Gluten, Grains, and Risk for Type 1 Diabetes in At-Risk Children
Dietary factors have been implicated for many years as potential pathophysiologic triggers in the development of type 1 diabetes (T1D). High intake of cereals and other gluten-containing products may lead to an increased risk for islet autoimmunity (IA).
In a prospective birth cohort study in Finland, researchers examined dietary intake of cereals, fiber, and gluten and risk for IA and T1D in over 5500 children with human leukocyte antigen–conferred susceptibility to T1D. Islet autoantibodies and other markers of autoimmunity were obtained every 3 to 12 months for up to 15 years, and dietary assessments (with attention to wheat, barley, rye, rice, and oats intake) were completed at 3, 6, and 12 months and at 2-, 3-, 4-, and 6-year visits.
Incidence of IA and T1D were 4.4% and 1.6%, respectively, during the 6-year follow-up period. A high intake of oats, wheat, rye, gluten-containing cereals, gluten, and dietary fiber was associated with increased risk for IA. After adjusting for energy intake, consumption of oats and gluten-containing cereals showed statistically significant associations with T1D risk, but significance was lost after multiple testing correction.
COMMENT
This is the first study to report associations between intake of specific cereals and IA in children genetically predisposed to T1D. Of concern is that some of the dietary components implicated, such as fiber, are promoted for their health benefits. Until more is understood, encouraging moderate intake, not exceeding standard recommended amounts, of gluten, fiber, and selected grains might be reasonable, especially in the child who has a known strong family history of autoimmune disease.
CITATION(S):
Hakola L et al. Association of cereal, gluten, and dietary fiber intake with islet autoimmunity and type 1 diabetes. JAMA Pediatr 2019 Aug 12; [e-pub]. (https://doi.org/10.1001/jamapediatrics.2019.2564)
Catherine M. Gordon, MD, MSc reviewing
da NEJM
