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Associations of dietary patterns between age 9 and 24 months with risk of celiac disease autoimmunity and celiac disease among children at increased risk

Hård af Segerstad, Elin M. LU orcid ; Mramba, Lazarus K. ; Liu, Xiang ; Uusitalo, Ulla ; Yang, Jimin ; Norris, Jill ; Virtanen, Suvi M. ; Liu, Edwin ; Kurppa, Kalle and Koletzko, Sibylle , et al. (2023) In American Journal of Clinical Nutrition 118(6). p.1099-1105
Abstract

Background: Higher gluten intake in childhood is associated with increased incidence of celiac disease autoimmunity (CDA) and celiac disease. It remains to be studied whether different dietary patterns independent of gluten intake contribute to the incidence. Objectives: This study aimed to explore associations of dietary patterns by age 2 y with risk of CDA and celiac disease in genetically susceptible children. Methods: Data was used from 6726 participants at genetic risk of type 1 diabetes and celiac disease enrolled in the observational cohort, The Environmental Determinants of Diabetes in the Young (TEDDY) study. Children were annually screened for tissue transglutaminase autoantibodies (tTGAs) from age 2 y. Principal component... (More)

Background: Higher gluten intake in childhood is associated with increased incidence of celiac disease autoimmunity (CDA) and celiac disease. It remains to be studied whether different dietary patterns independent of gluten intake contribute to the incidence. Objectives: This study aimed to explore associations of dietary patterns by age 2 y with risk of CDA and celiac disease in genetically susceptible children. Methods: Data was used from 6726 participants at genetic risk of type 1 diabetes and celiac disease enrolled in the observational cohort, The Environmental Determinants of Diabetes in the Young (TEDDY) study. Children were annually screened for tissue transglutaminase autoantibodies (tTGAs) from age 2 y. Principal component analysis extracted dietary patterns, based on intake of 27 food groups assessed by 3-d food records at age 9 to 24 mo. The primary outcome was CDA (i.e., persistently tTGA-positive in at least 2 consecutive samples), and the secondary outcome was celiac disease. During follow-up to mean age 11.0 (standard deviation 3.6) y, 1296 (19.3%) children developed CDA, and 529 (7.9%) were diagnosed with celiac disease. Associations of adherence to dietary patterns (per 5-unit increase) with the study outcomes were estimated by Cox regression models adjusted for risk factors including gluten intake. Results: At age 9 mo, a dietary pattern higher in the food groups vegetable fats and milk was associated with reduced risk of CDA (hazard ratio [HR]: 0.88; 95% confidence interval [CI]: 0.79, 0.98; P = 0.02). At 24 mo, a dietary pattern higher in the food groups wheat, vegetable fats, and juices, and lower in milk, meat, and oats at age 24 mo was associated with increased risk of CDA (HR: 1.18; 95% CI: 1.05, 1.33; P < 0.001) and celiac disease (HR: 1.24; 95% CI: 1.03, 1.50; P = 0.03). Conclusions: Dietary patterns in early childhood are associated with risk of CDA and celiac disease in genetically predisposed children, independent of gluten intake.

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publication status
published
subject
keywords
celiac disease, celiac disease autoimmunity, complementary feeding, dietary patterns, gluten, HLA-DQ2/DQ8, infant diet, principal component analysis, TEDDY
in
American Journal of Clinical Nutrition
volume
118
issue
6
pages
7 pages
publisher
Oxford University Press
external identifiers
  • pmid:38044022
  • scopus:85176364325
ISSN
0002-9165
DOI
10.1016/j.ajcnut.2023.08.009
language
English
LU publication?
yes
id
9445a2e4-67fc-4ab3-85e1-25222d26549e
date added to LUP
2024-01-12 11:58:11
date last changed
2024-04-13 05:27:39
@article{9445a2e4-67fc-4ab3-85e1-25222d26549e,
  abstract     = {{<p>Background: Higher gluten intake in childhood is associated with increased incidence of celiac disease autoimmunity (CDA) and celiac disease. It remains to be studied whether different dietary patterns independent of gluten intake contribute to the incidence. Objectives: This study aimed to explore associations of dietary patterns by age 2 y with risk of CDA and celiac disease in genetically susceptible children. Methods: Data was used from 6726 participants at genetic risk of type 1 diabetes and celiac disease enrolled in the observational cohort, The Environmental Determinants of Diabetes in the Young (TEDDY) study. Children were annually screened for tissue transglutaminase autoantibodies (tTGAs) from age 2 y. Principal component analysis extracted dietary patterns, based on intake of 27 food groups assessed by 3-d food records at age 9 to 24 mo. The primary outcome was CDA (i.e., persistently tTGA-positive in at least 2 consecutive samples), and the secondary outcome was celiac disease. During follow-up to mean age 11.0 (standard deviation 3.6) y, 1296 (19.3%) children developed CDA, and 529 (7.9%) were diagnosed with celiac disease. Associations of adherence to dietary patterns (per 5-unit increase) with the study outcomes were estimated by Cox regression models adjusted for risk factors including gluten intake. Results: At age 9 mo, a dietary pattern higher in the food groups vegetable fats and milk was associated with reduced risk of CDA (hazard ratio [HR]: 0.88; 95% confidence interval [CI]: 0.79, 0.98; P = 0.02). At 24 mo, a dietary pattern higher in the food groups wheat, vegetable fats, and juices, and lower in milk, meat, and oats at age 24 mo was associated with increased risk of CDA (HR: 1.18; 95% CI: 1.05, 1.33; P &lt; 0.001) and celiac disease (HR: 1.24; 95% CI: 1.03, 1.50; P = 0.03). Conclusions: Dietary patterns in early childhood are associated with risk of CDA and celiac disease in genetically predisposed children, independent of gluten intake.</p>}},
  author       = {{Hård af Segerstad, Elin M. and Mramba, Lazarus K. and Liu, Xiang and Uusitalo, Ulla and Yang, Jimin and Norris, Jill and Virtanen, Suvi M. and Liu, Edwin and Kurppa, Kalle and Koletzko, Sibylle and Ziegler, Annette G. and Toppari, Jorma and Rewers, Marian and Akolkar, Beena and Krischer, Jeffrey P. and Aronsson, Carin Andrén and Agardh, Daniel}},
  issn         = {{0002-9165}},
  keywords     = {{celiac disease; celiac disease autoimmunity; complementary feeding; dietary patterns; gluten; HLA-DQ2/DQ8; infant diet; principal component analysis; TEDDY}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{1099--1105}},
  publisher    = {{Oxford University Press}},
  series       = {{American Journal of Clinical Nutrition}},
  title        = {{Associations of dietary patterns between age 9 and 24 months with risk of celiac disease autoimmunity and celiac disease among children at increased risk}},
  url          = {{http://dx.doi.org/10.1016/j.ajcnut.2023.08.009}},
  doi          = {{10.1016/j.ajcnut.2023.08.009}},
  volume       = {{118}},
  year         = {{2023}},
}