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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)

Journal article
Authors N. A. Lund-Blix
F. Dong
Karl Mårild
J. Seifert
A. E. Baron
K. C. Waugh
G. Joner
K. Stordal
G. Tapia
L. C. Stene
R. K. Johnson
M. J. Rewers
J. M. Norris
Published in Diabetes Care
Volume 42
Issue 5
Pages 789-796
ISSN 0149-5992
Publication year 2019
Published at Institute of Clinical Sciences, Department of Pediatrics
Pages 789-796
Language en
Links dx.doi.org/10.2337/dc18-2315
Keywords food frequency questionnaire, celiac-disease, dietary gluten, autoantibodies, validation, exposure, titers, time, Endocrinology & Metabolism
Subject categories Endocrinology and Diabetes

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.

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