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expert reaction to conference abstract/poster looking at gluten intake in infancy and type 1 diabetes risk

A conference abstract/poster, presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD), reports a link between an infant’s gluten intake and their risk of type-1 diabetes.

 

Catherine Collins RD FBDA, NHS dietitian, said:

“This conference presentation is of interest as it appears to associate increasing intake of gluten-containing foods in a toddler diet with increased risk of childhood Type 1 diabetes – the type that requires insulin injections to manage.  Gluten is a natural protein found in wheat, with similar proteins in rye, barley and oats – and foods made from these grains1.  The authors emphasise the need for further studies to determine any causal association between gluten intake and diabetes arising from their observations.  However, the public may wrongly translate these preliminary findings as a need to alter their toddlers’ diet to prevent diabetes, given the current popular narrative surrounding the management of Type 2 diabetes by very low carbohydrate diets.

“The authors reported a 46% increased risk of Type 1 diabetes for every 10g per day increase in gluten intake, determined using a food frequency questionnaire.  Gluten intake was derived from estimating the protein intake of wheat, rye or barley eaten, then adoption of a ‘conversion factor 0.75 x protein content’ to ‘calculate’ gluten intake.  This calculation, plus the likelihood of gluten-containing foods eaten not included in their questionnaire design, raises concerns as to validity of gluten estimation.  Wheat flour, for example, contains gluten, but ‘strong’ wheat flour used for breadmaking has a higher gluten content than self-raising flour used for cake making.  Gluten content naturally varies depending on the growth, environment and harvest times.

“Should parents be concerned that their child is eating wheat, rye, oats or barley containing foods regularly in the light of this association?  I think not – but it is important to remind parents that foods containing gluten should not to be introduced too early into a weaning diet to minimise the risk of their child developing coeliac disease or Type 1 diabetes.  The current recommendation is for babies not to have gluten-containing foods when weaning starts – advice which has been constant for years.  A scientific report from the UK SACN and the Committee on Toxicology in 2010 supported the recommendation not to give gluten-containing foods to babies below 4 months of age, but that gluten containing foods could be introduced as part of a weaning diet from 4-6 months of age2.  Gluten introduction before 4 months, or delayed until after 7 months old, has been associated with an increased risk of Type 1 diabetes3,4.

“The link between Type 1 diabetes and the risk of coeliac disease (an intolerance to gluten) is well established.  Both are auto-immune conditions, sharing common genetic profile.  The risk of Type 1 diabetes in people with coeliac disease is raised when compared to the general population.  The reverse is also true and has been the subject of ongoing investigation in children5.

“Although the relative risk of developing Type 1 diabetes was reported as 46% higher per 10g increase in dietary gluten consumption, the average (mean) consumption in children was 8.8g per day (based on their model of determining gluten intake), and their findings became statistically significant only at the highest intakes of gluten – in 35 of 226 children diagnosed with diabetes within the sample of 66,725 children.  The quality and variety of the whole diet was not evaluated in this study, nor the genetic predisposition to Type 1 diabetes or coeliac disease, both important oversights.

“This is an interesting presentation but not one that should influence the current recommendations on weaning or healthy eating advice on offer.”

1 Gluten containing foods: Grains: https://www.coeliac.org.uk/information-and-support/living-gluten-free/the-gluten-free-diet/about-gluten/grains/

2 https://cot.food.gov.uk/sites/default/files/cot/cotsacnstatementgluten201101.pdf

3 Norris JM, Barriga K, Klingensmith G, et al. Timing of initial cereal exposure in infancy and risk of islet autoimmunity. JAMA. 2003;290(13):1713–1720

4 Ziegler AG, Schmid S, Huber D, Hummel M, Bonifacio E. Early infant feeding and risk of developing type 1 diabetes associated autoantibodies. JAMA. 2003;290(13):1721–1728

5 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5654393/pdf/PEDS_20171305.pdf

 

Dr Matthew Simmonds, Senior Lecturer in Biomedical Science and Programme Leader, University of Lincoln, said:

“This is an interesting and unique study looking at the link between gluten intake and development of type 1 diabetes in children within a large Norwegian population which was followed up over numerous years.  The authors found a link between increased gluten intake in children at 18 months of age and increased risk of developing type 1 diabetes in the future.

“Whilst this study is performed on a large cohort, the number of children developing type 1 diabetes is relatively small and the link between gluten intake and development of T1D only just shows association.  As such, we would need further work to confirm this interesting finding in other populations before we know whether or not the evidence supports limiting gluten intake in infants.”

 

Abstract title: ‘Amount of gluten in early life and risk of type 1 diabetes’.

Poster title: ‘Maternal and child gluten intake and risk of type 1 diabetes’.

by Nicolai A Lund-Blix et al.

This is a conference abstract from the Annual Meeting of the European Association for the Study of Diabetes (EASD), and is under embargo until 23:01 UK time on Wednesday 18 September 2019.

There is no paper as this is not published work.

 

Declared interests

Dr Matthew Simmonds: “I have no conflicts of interest that I can think of with regard to this study.”

Catherine Collins: “No conflicts of interest.”

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