Association Between Gluten Intake at 18 Months and Type 1 Diabetes

Each 10 g of gluten consumed daily during infancy is associated with a 46% increased risk for developing type 1 diabetes during the next 12 years, whereas maternal gluten intake during pregnancy was not associated with future diabetes risk, according to study data presented at the European Association for the Study of Diabetes annual meeting.

Regina Schaffer, Healio Endocrine Today ¹

“No studies have investigated the relation between the amount of gluten intake by both the mother during pregnancy and the child in early life and risk of developing type 1 diabetes in childhood,” Nicolai Lund-Blix, PhD, of Oslo University Hospital and the Norwegian Institute of Public Health in Oslo, Norway, and colleagues wrote in an abstract.

“Our objective was to examine the association between the maternal gluten intake during pregnancy, child’s gluten intake at age 18 months, and the risk of type 1 diabetes in the child in a Norwegian, population-based, nationwide study.”

Lund-Blix and colleagues analyzed data from 86,306 children participating in the Norwegian Mother and Child Cohort Study, born between 1999 and 2009 and followed through April 15, 2018. The outcome was type 1 diabetes, determined from a childhood diabetes registry. Researchers used Cox regression models to estimate HRs for the association between maternal gluten intake during pregnancy and child’s gluten intake at age 18 months with type 1 diabetes risk. Daily gluten intake was determined via a semiquantitative food frequency questionnaire completed at 22 weeks’ gestation and again when the child was aged 18 months.

During a mean follow-up of 12.3 years, 346 children (0.4%) developed type 1 diabetes, for an incidence rate of 32.6 per 100,000 person-years. The average gluten intake was 13.6 g per day for mothers during pregnancy and 8.8 g per day for the child at age 18 months.

Researchers found that maternal gluten intake in mid-pregnancy was not associated with the development of type 1 diabetes in the child.

However, each 10 g per day gluten consumed at age 18 months among offspring was associated with a 46% increased risk for developing type 1 diabetes during follow-up (adjusted HR = 1.46; 95% CI, 1.06-2.01) for each 10 g per day increase in gluten intake.

“This study suggests that the child’s gluten intake at 18 months of age, and not the maternal intake during pregnancy, could increase the risk of type 1 diabetes in the child,” the researchers said in a press release. “Our observations may motivate future interventional studies with reduced gluten intake to establish whether there is a true causal association between amount of gluten intake in the child’s early diet and type 1 diabetes in susceptible individuals.”

The researchers noted that the findings, together with existing evidence, are not enough to encourage people to avoid or reduce gluten intake.

“We need confirmation from further studies, and ideally a randomized controlled trial, to determine any relationship between gluten intake and type 1 diabetes with certainty,” the researchers said in the release. “Since our findings show the highest risk of developing type 1 diabetes is in the group with the highest gluten consumption, it could be that simply reducing gluten intake would be enough to reduce risk, and this is easier to achieve than complete avoidance. Based on experiences from patients with celiac disease, complete avoidance of gluten is hard but manageable, but this would probably not be necessary.”

SOURCE: Lund-Blix NA, et al. Abstract 369. Presented at: European Association for the Study of Diabetes Annual Meeting; Sept. 16-20, 2019; Barcelona, Spain.

Disclosures: The authors report no relevant financial disclosures.