To explore associations of adherence to dietary patterns up to age 2 years with risk of celiac disease autoimmunity (CDA) and celiac disease (CeD).
Data were retrieved from 6,677 participants enrolled in The Environmental Determinants of Diabetes in the Young (TEDDY) study, a longitudinal observational birth cohort with a 15-year follow-up on type 1 diabetes and CeD. Children were annually screened for tissue transglutaminase autoantibodies (tTGA) from age 2 years. Dietary patterns were based on intake of 27 food groups assessed by 22,410 3-day food records from age of 9 to 24 months. The primary outcome, CDA, was defined as being persistently tTGA positive confirmed in at least 2 consecutive samples. The secondary outcome, CeD, was defined as an intestinal biopsy showing Marsh >2 or having a mean level of tTGA >100 units if a biopsy was not performed. Associations of adherence to dietary patterns with the study outcomes were estimated by Cox regression models adjusted for daily gluten intake.
A total of 1287 (19.3%) children developed CDA and 527 (7.9%) CeD during follow-up to mean age 11.0 years (SD 3.6). At age 9 months, a dietary pattern high in vegetable fats and milk, and low in infant formula and breastmilk was associated with reduced risk of CDA (HR 0.88, 95% CI [0.81, 0.99], P=.04, per 5-unit increase). A dietary pattern high in wheat, vegetable fats, and juices, and low in milk, meat, and oats at age 24 months, was associated with increased risk of CDA (HR 1.18, 95% CI [1.05, 1.33], P<.001) and CeD (HR 1.24, 95% CI [1.03, 1.50], P=.03, per 5-unit increase).
Associations between dietary patterns in the first 2 years of life and risk of CDA and CeD indicate that additional dietary factors besides the gluten amount impact disease risk in genetically predisposed children.