近日，瑞典马尔默隆德大学、德国路德维希·马克西米利安大学、波兰瓦米娅和马祖里大学等机构组成的国际研究团队，探讨了5岁前摄入面筋与乳糜泻自身免疫和乳糜泻患病率的关系。相关论文于2019年8月13日发表于国际学术期刊《美国医学会杂志》上。

儿童时期高面筋摄入可能会带来乳糜泻的风险。这项前瞻性观察性出生队列研究从2004年至2010年招募了6605名携带1型糖尿病和乳糜泻相关HLA抗原基因型的新生儿，从2岁起每年进行组织型谷氨酰胺转氨酶自身抗体筛查，并对这些幼儿的面筋摄入量进行统计。乳糜泻自身免疫定义为连续2个血清样品中组织型谷氨酰胺转氨酶自身抗体阳性，乳糜泻则通过肠道活检或持续抗体阳性来确定。

中位随访9年后，1216名儿童发生乳糜泻自身免疫，447名儿童发展为乳糜泻，且在2-3岁时达到最高峰。每天摄入的面筋量每增加1克，乳糜泻自身免疫的风险比为1.3；3岁摄入面筋参考量的绝对风险为28.1%，比参考量高1克/日，绝对风险为34.2%，差值为6.1%。每天摄入的面筋量每增加1克，乳糜泻的风险比为1.5；3岁摄入面筋参考量的绝对风险为20.7%，比参考量高1克/日，绝对风险为27.9%，差值为7.2%。在遗传易感儿童中，5岁前摄入面筋可增加患乳糜泻自身免疫和乳糜泻的风险。

附：英文原文

Title: Association of Gluten Intake During the First 5 Years of Life With Incidence of Celiac Disease Autoimmunity and Celiac Disease Among Children at Increased Risk

Author: Carin Andrén Aronsson; Hye-Seung Lee; Elin M. Hård af Segerstad; Ulla Uusitalo; Jimin Yang; Sibylle Koletzko; Edwin Liu; Kalle Kurppa; Polly J. Bingley; Jorma Toppari; Anette G. Ziegler; Jin-Xiong She; William A. Hagopian; Marian Rewers; Beena Akolkar; Jeffrey P. Krischer; Suvi M. Virtanen; Jill M. Norris; Daniel Agardh; for the TEDDY Study Group

Issue&Volume: Vol 322，No.6

Abstract: 

Importance  High gluten intake during childhood may confer risk of celiac disease.

Objectives  To investigate if the amount of gluten intake is associated with celiac disease autoimmunity and celiac disease in genetically at-risk children.

Design, Setting, and Participants  The participants in The Environmental Determinants of Diabetes in the Young (TEDDY), a prospective observational birth cohort study designed to identify environmental triggers of type 1 diabetes and celiac disease, were followed up at 6 clinical centers in Finland, Germany, Sweden, and the United States. Between 2004 and 2010, 8676 newborns carrying HLA antigen genotypes associated with type 1 diabetes and celiac disease were enrolled. Screening for celiac disease with tissue transglutaminase autoantibodies was performed annually in 6757 children from the age of 2 years. Data on gluten intake were available in 6605 children (98%) by September 30, 2017.

Exposures  Gluten intake was estimated from 3-day food records collected at ages 6, 9, and 12 months and biannually thereafter until the age of 5 years.

Main Outcomes and Measures  The primary outcome was celiac disease autoimmunity, defined as positive tissue transglutaminase autoantibodies found in 2 consecutive serum samples. The secondary outcome was celiac disease confirmed by intestinal biopsy or persistently high tissue transglutaminase autoantibody levels.

Results  Of the 6605 children (49% females; median follow-up: 9.0 years [interquartile range, 8.0-10.0 years]), 1216 (18%) developed celiac disease autoimmunity and 447 (7%) developed celiac disease. The incidence for both outcomes peaked at the age of 2 to 3 years. Daily gluten intake was associated with higher risk of celiac disease autoimmunity for every 1-g/d increase in gluten consumption (hazard ratio [HR], 1.30 [95% CI, 1.22-1.38]; absolute risk by the age of 3 years if the reference amount of gluten was consumed, 28.1%; absolute risk if gluten intake was 1-g/d higher than the reference amount, 34.2%; absolute risk difference, 6.1% [95% CI, 4.5%-7.7%]). Daily gluten intake was associated with higher risk of celiac disease for every 1-g/d increase in gluten consumption (HR, 1.50 [95% CI, 1.35-1.66]; absolute risk by age of 3 years if the reference amount of gluten was consumed, 20.7%; absolute risk if gluten intake was 1-g/d higher than the reference amount, 27.9%; absolute risk difference, 7.2% [95% CI, 6.1%-8.3%]).

Conclusions and Relevance  Higher gluten intake during the first 5 years of life was associated with increased risk of celiac disease autoimmunity and celiac disease among genetically predisposed children.

DOI: 10.1001/jama.2019.10329

Source: https://jamanetwork.com/journals/jama/article-abstract/2747670