Associations of early life dietary diversity and healthy eating with celiac disease: A prospective cohort study.

Background & aims: The role of early-life overall diet in celiac disease risk is not well explored. The aim was to investigate associations of dietary diversity, and healthy eating in the second year of life with subsequent celiac disease risk.

Methods: In 64,315 children born 2002-2009 with available data in the Mother, Father and Child Cohort Study, a Dietary Diversity Score (0-4) and Healthy Eating Index (0-36) were calculated using questionnaire data collected at age 18 months. The outcome was celiac disease diagnosis in the nationwide patient registry. Associations of dietary diversity and healthy eating per standard deviation (SD) increase with celiac disease risk were estimated as adjusted odds ratios (aOR) using logistic regression, accounting for maternal pregnancy smoking and gluten intake, parent's celiac disease, early-life infections, and gluten intake. Data on celiac disease-associated human leukocyte antigen (HLA) haplotypes were available in 50,383 children (78.3 %) RESULTS: After a mean of 16.1 (SD 1.8) years of follow-up, 1041 (1.6 %) children were diagnosed with celiac disease. At age 18 months, the mean Dietary Diversity Score was 2.3 (SD 0.4) and mean Healthy Eating Index 24.9 (SD 3.6). Higher dietary diversity was associated with a lower subsequent celiac disease risk (aOR 0.91, 95 %CI = 0.85-0.98). The association remained in children with HLA risk haplotypes, and when additionally adjusting for potential confounders, including breastfeeding. Healthy eating was not associated with celiac disease (aOR 1.03, 95 %CI = 0.96-1.10).

Conclusions: In this population-based study, child dietary diversity in the second year of life (but not healthy eating) was associated with a modestly reduced risk of celiac disease.