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JAMA. 2019 Aug 13;322(6):514-523. doi: 10.1001/jama.2019.10329.

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.

Author information

Department of Clinical Sciences, Lund University, Malmö, Sweden.
Health Informatics Institute, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa.
Dr von Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany.
University of Warmia and Mazuri, Olsztyn, Poland.
Digestive Health Institute, University of Colorado Denver, Children's Hospital Colorado, Denver.
Tampere Centre for Child Health Research, University of Tampere, Tampere University Hospital, Tampere, Finland.
School of Clinical Sciences, University of Bristol, Bristol, England.
Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland.
Department of Pediatrics, Turku University Hospital, Turku, Finland.
Institute of Diabetes Research, Helmholtz Zentrum München, Klinikum rechts der Isar, Technische Universität München, and Forschergruppe Diabetes eV, Neuherberg, Germany.
Center for Biotechnology and Genomic Medicine, Augusta University, Augusta, Georgia.
Pacific Northwest Diabetes Research Institute, Seattle, Washington.
Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora.
National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.
National Institute for Health and Welfare, Department of Public Health Solutions, Helsinki, Finland.
Faculty of Social Sciences/Health Sciences, University of Tampere, Tampere, Finland.
Research Center for Child Health, Tampere University, University Hospital, Science Center of Pirkanmaa Hospital District, Tampere, Finland.
Colorado School of Public Health, Department of Epidemiology, University of Colorado, Aurora.



High gluten intake during childhood may confer risk of celiac disease.


To investigate if the amount of gluten intake is associated with celiac disease autoimmunity and celiac disease in genetically at-risk children.

Design, Setting, and Participants:

The participants in The Environmental Determinants of Diabetes in the Young (TEDDY), a prospective observational birth cohort study designed to identify environmental triggers of type 1 diabetes and celiac disease, were followed up at 6 clinical centers in Finland, Germany, Sweden, and the United States. Between 2004 and 2010, 8676 newborns carrying HLA antigen genotypes associated with type 1 diabetes and celiac disease were enrolled. Screening for celiac disease with tissue transglutaminase autoantibodies was performed annually in 6757 children from the age of 2 years. Data on gluten intake were available in 6605 children (98%) by September 30, 2017.


Gluten intake was estimated from 3-day food records collected at ages 6, 9, and 12 months and biannually thereafter until the age of 5 years.

Main Outcomes and Measures:

The primary outcome was celiac disease autoimmunity, defined as positive tissue transglutaminase autoantibodies found in 2 consecutive serum samples. The secondary outcome was celiac disease confirmed by intestinal biopsy or persistently high tissue transglutaminase autoantibody levels.


Of the 6605 children (49% females; median follow-up: 9.0 years [interquartile range, 8.0-10.0 years]), 1216 (18%) developed celiac disease autoimmunity and 447 (7%) developed celiac disease. The incidence for both outcomes peaked at the age of 2 to 3 years. Daily gluten intake was associated with higher risk of celiac disease autoimmunity for every 1-g/d increase in gluten consumption (hazard ratio [HR], 1.30 [95% CI, 1.22-1.38]; absolute risk by the age of 3 years if the reference amount of gluten was consumed, 28.1%; absolute risk if gluten intake was 1-g/d higher than the reference amount, 34.2%; absolute risk difference, 6.1% [95% CI, 4.5%-7.7%]). Daily gluten intake was associated with higher risk of celiac disease for every 1-g/d increase in gluten consumption (HR, 1.50 [95% CI, 1.35-1.66]; absolute risk by age of 3 years if the reference amount of gluten was consumed, 20.7%; absolute risk if gluten intake was 1-g/d higher than the reference amount, 27.9%; absolute risk difference, 7.2% [95% CI, 6.1%-8.3%]).

Conclusions and Relevance:

Higher gluten intake during the first 5 years of life was associated with increased risk of celiac disease autoimmunity and celiac disease among genetically predisposed children.


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