title: Effects of Gluten Intake on Risk of Celiac Disease: A Case-Control Study on a Swedish Birth Cohort.
abstract: OBJECTIVE
  Early nutrition may affect the risk of celiac disease. We investigated whether amount of gluten in diet until 2 years of age increases risk for celiac disease.
  
  
  METHODS
  We performed a 1-to-3 nested case-control study of 146 cases, resulting in 436 case-control pairs matched for sex, birth year, and HLA genotype generated from Swedish children at genetic risk for celiac disease. Newborns were annually screened for tissue transglutaminase autoantibodies (tTGA). If tested tTGA positive, time point of seroconversion was determined from frozen serum samples taken every 3 months. Celiac disease was confirmed by intestinal biopsies. Gluten intake was calculated from 3-day food records collected at ages 9, 12, 18 and 24 months. Odds ratios (OR) were calculated through conditional logistic regression.
  
  
  RESULTS
  Breastfeeding duration (median, 32 wk) and age at first introduction to gluten (median, 22 wk) did not differ between cases and tTGA-negative controls. At the visit before tTGA seroconversion, cases reported a larger intake of gluten than controls (OR, 1.28; 95% confidence interval [CI], 1.13-1.46; P = .0002). More cases than controls were found in the upper third tertile (ie, >5.0 g/d) before they tested positive for tTGA seroconversion than controls (OR, 2.65; 95% CI, 1.70-4.13; P < .0001). This finding was similar in children homozygous for DR3-DQ2 (OR, 3.19; 95% CI, 1.61-6.30; P = .001), heterozygous for DR3-DQ2 (OR, 2.24; 95% CI, 1.08-4.62; P = .030), and for children not carrying DR3-DQ2 (OR, 2.43; 95% CI, 0.90-6.54; P = .079).
  
  
  CONCLUSIONS
  The amount of gluten consumed until 2 years of age increases the risk of celiac disease at least 2-fold in genetically susceptible children. These findings may be taken into account for future infant feeding recommendations.
authors.affiliation: Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.
authors.forename: Carin
authors.initials: C
authors.lastname: Andrén Aronsson
authors.affiliation: Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, Florida.
authors.forename: Hye-Seung
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Dr. von Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany.
authors.forename: Sibylle
authors.initials: S
authors.lastname: Koletzko
authors.affiliation: Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, Florida.
authors.forename: Ulla
authors.initials: U
authors.lastname: Uusitalo
authors.affiliation: Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, Florida.
authors.forename: Jimin
authors.initials: J
authors.lastname: Yang
authors.affiliation: National Institute for Health and Welfare, Nutrition Unit, Helsinki, Finland; School of Health Sciences, University of Tampere, Finland; Research Center for Child Health, Tampere University and University Hospital, Science Center of Pirkanmaa Hospital District, University of Tampere, Finland.
authors.forename: Suvi M
authors.initials: SM
authors.lastname: Virtanen
authors.affiliation: Digestive Health Institute, Children's Hospital Colorado, University of Colorado Denver, Aurora, Colorado.
authors.forename: Edwin
authors.initials: E
authors.lastname: Liu
authors.affiliation: Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.
authors.forename: Åke
authors.initials: Å
authors.lastname: Lernmark
authors.affiliation: Department of Epidemiology, Colorado School of Public Campus, University of Colorado Denver, Aurora, Colorado.
authors.forename: Jill M
authors.initials: JM
authors.lastname: Norris
authors.affiliation: Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden. Electronic address: daniel.agardh@med.lu.se.
authors.forename: Daniel
authors.initials: D
authors.lastname: Agardh
mesh_terms: D001323:Autoantibodies / Q000097:blood; D001706:Biopsy; D016022:Case-Control Studies; D002446:Celiac Disease / Q000139:chemically induced* / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D004032:Diet / Q000009:adverse effects*; D005260:Female; D019204:GTP-Binding Proteins / Q000276:immunology; D005983:Glutens / Q000008:administration & dosage* / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D007422:Intestines / Q000473:pathology; D008297:Male; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D018570:Risk Assessment; D013548:Sweden / Q000453:epidemiology; D011503:Transglutaminases / Q000276:immunology
chemical_list: D001323:Autoantibodies; D005983:Glutens; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins
keywords: Diet; Pediatric; TEDDY Study; Wheat