There is no significant association between gluten intake and development of islet autoimmunity or type 1 diabetes in children at increased risk for diabetes, according to study results published in Diabetes Care.
To determine whether infant gluten intake is associated with development of islet autoimmunity and progression to type 1 diabetes, researchers followed 1916 participants at risk for islet autoimmunity and type 1 diabetes longitudinally for a median of 13.5 years. The researchers collected blood samples for each individual at 9, 15, and 24 months, and annually thereafter. Gluten intake was measured using food frequency questionnaires.
Overall, islet autoimmunity developed in 178 participants, defined as the presence of at least 1 autoantibody against insulin in ≥2 consecutive blood samples. Islet autoimmunity progressed to type 1 diabetes in 56 of these individuals.
Average daily gluten intake between age 1 to 2 years was 11.4 ± 5.61 g. The researchers discovered no association between development of islet autoimmunity and gluten intake at 1 to 2 years (adjusted hazard ratio [HR] for each 4 g/day increase in gluten, 1.00; 95% CI, 0.85-1.17) or during follow-up (adjusted HR for each 4 g/day increase in gluten, 1.01; 95% CI, 0.99-1.02). There was also no significant association between gluten intake and progression from islet autoimmunity to type 1 diabetes (adjusted HR for each 4 g/day increase in gluten, 0.86; 95% CI, 0.57-1.29).
However, there was a significant association between introduction of gluten before age 4 months and an increased risk for progression from islet autoimmunity to type 1 diabetes (adjusted HR, 8.69; 95% CI, 1.69-44.8) compared with introduction of gluten at age 4 to 5.9 months.
The researchers noted certain limitations to their findings, including an inability to exclude unmeasured confounding given the observational study design.
“Given our finding of no association between the amount of gluten intake at age [1 to 2] years or throughout childhood and adolescence and the risk [for] islet autoimmunity and progression to type 1 diabetes,” the researchers said, “we conclude that there is no rationale to reduce the amount of gluten during childhood and adolescence in the high-risk population to prevent the development of type 1 diabetes.”
Lund-Blix NA, Dong F, Mårild K, et al. Gluten intake and risk of islet autoimmunity and progression to type 1 diabetes in children at increased risk of the disease: the diabetes autoimmunity study in the young (DAISY) [published online February 22, 2019]. Diabetes Care. doi:10.2337/dc18-2315