August 13, 2019

expert reaction to study looking at gluten intake in childhood and risk of coeliac disease in children with a genetic risk

A study, published in JAMA, reports an association between eating gluten in early life and an increased risk of coeliac disease among genetically predisposed children.

Prof Kevin Whelan, Professor of Dietetics, King’s College London, said:

“This impressive and large cohort study is an important addition to the scientific literature on gluten exposure and the risk of developing coeliac disease in early childhood.  The research included over 8,000 newborns who were all genetically predisposed to develop coeliac disease and monitored their gluten intake and their development of coeliac autoimmunity (having antibodies resulting from gluten) and clinically-diagnosed coeliac disease over the next five years.  In the 6,605 of these children who were available in the final analysis, for every 1 g of gluten consumed above the average amount, an additional 7.2 in every 100 children developed coeliac disease by the age of 3 years.

“Gluten is contained in wheat, barley and rye, and so is present in breads, many breakfast cereals, pasta, cakes, pastries and biscuits.  But wheat flour is often used as a thickening, bulking or coating agent in sauces, puddings, meat and fish products and ready meals and so gluten is widely consumed in a large variety of foods eaten by both children and adults.  One limitation of this study is that gluten intake was measured using food records over a 3-day period, a method that is unlikely to capture gluten exposure from less commonly consumed foods that are eaten only once or twice a week.

“It is crucial to point out that these were children who were already pre-disposed to developing coeliac disease because they had HLA genes that we know increase a child’s risk.  For example, during the study 7% of these at-risk children developed coeliac disease, which is much higher than the general population in whom less than 1% would develop coeliac disease.  Therefore, we cannot use these results to make recommendations for how we feed all children, because the large majority of young children can eat gluten without experiencing an increased risk of coeliac disease.

“What this study tells us is that, in children genetically predisposed to develop coeliac disease, eating more gluten than average may increase the risk of developing coeliac disease, however, this study is only observational, so before we start giving dietary advice we need a large clinical trial to tell us whether removing gluten from the diet reduces the risk of developing coeliac disease, how strictly gluten needs to be removed from the diet and for how long.  Certainly, any special dietary restrictions in babies and toddlers needs to be done following consultation with a doctor and a dietitian for expert advice.”

‘Association of gluten intake during the first 5 years of life with incidence of celiac disease autoimmunity and celiac disease among children at increased risk’ by Carin Andrén Aronsson et al. was published in JAMA at 16:00 UK time on Tuesday 13 August 2019. 

DOI: 10.1001/jama.2019.10329

Declared interests

Prof Kevin Whelan: “I don’t have any conflicts of interest relating to gluten or coeliac disease, but as a researcher in nutrition and diet I have research funding from foods completely unrelated to coeliac disease (e.g. Almond Board of California, Clasado, Danone, International Dried Fruit and Nut Council).”