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American Academy of Pediatrics
Article

Age at Gluten Introduction and Risk of Celiac Disease

Carin Andrén Aronsson, Hye-Seung Lee, Edwin Liu, Ulla Uusitalo, Sandra Hummel, Jimin Yang, Michael Hummel, Marian Rewers, Jin-Xiong She, Olli Simell, Jorma Toppari, Anette-G. Ziegler, Jeffrey Krischer, Suvi M. Virtanen, Jill M. Norris, Daniel Agardh and for the TEDDY STUDY GROUP
Pediatrics January 2015, peds.2014-1787; DOI: https://doi.org/10.1542/peds.2014-1787
Carin Andrén Aronsson
aDepartment of Clinical Sciences, Lund University, Malmö, Sweden;
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Hye-Seung Lee
bPediatrics Epidemiology Center, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, Florida;
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Edwin Liu
cDigestive Health Institute, University of Colorado, Children’s Hospital Colorado, Denver, Colorado;
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Ulla Uusitalo
bPediatrics Epidemiology Center, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, Florida;
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Sandra Hummel
dInstitute of Diabetes Research, Helmholtz Zentrum München, and Klinikum rechts der Isar, Technische Universität München, and Forschergruppe Diabetes e.V., Neuherberg, Germany;
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Jimin Yang
bPediatrics Epidemiology Center, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, Florida;
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Michael Hummel
dInstitute of Diabetes Research, Helmholtz Zentrum München, and Klinikum rechts der Isar, Technische Universität München, and Forschergruppe Diabetes e.V., Neuherberg, Germany;
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Marian Rewers
eBarbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, Colorado;
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Jin-Xiong She
fCenter for Biotechnology and Genomic Medicine, Medical College of Georgia, Georgia Regents University, Augusta, Georgia;
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Olli Simell
gDepartment of Pediatrics, Turku University Hospital, Turku, Finland;
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Jorma Toppari
hDepartment of Physiology and Pediatrics, University of Turku, Turku, Finland;
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Anette-G. Ziegler
dInstitute of Diabetes Research, Helmholtz Zentrum München, and Klinikum rechts der Isar, Technische Universität München, and Forschergruppe Diabetes e.V., Neuherberg, Germany;
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Jeffrey Krischer
bPediatrics Epidemiology Center, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, Florida;
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Suvi M. Virtanen
iNational Institutes for Health and Welfare, Nutrition Unit, Helsinki, Finland;
jSchool of Health Sciences, University of Tampere, Tampere, Finland;
kResearch Center for Child Health, Tampere University and University Hospital and the Science Center of Pirkanmaa Hospital District, Tampere, Finland; and
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Jill M. Norris
lDepartment of Epidemiology, Colorado School of Public Health, University of Colorado, Denver, Aurora, Colorado
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Daniel Agardh
aDepartment of Clinical Sciences, Lund University, Malmö, Sweden;
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Abstract

OBJECTIVES: The goal of this study was to determine whether age at introduction to gluten was associated with risk for celiac disease (CD) in genetically predisposed children.

METHODS: TEDDY (The Environmental Determinants of Diabetes in the Young) is a prospective birth cohort study. Newborn infants (N = 6436) screened for high-risk HLA-genotypes for CD were followed up in Finland, Germany, Sweden, and the United States. Information about infant feeding was collected at clinical visits every third month. The first outcome was persistent positive for tissue transglutaminase autoantibodies (tTGA), the marker for CD. The second outcome was CD, defined as either a diagnosis based on intestinal biopsy results or on persistently high levels of tTGA.

RESULTS: Swedish children were introduced to gluten earlier (median: 21.7 weeks) compared with children from Finland (median: 26.1 weeks), Germany, and the United States (both median: 30.4 weeks) (P < .0001). During a median follow-up of 5.0 years (range: 1.7–8.8 years), 773 (12%) children developed tTGA and 307 (5%) developed CD. Swedish children were at increased risk for tTGA (hazard ratio: 1.74 [95% CI: 1.47–2.06]) and CD (hazard ratio: 1.76 [95% CI: 1.34–2.24]) compared with US children, respectively (P < .0001).Gluten introduction before 17 weeks or later than 26 weeks was not associated with increased risk for tTGA or CD, adjusted for country, HLA, gender, and family history of CD, neither in the overall analysis nor on a country-level comparison.

CONCLUSIONS: In TEDDY, the time to first introduction to gluten introduction was not an independent risk factor for developing CD.

  • breastfeeding
  • celiac disease
  • gluten
  • infant feeding
  • Accepted October 29, 2014.
  • Copyright © 2015 by the American Academy of Pediatrics
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Age at Gluten Introduction and Risk of Celiac Disease
Carin Andrén Aronsson, Hye-Seung Lee, Edwin Liu, Ulla Uusitalo, Sandra Hummel, Jimin Yang, Michael Hummel, Marian Rewers, Jin-Xiong She, Olli Simell, Jorma Toppari, Anette-G. Ziegler, Jeffrey Krischer, Suvi M. Virtanen, Jill M. Norris, Daniel Agardh, for the TEDDY STUDY GROUP
Pediatrics Jan 2015, peds.2014-1787; DOI: 10.1542/peds.2014-1787

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Age at Gluten Introduction and Risk of Celiac Disease
Carin Andrén Aronsson, Hye-Seung Lee, Edwin Liu, Ulla Uusitalo, Sandra Hummel, Jimin Yang, Michael Hummel, Marian Rewers, Jin-Xiong She, Olli Simell, Jorma Toppari, Anette-G. Ziegler, Jeffrey Krischer, Suvi M. Virtanen, Jill M. Norris, Daniel Agardh, for the TEDDY STUDY GROUP
Pediatrics Jan 2015, peds.2014-1787; DOI: 10.1542/peds.2014-1787
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