High gluten levels in toddlers raises type 1 diabetes risk

By Editor
23rd September 2019
Paediatrics, Type 1 diabetes

A child with a high gluten intake at 18 months old can see their risk of developing type 1 diabetes increased, according to new research.

The study showed that for every extra 10g of gluten consumed by a toddler,  the risk of developing type 1 diabetes increases by 46%. However, no link was found between the mother’s intake of gluten during pregnancy and type 1 diabetes in her child.

A previous Danish study had suggested that a high maternal gluten intake during pregnancy increased the risk of type 1 diabetes in the child. No studies have investigated the relation between the amount of gluten intake by both the mother during pregnancy and the child in early life and risk of developing type 1 diabetes in childhood.

Since our findings show the highest risk of developing T1D is in the group with the highest gluten consumption, it could be that simply reducing gluten intake would be enough to reduce risk and this is easier to achieve than complete avoidance

Health data taken from 86,306 children born from 1999 to 2009 were used for this latest study. The outcome was clinical type 1 diabetes, ascertained in a nationwide childhood diabetes registry.

Maternal gluten

The increased risk was calculated using statistical modelling for maternal gluten intake during pregnancy and child’s gluten intake at 18 months.

The authors estimated the amount (g/day) of gluten intake from a semi-quantitative food frequency questionnaire at week 22 of pregnancy and from a questionnaire completed by the guardian when the child was 18 months old.

During a mean follow-up of 12.3 years, 346 children (0.4%) developed type 1 diabetes (incidence rate 32.6 per 100,000 person-years). The average gluten intake was 13.6 grams/day for mothers during pregnancy, and 8.8 grams/day for the child at 18 months of age.

Lead author Dr Nicolai Lund-Blix from Oslo University Hospital and the Norwegian Institute of Public Health, said: “This study suggests that the child’s gluten intake at 18 months of age, and not the maternal intake during pregnancy, could increase the risk of type 1 diabetes in the child.

“Our observations may motivate future interventional studies with reduced gluten intake to establish whether there is a true causal association between amount of gluten intake in the child’s early diet and type 1 diabetes in susceptible individuals.

“There is some evidence that gluten intake may influence the gut microbiota and induce inflammation in so-called ‘leaky gut’ (increased absorption of dietary antigens and/or gut infections).

“These are plausible mechanisms, but the exact mechanism explaining our findings is not known. If anything, we believe that gluten works in combination with another environmental factors such as virus infections in predisposed children.”

In this study, the main sources of gluten in the diet are cereal and bread. However, at this stage the authors say their study, together with existing evidence, is not enough to encourage people to avoid or reduce gluten intake.

They added: “We need confirmation from further studies, and ideally a randomised controlled trial (RCT) to determine any relationship between gluten intake and type 1 diabetes with certainty.

“Since our findings show the highest risk of developing T1D is in the group with the highest gluten consumption, it could be that simply reducing gluten intake would be enough to reduce risk and this is easier to achieve than complete avoidance. Based on experiences from patients with celiac disease, complete avoidance of gluten is hard but manageable, but this would probably not be necessary.”

The findings were presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD) in Barcelona, Spain (16-20 September).

For full abstract click here

Picture credit:Jelleke Vanooteghem

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