Dietary Patterns After the Weaning and Lactation Period Are Associated With Celiac Disease Autoimmunity in Children

doi:10.1053/j.gastro.2018.02.024

Gastroenterology

Volume 154, Issue 8, June 2018, Pages 2087-2096.e7

https://doi.org/10.1053/j.gastro.2018.02.024 Get rights and content

Background & Aims

There have been many studies of associations between infant feeding practices and development of celiac disease during childhood, but few studies have focused on overall diets of young children after the weaning period. We aimed to examine the association between common dietary patterns in infants and the occurrence of celiac disease autoimmunity during childhood.

Methods

We performed a prospective analysis of data from the Generation R Study that comprised 1997 children born from April 2002 through January 2006 in Rotterdam, the Netherlands. Food consumption around 1 year of age was assessed with a validated food-frequency questionnaire. Dietary data were examined using a priori (based on existing guidelines) and a posteriori (principal component analysis and reduced rank regression) dietary pattern analyses. Five dietary patterns were compared. Celiac disease autoimmunity, determined on the basis of serum concentration of transglutaminase-2 autoantibody (ie, TG2A) below or above 7 U/mL, was evaluated at 6 years. Associations between dietary pattern adherence scores and celiac disease autoimmunity were examined using multivariable logistic regression models.

Results

Higher adherence to the a posteriori–derived prudent dietary pattern (high intake of vegetables, vegetable oils, pasta, and grains and low consumption of refined cereals and sweet beverages) at 1 year was significantly associated with lower odds of celiac disease autoimmunity at 6 years (odds ratio, 0.67; 95% confidence interval, 0.53–0.84). No significant associations were found for the 4 remaining dietary patterns.

Conclusions

In a prospective study of dietary patterns of young children in the Netherlands, we associated a dietary pattern characterized by high consumption of vegetables and grains and low consumption of refined cereals and sweet beverages, with lower odds of celiac disease autoimmunity. Early-life dietary patterns might therefore be involved in the development of celiac disease during childhood.

Section snippets

Study Design and Population

This study was embedded in the Generation R Study, a multiethnic, population-based, prospective cohort study, which follows mothers and their children from fetal life onward, in Rotterdam, the Netherlands. The design of the Generation R Study has been described in detail elsewhere.¹⁹ Of the 9749 children born between April 2002 and January 2006, 7893 were available for the postnatal follow-up. Complete dietary information around 1 year of age was available for 3629 children, after exclusion of

Subject Characteristics

Table 1 shows the characteristics of the study population. Of the 1997 children, 1.4% (n = 27) was TG2A positive at the median age of 5.9 years. Girls represented 49% of the TG2A-negative group and 56% of the TG2A-positive group (P = .51); 78% of the TG2A-negative children and 89% of the TG2A-positive children were white (P = .17). TG2A-positive children had lower weight at the 6-year follow-up visit to the research center (20.2 vs 22.0 kg; P < .001) and were more often HLA-DQ2/8 positive (90%

Discussion

In this study, we aimed at identifying possible associations between common dietary patterns of infants around the first year of life and the risk of developing celiac disease autoimmunity at the age of 6 years. Five empirical dietary patterns were used to characterize the children’s food consumption: the diet quality score extracted a priori on the basis of existing recommendations for preschool children,²⁵ 3 dietary patterns extracted a posteriori by principal component analysis, and 1

Conclusions

Our results suggest that an early-life dietary pattern rich in vegetables, grains, and vegetable oils and with low consumption of sugar, confectionery products, and refined cereals is associated with a lower risk of developing celiac disease autoimmunity at 6 years of age. These findings may be useful in identifying possible underlying mechanisms linking diet and celiac disease and thus contribute to the development of new dietary-based prevention strategies for genetically predisposed

Acknowledgments

The Generation R study is conducted by the Erasmus Medical Center in close collaboration with the School of Law and Faculty of Social Sciences of the Erasmus University Rotterdam, the Municipal Health Service–Rotterdam Metropolitan Area, the Rotterdam Homecare Foundation, and the Stichting Trombosedienst & Artsenlaboratorium Rijnmond. We acknowledge the contributions of children and parents, general practitioners, hospitals, and midwives in Rotterdam. We also thank Saskia Meyboom, Corine

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: Conflicts of interest The authors disclose no conflicts.

: Funding The Generation R Study is made possible by financial support from Erasmus Medical Center (EMC), Rotterdam, Erasmus University Rotterdam (EUR), and the Netherlands Organization for Health Research and Development (ZonMw) ‘Geestkracht’ program (10.000.1003). T.V. and J.C.K. work in ErasmusAGE, a center for aging research across the life course funded by Nestlé Nutrition (Nestec Ltd.), Metagenics Inc. and AXA. V.W.V.J. received an additional grant from the Netherlands Organization for Health Research and Development (ZonMw-VIDI). The Generation R Study received funding from the European Union’s Horizon 2020 research and innovation programme (LIFECYCLE project, grant agreement No 733206; 2016). The funders were not involved in the study design; collection, analysis, and interpretation of the data; writing of the report; or in the decision to submit this article for publication.

: Author names in bold designate shared co-first authorship.

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Original ResearchFull Report: Clinical—Alimentary TractDietary Patterns After the Weaning and Lactation Period Are Associated With Celiac Disease Autoimmunity in Children

Background & Aims

Methods

Results

Conclusions

Section snippets

Study Design and Population

Subject Characteristics

Discussion

Conclusions

Acknowledgments

Best Pract Res Clin Gastroenterol

Am J Clin Nutr

Immunity

Am J Clin Nutr

J Nutr

Am J Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

J Nutr

Am J Clin Nutr

Celiac disease: a review

JAMA Pediatr

Gluten introduction and the risk of coeliac disease: a position paper by the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition

J Pediatr Gastroenterol Nutr

European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease

J Pediatr Gastroenterol Nutr

The new epidemiology of celiac disease

J Pediatr Gastroenterol Nutr

Prevalence of childhood celiac disease and changes in infant feeding

Pediatrics

Systematic review: early infant feeding and the prevention of coeliac disease

Aliment Pharmacol Ther

Introduction of gluten, HLA status, and the risk of celiac disease in children

N Engl J Med

Randomized feeding intervention in infants at high risk for celiac disease

N Engl J Med

Low-grade inflammation, diet composition and health: current research evidence and its translation

Br J Nutr

The immune protective effect of the Mediterranean diet against chronic low-grade inflammatory diseases

Endocr Metab Immune Disord Drug Targets

Dietary pattern analysis and biomarkers of low-grade inflammation: a systematic literature review

Nutr Rev

Inflammatory disease processes and interactions with nutrition

Br J Nutr

Diet and inflammation

Nutr Clin Pract

Original Research
Full Report: Clinical—Alimentary Tract
Dietary Patterns After the Weaning and Lactation Period Are Associated With Celiac Disease Autoimmunity in Children