Hård Af Segerstad Elin M, Borge Tiril Cecilie, Guo Annie, Mårild Karl, Stene Lars C, Brantsæter Anne Lise, Størdal Ketil
Department of Pediatric Research, Oslo University Hospital, Oslo, Norway; Unit for Celiac and Diabetes Research, Clinical Sciences, Lund University, Malmoe, Sweden.
Cluster for Reviews and Health Technology Assessments, Norwegian Institute of Public Health, Oslo, Norway.
J Nutr. 2024 Dec;154(12):3770-3779. doi: 10.1016/j.tjnut.2024.10.033. Epub 2024 Oct 18.
High gluten and low dietary fiber in pregnancy intake is associated with an increased risk of celiac disease (CeD) in the child. Early life higher dietary quality is suggested to reduce the subsequent risk of CeD.
The aim was to investigate associations of pregnancy dietary quality and diversity with child risk of CeD.
In The Norwegian Mother, Father and Child Cohort Study, 85,122 mother-child pairs had available data from a validated pregnancy food frequency questionnaire. Pregnancy dietary quality and diversity were estimated by a Pregnancy Healthy Eating Index [mean 99.3, standard deviation (SD) 9.9, range 48.8-128.3], and a Diet Diversity Score (mean 7.0, SD 1.0, range 1.6-9.8), respectively. Child CeD was captured by ≥2 diagnostic codes in the Norwegian Patient Registry. Logistic regression was used to estimate associations between pregnancy dietary quality, diversity and child CeD, adjusted for socioeconomic factors, and parents CeD [adjusted odds ratio (aOR), 95% confidence intervals (CI)]. CeD-susceptible human leukocyte antigen haplotypes (DQ2/DQ8) were present in 30,718 (45.5%).
Up to mean age 16.0 (SD 1.8, 12.4-19.8) y, 1363 (1.6%) children were diagnosed with CeD. Lower as well as higher pregnancy dietary quality associated with a reduced risk of CeD in the child (<5th percentile aOR = 0.67, 95% CI: 0.48, 0.93, >95th percentile aOR = 0.71, 95% CI: 0.52, 0.98, respectively, nonlinear squared term P = 0.011). Analyses on genetically susceptible children, adjustments for pregnancy iron supplementation, gluten, and dietary fiber intake, and child early life dietary quality, gluten intake and iron supplementation, supported the finding. Pregnancy dietary diversity was not associated with child CeD (aOR = 1.00, 95% CI: 0.94, 1.07/score).
In this population-based study, lower as well as higher pregnancy dietary quality associated with a reduced risk of CeD diagnosis in the child. In contrast, no such association was observed with maternal dietary diversity.
孕期高麸质和低膳食纤维摄入与儿童患乳糜泻（CeD）的风险增加有关。建议早期更高的饮食质量可降低后续患CeD的风险。
旨在研究孕期饮食质量和多样性与儿童患CeD风险之间的关联。
在挪威母婴队列研究中，85122对母婴对可从经过验证的孕期食物频率问卷中获取数据。孕期饮食质量和多样性分别通过孕期健康饮食指数[均值99.3，标准差（SD）9.9，范围48.8 - 128.3]和饮食多样性评分（均值7.0，SD 1.0，范围1.6 - 9.8）进行评估。儿童CeD通过挪威患者登记处的≥2个诊断代码确定。采用逻辑回归来估计孕期饮食质量、多样性与儿童CeD之间的关联，并对社会经济因素和父母CeD进行调整[调整后的优势比（aOR），95%置信区间（CI）]。30718名（45.5%）存在CeD易感性人类白细胞抗原单倍型（DQ2/DQ8）。
在平均年龄16.0（SD 1.8，12.4 - 19.8）岁时，1363名（1.6%）儿童被诊断为CeD。孕期饮食质量较低以及较高均与儿童患CeD风险降低相关（第5百分位数以下aOR = 0.67，95% CI：0.48，0.93；第95百分位数以上aOR = 0.71，95% CI：0.52，0.98，非线性平方项P = 0.011）。对基因易感性儿童的分析、对孕期铁补充剂、麸质和膳食纤维摄入量以及儿童早期饮食质量、麸质摄入量和铁补充剂的调整，均支持这一发现。孕期饮食多样性与儿童CeD无关（aOR = 1.00，95% CI：0.94，1.07/评分）。
在这项基于人群的研究中，孕期饮食质量较低以及较高均与儿童CeD诊断风险降低相关。相比之下，未观察到与母亲饮食多样性存在此类关联。
