• Carin Andrén Aronsson, Hye-Seung Lee, Elin M Hård Af Segerstad, Ulla Uusitalo, Jimin Yang, Sibylle Koletzko, Edwin Liu, Kalle Kurppa, Polly J Bingley, Jorma Toppari, Anette G Ziegler, Jin-Xiong She, William A Hagopian, Marian Rewers, Beena Akolkar, Jeffrey P Krischer, Suvi M Virtanen, Jill M Norris, Daniel Agardh, and TEDDY Study Group.
• Department of Clinical Sciences, Lund University, Malmö, Sweden.
• JAMA. 2019 Aug 13; 322 (6): 514-523.

ImportanceHigh gluten intake during childhood may confer risk of celiac disease.ObjectivesTo investigate if the amount of gluten intake is associated with celiac disease autoimmunity and celiac disease in genetically at-risk children.Design, Setting, And ParticipantsThe 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.ExposuresGluten 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 MeasuresThe 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.ResultsOf 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 RelevanceHigher 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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