在有遗传风险的儿童中,高麸质摄入与乳糜泻(CD)的风险增加有关。
我们的目的是调查2岁以下不同的饮食麸质来源是否会在有遗传风险的儿童中赋予不同的乳糜泻自身免疫(CDA)和CD风险。
在6、9、12、18和24个月时,从2088名瑞典遗传高危儿童中收集了三天的食物记录,这些儿童参与了15年的1型糖尿病和CD随访队列研究。用组织转谷氨酰胺酶自身抗体(tTGA)进行CD的筛选。主要结果是CDA,定义为持续的TTGA阳性。次要结果是CD,定义为具有显示Marsh评分≥2或平均tTGA水平≥100单位的活检标本。Cox回归校正了总面筋摄入量估计的HR,每日面筋来源的CI为95%。
随访期间,487例(23.3%)儿童发展为CDA,242例(11.6%)儿童发展为CD。与不摄入相比,在9个月时每日摄入≤158g粥与CDA风险增加相关(HR:1.53;95%CI:1.05,2.23;P=0.026)。与不摄入面包相比,12个月时每日高面包摄入量(>18.3g)与CDA(HR:1.47;95%CI:1.05,2.05;P=0.023)和CD(HR:1.79;95%CI:1.10,2.91;P=0.019)的风险增加相关。18个月时,每增加200g/d的摄入量,牛奶谷物饮料与CD风险增加相关(HR:1.16;95%CI:1.00,1.33;P=0.047).在24个月之前,未发现其他麸质来源与CDA或CD风险相关。
在基因高危儿童中,12个月时每天摄入较高的面包和第二年的牛奶谷物饮料与CDA和CD的风险增加有关。
High gluten intake is associated with increased risk of celiac disease (CD) in children at genetic risk.
We aimed to investigate if different dietary gluten sources up to age 2 y confer different risks of celiac disease autoimmunity (CDA) and CD in children at genetic risk.
Three-day food records were collected at ages 6, 9, 12, 18, and 24 mo from 2088 Swedish genetically at-risk children participating in a 15-y follow-up cohort
study on type 1 diabetes and CD. Screening for CD was performed with tissue transglutaminase autoantibodies (tTGA). The primary outcome was CDA, defined as persistent tTGA positivity. The secondary outcome was CD, defined as having a biopsy specimen showing Marsh score ≥ 2 or an averaged tTGA level ≥ 100 Units. Cox regression adjusted for total gluten intake estimated HRs with 95% CIs for daily intake of gluten sources.
During follow-up, 487 (23.3%) children developed CDA and 242 (11.6%) developed CD. Daily intake of ≤158 g porridge at age 9 mo was associated with increased risk of CDA (HR: 1.53; 95% CI: 1.05, 2.23; P = 0.026) compared with no intake. A high daily bread intake (>18.3 g) at age 12 mo was associated with increased risk of both CDA (HR: 1.47; 95% CI: 1.05, 2.05; P = 0.023) and CD (HR: 1.79; 95% CI: 1.10, 2.91; P = 0.019) compared with no intake. At age 18 mo, milk cereal drink was associated with an increased risk of CD (HR: 1.16; 95% CI: 1.00, 1.33; P = 0.047) per 200-g/d increased intake. No association was found for other gluten sources up to age 24 mo and risk of CDA or CD.
High daily intakes of bread at age 12 mo and of milk cereal drink during the second year of life are associated with increased risk of both CDA and CD in genetically at-risk children.