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.

Andrén Aronsson C, et al. · 2019

PubMed 31408136 ↗DOI: 10.1001/jama.2019.10329JAMA

🌱 La lettura di LEO

Coorte prospettica dalla nascita (TEDDY, 6.605 bambini geneticamente a rischio in 4 paesi, follow-up mediano 9 anni) — associativo, esposizione da diari alimentari di 3 giorni

La domanda

La quantita' di glutine mangiata nei primi 5 anni cambia il rischio di celiachia in un bambino geneticamente predisposto?

Cosa hanno trovato

Studio TEDDY: 8.676 neonati con genotipi HLA associati a diabete tipo 1 e celiachia, arruolati fra il 2004 e il 2010; dati sul glutine disponibili per 6.605 bambini (98%), stimati da diari alimentari di 3 giorni a 6, 9 e 12 mesi e poi ogni sei mesi fino a 5 anni. Nel follow-up mediano di 9 anni, 1.216 bambini (18%) hanno sviluppato autoimmunita' celiaca e 447 (7%) celiachia; l'incidenza di entrambe ha il picco fra i 2 e i 3 anni. Per ogni grammo al giorno di glutine in piu': autoimmunita' celiaca HR 1,30 (IC 95% 1,22-1,38), con rischio assoluto a 3 anni che passa dal 28,1% al 34,2% (differenza 6,1%, IC 4,5-7,7%); celiachia HR 1,50 (IC 95% 1,35-1,66), con rischio assoluto a 3 anni dal 20,7% al 27,9% (differenza 7,2%, IC 6,1-8,3%).

Cosa significa per te

Riguarda solo i bambini che hanno il corredo genetico a rischio — non la popolazione generale, e non e' un argomento per togliere il glutine a un bambino qualunque. Il motivo per cui sta nell'asse pediatrico del tipo 1 e' che la celiachia e' LA comorbidita' che cambia davvero la dieta di un bambino diabetico, e questa coorte e' la stessa che studia l'origine del tipo 1. Il messaggio operativo e' che la celiachia si cerca, non si aspetta (vedi PMID 39497278 sulla sua frequenza nel tipo 1). Che si debba ridurre il glutine per prevenirla, questo studio non lo dimostra: e' un'associazione dose-risposta, e servirebbe un trial.

Abstract (in lingua originale)

IMPORTANCE: High gluten intake during childhood may confer risk of celiac disease. OBJECTIVES: 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. EXPOSURES: 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. RESULTS: 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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Come leggerlo: è uno studio scientifico peer-reviewed. Le evidenze aiutano a capire i trend, ma un singolo studio non è una prescrizione: parlane col tuo diabetologo prima di cambiare dieta o terapia.