Is There a Link Between Celiac Disease and Early Diet? Yes!
“A healthy, prudent diet in early-life can influence the likelihood that children will develop celiac disease, Dutch researchers reported.”
- by Nancy Walsh, Senior Staff Writer, MedPage Today –
Children whose diets were rich in vegetables, grains, and vegetable oils at age 1 — the so-called “prudent” diet — were at decreased risk of developing celiac disease autoimmunity by age 6, with an odds ratio of 0.67 (95% CI 0.53-0.84), according to Jessica C. Kiefte-de Jong, RD, PhD, of Erasmus University Medical Center in Rotterdam, The Netherlands, and colleagues.
In contrast, young children whose diets were high in snacks and processed foods had a greater likelihood (although not statistically significant) of developing the disease (OR 1.19, 95% CI 0.76-1.87), as did those with diets containing predominantly dairy, cereals, and meat (OR 1.18, 95% CI 0.96-1.46), the researchers reported online in Gastroenterology.
“Although originally considered a pediatric malabsorption syndrome, celiac disease is now recognized as a common autoimmune systemic disorder affecting approximately 1% to 3% of the general population,” the team explained.
The researchers added, however, that that percentage is probably an underestimate, and the incidence of the disease has been rapidly increasing.
Supporting the concept of celiac disease as an autoimmune disorder is the finding that exposure to gluten in genetically predisposed individuals leads to the development of autoantibodies — most specifically, anti-tissue transglutaminase 2 (TG2A), and inflammation of the small intestine mucosa.
Recent research has begun to shed light on the influence of diet in chronic disease, including the potential benefits of Mediterranean-like plant-based diets in preventing autoimmune and inflammatory disorders. For instance, studies have suggested that foods such as red meat and saturated fatty acids may upregulate inflammatory mediators and trigger systemic inflammation. In addition, disturbances in the gut microbiome may lead to immune imbalances that in turn can trigger immune-mediated disease.
But little is known about the potential influence of dietary patterns in very young children and the development of celiac disease, so the researchers analyzed data from the Generation R study, which is a population-based prospective cohort trial in Rotterdam that enrolled children from 2002 to 2006. When the children were approximately 1 year old, their parents completed a food-frequency questionnaire that included approximately 200 food items commonly consumed by young Dutch children.
The investigators identified a total of 1,997 children who had complete dietary information and whose TG2A status was known.
Five empirical dietary patterns were evaluated:
- One a priori-defined pattern was based on food groups such as vegetables, fruit, bread and cereals, legumes, dairy, meat, fish, and candy/snacks, with a diet quality score calculated based on actual and recommended consumption. This was referred to as the “diet quality score” pattern.
- Three a posteriori dietary patterns were identified through principal component analysis:
- the prudent diet;
- a diet consisting of a large component of savory snacks, refined cereal, and sweets (the “snacks and processed foods” pattern);
- and a diet with predominantly low-fat dairy products, whole grain cereals, butter, and meat (the “dairy, cereals, and meat” pattern).
- A fifth dietary pattern was identified through reduced rank regression analysis, reflecting the relation between food group intake and TG2A status. This diet was characterized by high intake of fruit and whole grain products, and was referred to as the “TG2A-specific” pattern.
Along with the prudent dietary pattern, the diet quality score pattern and the TG2A-specific pattern were associated with lower risk of celiac disease, with odds ratios of 0.88 (95% CI 0.72-1.07) and 0.73 (95% CI 0.49-1.08), although these were not statistically significant.
Those analyses were adjusted for sex, ethnicity, and age at the time of assessment. Further adjustments for maternal socioeconomic status and lifestyle, childhood factors such as birth weight, breastfeeding, and timing of introduction to gluten and fruits/vegetables, did not significantly change the outcome.
- The observation that the prudent dietary pattern was associated with a decreased likelihood of celiac disease autoimmunity “supports the possible protective role against celiac disease of dietary patterns typically associated with healthy behaviors,” the authors noted.
The prudent diet also was similar to the Mediterranean diet, which has been linked with low levels of pro-inflammatory markers such as C-reactive protein and interleukin (IL)-6 and high levels of anti-inflammatory markers such as IL-10 and adiponectin.
Mediterranean and other plant-predominant diets contain large quantities of fiber, which is metabolized by bacteria in the intestine to short-chain fatty acids. “These metabolites, particularly butyrate, are known to have an impact on the immune system and regulate inflammation by suppressing the effect of pro-inflammatory cytokines, as well as contributing to a balanced gut microflora,” Kiefte-de Jong and colleagues wrote.
They added that more research is needed to fully elucidate the mechanisms by which nutrition may contribute to autoimmune diseases such as celiac disease, and determine whether dietary interventions could be useful for genetically predisposed children.
A limitation of the study, the investigators said, was the use of the food-frequency questionnaire, since that can result in information bias.
The study was funded by Erasmus University Rotterdam, the Netherlands Organization for Health Research and Development, and NutsOhra. Kiefte-de Jong and co-authors reported having no financial conflicts.
- 1 https://www.medpagetoday.com/gastroenterology/generalgastroenterology/71407
- Source Reference: Barroso M, et al “Dietary patterns after the weaning and lactation period associate with celiac disease autoimmunity in children” Gastroenterology 2018; DOI:10.1053/j.hsdyto.2018.02.024.