The TEDDY (The Environmental Determinants of Diabetes in the Young) study is looking for the cause of type 1 diabetes mellitus (T1DM). A prospective observational birth cohort study designed to identify environmental triggers of type 1 diabetes and celiac disease, participants were followed up at 6 clinical investigator sties in Finland, Germany, Sweden and the United States. 8,676 newborns were enrolled between 2004 and 2010. Screening for celiac disease was performed annually in 6,757 children from the age of 2 years. Gluten intake was available in 6,605 children by September 30, 2017.

The Study

The study long-term goal is the identification of infectious factors, or other environmental agents, including psychosocial factors, which trigger T1DM in genetically susceptible individuals or which protect against the disease. Identification of such factors will lead to a better understanding of disease pathogenesis and result in new strategies to prevent, delay or reverse T1DM.

The study has been sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) as well as collaborators including:

  • National Institute of Allergy and Infectious Disease
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
  • National Institute of Environmental Health Sciences (NIEHS)
  • Juvenile Diabetes Research Foundation
  • Centers for Disease Control and Prevention

The Results

The TEDDY study results reveal that a higher gluten intake in the first 5 years of life was an independent risk factor for both celiac disease autoimmunity and celiac disease among genetically predisposed children.

In the multinational prospective birth cohort of at-risk children, every 1-g/d increase in gluten consumption increased the risk of autoimmunity, for a hazard ratio (HR) of 1.30 (95% Cl 1.22-1.38).

Absolute risk by age 3 was 28.1% if the mean reference amount of gluten was consumed, reports another summary in Medpage Today and published in JAMA. If gluten intake was 1-g/d higher than reference amount, the risk rises to 34.2% for an absolute delta of 6.1% (95% Cl 4.5-7.7).

The researchers noted daily gluten intake is associated with grater risks tied to developing celiac disease as for every 1-g/d increase in gluten consumption (HR 1.50, 95% Cl 1.35-1.66), the equivalent of eating half a slice of white bread the authors noted in JAMA.

The research summarized in MedPage Today noted the absolute risk by age 3 if the mean reference amount of gluten was consumed was 20.7%; at 1-g/d higher than the reference amount it rose to 27.9% for an absolute risk difference of 7.2% (95.2% Cl 6.1%-8.3%)—the incidence of both outcomes peaked in children at ages 2 to 3 years old.

Lead Research/Investigators

Carin Andren Aronsson, PhD, Lund University, Malmo Sweden

Hye-Seung Lee, PhD, University of South Florida, Tampa, FL

Elin M. Hård ad Segerstad, MSc, Lund University, Malmo Sweden

Source: The Environmental Determinants of Diabetes in the Young

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