Maternal and child gluten intake and association with type 1 diabetes: The Norwegian Mother and Child Cohort Study.

Nicolai A Lund-Blix,Lars C Stene,Torild Skrivarhaug,Karl Mårild,Pål R Njølstad,Geir Joner,Ketil Størdal,Anne Lise Brantsaeter,German Tapia,Ronald Ching Wan Ma

doi:10.1371/journal.pmed.1003032

Abstract

The relationship between maternal gluten intake in pregnancy, offspring intake in childhood, and offspring risk of type 1 diabetes has not been examined jointly in any studies. Our aim was to study the relationship between maternal and child intake of gluten and risk of type 1 diabetes in children. We included 86,306 children in an observational nationwide cohort study, the Norwegian Mother and Child Cohort Study (MoBa), with recruitment from 1999 to 2008 and with follow-up time to April 15, 2018. We used registration of type 1 diabetes in the Norwegian childhood diabetes registry as the outcome. We used Cox proportional hazard regression to estimate hazard ratios (HRs) for the mother's intake of gluten up to week 22 of pregnancy and offspring gluten intake when the child was 18 months old. The average time followed was 12.3 years (0.70-16.0). A total of 346 children (0.4%) children were diagnosed with type 1 diabetes, resulting in an incidence rate of 32.6/100,000 person-years. Mean gluten intake per day was 13.6 g for mothers and 8.8 g for children. There was no association between the mother's intake of gluten in pregnancy and offspring type 1 diabetes, with an adjusted HR (aHR) of 1.02 (95% confidence interval [CI] 0.73-1.43, p = 0.91) for each 10-g-per-day increment. There was an association between offspring intake of gluten and a higher risk of type 1 diabetes, with an aHR of 1.46 (95% CI 1.06-2.01, p = 0.02) for each 10-g-per-day increment. Among the limitations are the likely imprecision in estimation of gluten intake and that we only had information regarding gluten intake at 2 time points in early life. Our results show that, while the mother's intake of gluten in pregnancy was not associated with type 1 diabetes, a higher intake of gluten by the child at an early age may give a higher risk of type 1 diabetes.

Highlights

Type 1 diabetes is an increasingly common disease often presenting in childhood, with some of the highest incidence rates in the Nordic countries [1]
There was an association between offspring intake of gluten and a higher risk of type 1 diabetes, with an adjusted hazard ratio (HR) (aHR) of 1.46 for each 10-g-per-day increment
While the mother’s intake of gluten in pregnancy was not associated with type 1 diabetes, a higher intake of gluten by the child at an early age may give a higher risk of type 1 diabetes

Summary

Introduction

Type 1 diabetes is an increasingly common disease often presenting in childhood, with some of the highest incidence rates in the Nordic countries [1]. Gluten has been hypothesised to be one of the environmental factors involved in the development of type 1 diabetes [3] It has been found in animal models and in vitro studies that gluten may have an effect on the immune system by increasing proinflammatory cytokine production or may lead to dysbiosis of the gut microbiota [3]. Two small studies reported no association between maternal intake of gluten-containing foods in pregnancy and development of islet autoimmunity [12, 13], but a recent, large cohort study found that the mother’s intake of gluten while pregnant may increase the probability of the offspring having type 1 diabetes [14]. Our aim was to study the relationship between maternal and child intake of gluten and risk of type 1 diabetes in children

Objectives

Methods

Results

Conclusion