The research, published in the journal JAMA looked at whether the amount of gluten intake during the first five years of life is associated with the risk of coeliac disease autoimmunity and coeliac disease in at-risk children.
In total, 6 600 children born between 2004 to 2010 at increased risk of developing coeliac disease were followed from birth until the age of five, in Sweden, Finland, Germany, and the US.
Higher gluten intake was associated with a 6.1% increased risk of coeliac disease autoimmunity, an immunological response to gluten, and a 7.2% increased risk of coeliac disease per each additional gram of gluten per day, according to the study.
The study concluded that higher gluten intake during the first five years of life was associated with increased risk of coeliac disease autoimmunity and coeliac disease among genetically predisposed children.
"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," said 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.
The current results also showed 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 two was associated with a 75% 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," said Carin Andrén Aronsson, lead author of the article and dietician at Lund University.
‘We can’t say whether gluten foods cause coeliac disease’
Agardh stressed to FoodNavigator that this was an observational study and therefore does not prove causation.
“We can’t say what causes coeliac disease,” he said. “Everyone wants to know: ‘does this mean we can’t give our infants gluten any longer’? But that is not our conclusion and we can’t say anything about that. We can just conclude that among the population in children that carry these risk genes for developing coeliac disease, a higher intake of gluten is associated with increased risk of coeliac disease.”
He said further studies were needed to establish causation and to investigate, for example, whether cutting back on high gluten foods can protect children who are at genetic risk of developing it.
“We need to do more quality studies to see whether if you reduce the gluten if that protects children from coeliac disease because we don’t know at this stage. We don’t know if the high gluten intake just makes these children develop coeliac at an earlier stage.”
Neither did the study investigate different food groups. “We can’t conclude whether gluten intake from bread or pasta or from other foods differ at this time point. We will study those in the future, that is our plan.”
He stressed that the key to this study was whether the amount of gluten intake has an association.
Coeliac disease in children
- Coeliac disease affects one in 100 children and up to three in 100 in some other European countries.
- Most children are undiagnosed and don’t get diagnosed until later in life.
- Symptoms include diarrhoea and other gut symptoms, faltering growth or a change in growth pattern, irritability and a bloated tummy.
- In undiagnosed, untreated coeliac disease there is a greater risk of complications including impaired weight gain and growth problems, delayed puberty, iron deficiency anaemia, chronic fatigue and osteoporosis.
- A gluten-free diet should only begin once a child is formally diagnosed with coeliac disease by a healthcare professional.
‘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’
Authors: Daniel Agardh, Carin Andrén Aronsson