Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
Department of Pediatrics, Queen Silvia Children's Hospital, Gothenburg, Sweden.
Am J Gastroenterol. 2019 Aug;114(8):1307-1314. doi: 10.14309/ajg.0000000000000255.
To determine the association between the amount of gluten intake in childhood and later celiac disease (CD), for which data are currently scarce.
The prospective Diabetes Autoimmunity Study in the Young cohort includes 1875 at-risk children with annual estimates of gluten intake (grams/d) from age 1 year. From 1993 through January 2017, 161 children, using repeated tissue transglutaminase (tTGA) screening, were identified with CD autoimmunity (CDA) and persistent tTGA positivity; of these children, 85 fulfilled CD criteria of biopsy-verified histopathology or persistently high tTGA levels. Cox regression, modeling gluten intake between ages 1 and 2 years (i.e., in 1-year-olds), and joint modeling of cumulative gluten intake throughout childhood were used to estimate hazard ratios adjusted for confounders (aHR).
Children in the highest third of gluten intake between the ages of 1 and 2 years had a 2-fold greater hazard of CDA (aHR 2.17; 95% confidence interval [CI], 1.22-3.88; P value = 0.01) and CD (aHR 1.96; 95% CI, 0.90-4.24; P value = 0.09) than those in the lowest third. The risk of developing CDA increased by 5% per daily gram increase in gluten intake (aHR 1.05; 95% CI, 1.00-1.09; P value = 0.04) in 1-year-olds. The association between gluten intake in 1-year-olds and later CDA or CD did not differ by the child's human leukocyte antigen genotype. The incidence of CD increased with increased cumulative gluten intake throughout childhood (e.g., aHR 1.15 per SD increase in cumulative gluten intake at age 6; 95% CI, 1.00-1.32; P value = 0.04).
Gluten intake in 1-year-olds is associated with the future onset of CDA and CD in children at risk for the disease.
确定儿童时期摄入的麸质量与后来的乳糜泻（CD）之间的关联，目前这方面的数据还很缺乏。
前瞻性糖尿病自身免疫研究中的年轻队列包括 1875 名有患病风险的儿童，他们在 1 岁时每年估计摄入的麸质量（克/天）。从 1993 年到 2017 年 1 月，通过重复组织转谷氨酰胺酶（tTGA）筛查，有 161 名儿童被确定患有 CD 自身免疫（CDA）和持续的 tTGA 阳性；其中，85 名儿童符合活检证实的组织病理学或持续高 tTGA 水平的 CD 标准。采用 Cox 回归模型，对 1 岁和 2 岁之间的麸质摄入量（即 1 岁儿童）进行建模，以及对整个儿童时期的累积麸质摄入量进行联合建模，以估计调整混杂因素后的危险比（aHR）。
1 至 2 岁期间摄入麸质最高三分之一的儿童患 CDA 的危险是摄入最低三分之一的儿童的 2 倍（aHR 2.17；95%置信区间[CI]，1.22-3.88；P 值=0.01）和 CD（aHR 1.96；95% CI，0.90-4.24；P 值=0.09）。儿童每日摄入的麸质增加 1 克，患 CDA 的风险就会增加 5%（aHR 1.05；95% CI，1.00-1.09；P 值=0.04）。1 岁儿童麸质摄入量与后期 CDA 或 CD 之间的关联与儿童人类白细胞抗原基因型无关。随着儿童时期累积麸质摄入量的增加，CD 的发病率也随之增加（例如，6 岁时累积麸质摄入量每增加 1 个标准差，aHR 为 1.15；95% CI，1.00-1.32；P 值=0.04）。
儿童 1 岁时的麸质摄入量与该疾病风险儿童未来发生 CDA 和 CD 有关。
