medwireNews: Findings from a large cohort study suggest a dose-dependent relationship between the consumption of gluten in pregnancy and the risk for type 1 diabetes in offspring.
As reported in The BMJ, the risk for type 1 diabetes was doubled for children whose mothers ate at least 20 g of gluten per day, compared with those who ate less than 7 g per day, although the absolute risk remained very low.
In an accompanying editorial, Maija Miettinen and Suvi Virtanen, both from the National Institute for Health and Welfare in Helsinki, Finland, note that the study is the first to show “a clear dose-dependent association” and “could help resolve inconsistencies in the existing literature.”
But they stress: “Given that a causal association between maternal gluten intake and type 1 diabetes in children has not yet been established, it is too early to change dietary recommendations on gluten intake in pregnancy.”
For the study, Knud Josefsen (Rigshospitalet, Copenhagen, Denmark) and co-researchers identified 67,565 women in the Danish National Birth Cohort who had completed a 360-item food frequency questionnaire at week 25 of pregnancy.
In all, 0.37% of the women’s children developed type 1 diabetes, ranging from 0.30% for children of women in the lowest 10% of gluten intake to 0.52% for those in the top 10%.
Women in the top versus bottom 10% of gluten intake had higher overall energy intake, but were more likely to be a healthy weight, nonsmoking, and to have breastfed for more than 1 month. After accounting for these variables and others including age, socioeconomic status, offspring sex, and maternal gestational or pre-existing type 2 diabetes, there was a significant 31% increase in the children’s risk for diabetes per 10 g/day increase in maternal gluten intake during pregnancy.
In their editorial, Miettinen and Virtanen highlight several possible alternative mechanisms underlying the association, rather than a direct causal one. They suggest that a high intake of gluten could be a marker of a generally poor diet, that other elements present in the grains might be driving the association, and that, even if responsible, the high gluten intake might wield its effect via breast milk or the infant’s solid food diet rather than during pregnancy.
“[F]urther studies are needed to confirm or rule out these findings, and to explore possible underlying mechanisms,” they conclude.
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