Fibre intake may prevent celiac disease in first 2 years of life

Increased intake of dietary fibre at age 2 years and below tends to reduce the risks for celiac disease (CD) and celiac disease autoimmunity (CDA) in genetically at-risk children, suggests a study presented at the recent ESPGHAN 2024.

“[H]igher amounts of dietary fibre in the first 2 years of life is associated with a lower risk of CDA and CD in children at genetic risk,” said lead author Elin M Hard af Segerstad from Oslo University Hospital, Oslo, Norway. “And this effect seemed to be independent of the gluten intake and other components in fibre rich foods.”

Participants of the TEDDY study, which started 20 years ago and screened more than 420,000 infants for human leukocyte antigens, were used in the current analysis. Of these, 20,000 were at risk for type 1 diabetes and CD. Researchers followed up the participants in clinics in Sweden, Germany, Finland, and the US. A total of 8,700 children were assessed and monitored up to age 15 years.

In the current study, Segerstad and her team used data from repeated 3-day food records between the age of 6 months and 5 years, in a total of 11 timepoints. More than 50,000 records were assessed. German children, however, were excluded from the analysis because their “dietary fibre intake was not harmonized with that of other countries.”

Tissue transglutaminase IgA (TTGA) tests were carried out yearly to screen children for CD. In the end, 6,500 children were included in the latest study and were followed up until age 13 years. Of these, 1,268 developed CDA, defined as “having at least two positive TTGA samples in consecutive samples,” and 483 were diagnosed with CD, most of whom with a small intestinal biopsy.

In the first 2 years of life, dietary fibre intake was highest among Finnish children and lowest among US children. However, after the age of 3 years, no more differences were seen between countries, and dietary fibre intake became stable over time. Looking into fibre sources, fruits and berries contributed the most fibre in the diet, followed by vegetables. This was consistent across age groups.

Dietary fibre intake in the first and second year of life significantly correlated with a lower CDA risk (1 year: adjusted hazard ratio [aHR], 0.95, 95 percent confidence interval [CI], 0.90‒0.99; 2 years: aHR, 0.99, 95 percent CI, 0.98‒1.00). The same was true for the risk of CD in the first 2 years (1 year: aHR, 0.91, 95 percent CI, 0.89‒0.92; 2 years: aHR, 0.83, 95 percent CI, 0.80‒0.87).

When data up to the age of 5 years were included, however, dietary fibre intake correlated with a higher risk of CDA. This increased risk, on the other hand, was not observed for CD.

“It seemed to be more pronounced these first 2 years of life, and we wanted to look a little bit more deep into details in these first 2 years of life and to make sure that it was really the dietary fibre that was driving this association and not some other components, such as vitamins or minerals or phytochemicals that you also find in dietary fibre-rich foods,” Segerstad said.

In models adjusted for intakes of other fibre-rich food groups, the results were consistent that the [beneficial] effect was indeed driven by dietary fibre itself, according to Segerstad.

When compared with the other findings from the TEDDY study, the results showed that gluten intake on the first 5 years of life was associated with an increased risk of CD (HR, 1.5 for every 1-g increase in 1,000 kcal/day, 95 percent CI, 1.35‒1.66). Notably, fibre intake at age <2 years correlated with a reduced CD risk (HR, 0.83, 95 percent CI, 0.80‒0.87).