Dietary factors early in life may influence the development of celiac disease

1. In this cohort study, diets high in vegetable fats and milk at 9 months were associated with a decreased risk of developing celiac disease autoimmunity (CDA).

2. However, at 24 months, a diet high in wheat, vegetable fats, and juices and diets low in milk, meat, and oats were associated with an increased risk of developing CDA and celiac disease.

Evidence Rating Level: 2 (Good)

An intolerance to dietary gluten characterizes celiac disease, and both genetic and environmental factors have been implicated in the development of the condition. Previous studies have indicated that a higher gluten intake early in life is associated with an increased risk of developing celiac disease autoimmunity (CDA) and celiac disease in those with genetic risks. However, the impact of other dietary habits early in life on the risk of CDA and celiac disease has not been well characterized. Thus, the present study aimed to evaluate the role of dietary patterns, other than gluten intake, early in life on the risk of developing CDA and celiac disease in genetically at-risk children.

This cohort study included 6,726 participants from The Environmental Determinants of Diabetes in the Young (TEDDY) study, which included 15 years of follow-up from 2004 to 2010. Study participants were followed from 6 centers across the United States and Europe. Participants were included if they were at genetic risk of developing type 1 diabetes or celiac disease. Those with missing dietary data between 9 and 24 months or those who did not receive screening for celiac disease were excluded from the study. Dietary intake was assessed with three-day food records at 9, 12, 18, and 24 months, while celiac disease and CDA was assessed via measurement of transglutaminase autoantibodies (tTGAs) at 24 months and continued annually for the remainder of the study period. Participants were followed until November 2020. The primary outcome was the association between various food groups and the risk of developing CDA and celiac disease.

The results demonstrated that a dietary pattern high in vegetable fats and milk at 9 months was associated with a reduced risk of developing CDA, even after adjusting for gluten intake. Diets high in wheat and vegetable fats were associated with an increased risk of CDA at 24 months after adjusting for gluten intake. Similarly, a dietary pattern high in wheat, vegetable fats, and juices and those low in milk, meat, and oats were associated with an increased risk of CDA and celiac disease. However, the study is limited by the use of general dietary patterns, which does not allow for the assessment of individual foods. Nonetheless, the present study suggested that dietary factors other than gluten influence the development of CDA and celiac disease early in life.

Click to read the study in The American Journal of Clinical Nutrition

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