aimed at determining whether the amount of gluten intake at age 18 months predicted later risk of CD.

METHODS: In an observational nationwide cohort study, the Norwegian Mother and Child Cohort Study (MoBa), we included 67,608 children born during 2000–2009 and followed up for a mean of 11.5 years (range 7.5–15.5) after exclusions for missing data. Information regarding CD diagnosis was obtained from the Norwegian Patient Register 2008–2016 and from parental questionnaires at child age 7 and 8 years. We estimated gluten intake at age 18 months from a prospectively collected parental questionnaire.

RESULTS: CD was diagnosed in 738 children (1.1%, 62% girls). The mean estimated amount of gluten in the diet at 18 months was 8.8 g/d (SD 3.6). The adjusted relative risk of CD was 1.10 (95% confidence interval 1.03–1.18) per SD increase in daily gluten amount at age 18 months. Children in the upper quartile of gluten intake compared with the lower quartile had an increased risk of CD (adjusted relative risk 1.29, 95% confidence interval 1.06–1.58). The association with gluten amount was independent of the age at introduction of gluten. Gluten introduction ≥6 months was also an independent risk factor for CD.

DISCUSSION: In this nationwide study, increased gluten intake at 18 months was associated with a modestly increased risk of CD later in childhood.

1Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway;

2Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA;

3Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA;

4Department of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway;

5Department of Pediatrics, The Sahlgrenska Academy at University of Gothenburg and Queen Silvia Children's Hospital, Gothenburg, Sweden;

6Department of Pediatrics, Østfold Hospital Trust, Grålum, Norway.

Correspondence: Ketil Størdal, MD, PhD. E-mail: ketil.stordal@fhi.no.

SUPPLEMENTARY MATERIAL accompanies this paper at http://links.lww.com/AJG/B247

Received November 13, 2018

Accepted May 13, 2019

Online date: July 23, 2019

© The American College of Gastroenterology 2019. All Rights Reserved.
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