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Diabetes Care. 2019 Feb 22. pii: dc182315. doi: 10.2337/dc18-2315. [Epub ahead of print]

Gluten Intake and Risk of Islet Autoimmunity and Progression to Type 1 Diabetes in Children at Increased Risk of the Disease: The Diabetes Autoimmunity Study in the Young (DAISY).

Author information

1
Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway nicolai.andre.lund-blix@fhi.no.
2
Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, CO.
3
Department of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.
4
Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO.
5
Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway.
6
Department of Pediatrics, The Sahlgrenska Academy at University of Gothenburg and Queen Silvia Children's Hospital, Gothenburg, Sweden.
7
Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO.
8
Department of Pediatrics, Østfold Hospital Trust, Grålum, Norway.

Abstract

OBJECTIVE:

To study the association of gluten intake with development of islet autoimmunity and progression to type 1 diabetes.

RESEARCH DESIGN AND METHODS:

The Diabetes Autoimmunity Study in the Young (DAISY) follows children with an increased risk of type 1 diabetes. Blood samples were collected at 9, 15, and 24 months of age, and annually thereafter. Islet autoimmunity was defined by the appearance of at least one autoantibody against insulin, IA2, GAD, or ZnT8 (zinc transporter 8) in at least two consecutive blood samples. Using food frequency questionnaires, we estimated the gluten intake (in grams per day) annually from 1 year of age. Cox regression modeling early gluten intake, and joint modeling of the cumulative gluten intake during follow-up, were used to estimate hazard ratios adjusted for confounders (aHR).

RESULTS:

By August 2017, 1,916 subjects were included (median age at end of follow-up 13.5 years), islet autoimmunity had developed in 178 participants, and 56 of these progressed to type 1 diabetes. We found no association between islet autoimmunity and gluten intake at 1-2 years of age or during follow-up (aHR per 4 g/day increase in gluten intake 1.00; 95% CI 0.85-1.17; and 1.01; 0.99-1.02, respectively). We found similar null results for progression from islet autoimmunity to type 1 diabetes. Introduction of gluten at <4 months of age was associated with an increased risk of progressing from islet autoimmunity to type 1 diabetes compared with introduction at 4-5.9 months (aHR 8.69; 95% CI 1.69-44.8).

CONCLUSIONS:

Our findings indicate no strong rationale to reduce the amount of gluten in high-risk children to prevent development of type 1 diabetes.

PMID:
30796108
DOI:
10.2337/dc18-2315

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