An extensive study has confirmed that the risk of developing coeliac disease is connected to the amount of gluten children consume. The new study is observational and therefore does not prove causation; however, it is the most comprehensive of its kind to date. The results are presented in the prestigious journal JAMA.
In total, 6 600 children at increased risk of developing coeliac disease were followed from birth until the age of five, in Sweden, Finland, Germany and the USA.
“Our study shows a clear association between the amount of gluten the children consumed and the risk of developing coeliac disease or pre-coeliac disease. This confirms our earlier findings from studies on Swedish children”, says Daniel Agardh, associate professor at Lund University and consultant at Skåne University Hospital in Malmö, and leader of the study.
The previous findings were from a smaller pilot study in 2016 by the same research group. Only Swedish children took part in that study, and the follow-up time was shorter.
The current results also show that the risk of developing pre-coeliac disease or coeliac disease was highest in 2-3 year olds at increased risk of developing coeliac disease. The increase in risk was noticeable even with small amounts of gluten – a daily intake of 2 grams – or the equivalent of one slice of white bread.
“A daily gluten intake over 2 grams at the age of 2 was associated with a 75 per cent increase in risk of developing coeliac disease. This is in comparison with children who ate less than 2 grams of gluten. However, determining a recommendation or limit is a challenge as gluten intake varies and increases during the first years of life”, says Carin Andrén Aronsson, lead author of the article and dietician at Lund University.
The association was evident in all participating countries except for Germany, where there was insufficient data to draw any definitive conclusions.
When it comes to dietary advice, Daniel Agardh considers it is the Swedish National Food Agency or equivalent organisations in other countries that should draw conclusions on if and how recommendations on gluten should be changed. He also emphasises that the majority of the group at increased risk of coeliac disease do not develop the disease.
“Therefore, serious consideration should be taken before issuing advice on a particular diet or food restrictions”, says Daniel Agardh.
The research team previously carried out several comprehensive studies on the causes of coeliac disease. Among other things, they have demonstrated that the significance of the timing of when a child begins to eat gluten likely to play a very small role, if any. Neither have they been able to demonstrate any clear protective effect from breastfeeding.
The current research is based on total intake of gluten. The next step is to study which food groups that contain gluten are of greater significance compared to others for the development of coeliac disease. In other research projects, Daniel Agardh and his colleagues are investigating the significance of infectious diseases as well as whether an entirely gluten-free diet could reduce the risk of coeliac disease in children who have been assessed as being at the highest risk of developing the disease.
Daniel Agardh, associate professor at the Department of Clinical Sciences in Malmö, Lund University, and consultant at Skåne University Hospital in Malmö, +46 768-87 03 87, [email protected]
Coeliac disease is an autoimmune disease in which the immune system attacks parts of its own body. Among other things, the disease causes damage to the mucosa of the small intestine. It can lead to the sufferer not being able to tolerate gluten which is found in foods that contain wheat, rye and barley. Some examples of symptoms are fatigue, diarrhoea, weight loss and anaemia. Untreated coeliac disease has also been linked to osteoporosis, depression and delayed puberty.
In Sweden, statistics show that the prevalence among children is increasing again and that approximately two per cent of the total population has developed coeliac disease. Tests through screening of the general population show higher prevalence in younger age groups and that there may be a large number of undiagnosed cases.
These days, the term gluten intolerance is avoided as it does not accurately describe the disease.
Facts/Risk group for coeliac disease
Genetic factors account for 30-50 per cent of coeliac disease cases. Risk genes in the so-called HLA region located on one of our chromosomes are responsible for the largest genetic part but not all of it.
Children assessed as being at risk of developing coeliac disease can be identified through blood tests, a so-called HLA test. Specific HLA types (DQ2 and DQ8) are strongly linked to the risk of developing coeliac disease.
Type 1 diabetes or close family members with coeliac disease are risk factors that indicate an HLA test could be appropriate. Gender and country of origin are other factors that may affect the risk. Coeliac disease is more common among girls/women and the prevalence is higher in some countries. According to research, Sweden and Finland are the countries where the risk of developing coeliac disease is the highest.
TEDDY (The Environmental Determinants of Diabetes in the Young) is an international research project aiming to find out what causes a child to develop type 1 diabetes and/or coeliac disease. In Sweden, the catchment area is Skåne. The principal funding body is the National Institutes of Health, USA (NIH). Read more about TEDDY at http://www.med.lu.se/teddy/ (in Swedish)