“This is the first time the risk of coeliac disease has been studied based on fibre in children’s diets. But a clinical trial is also needed to possibly confirm this connection.”
So says Elin Hård af Segerstad, dietitian specialised in pediatrics and researcher at Lund University. She and her research colleagues have based their work on the TEDDY cohort, a large study that has followed children with a genetic risk in Skåne, Germany, Finland and the United States for many years. The children are mainly screened for type 1 diabetes, but also for coeliac disease.
“In our study, we followed 6,500 children from birth until they are at least 13 years old. With the help of blood samples, we have looked for antibodies specific to coeliac disease. When we detect such antibodies, we can pinpoint when the disease debuts,” says Elin Hård af Segerstad.
The new study, published in the American journal Gastroenterology, is the first to examine fibre intake among children. At first, the researchers thought that the type of fibre the children ate might be a factor. There are different types of dietary fibre – found in fruits, vegetables, grains and legumes.
“But when we examined each type of fibre individually, it didn’t seem to matter what kind of fibre it was. It was the proportion of fibre the children ate that seemed to influence the risk of coeliac disease.”
The parents of the participating children regularly completed food records of the child’s intake of foods and drinks. Fibre intake was studied on eleven occasions. The researchers accounted for whether any of the child’s parents or siblings have coeliac disease, as well as biological sex – factors that also affect the risk of the disease. Coeliac disease is to some extent genetic, and it is well documented that, although not why, girls and women account for about two-thirds of all cases of coeliac disease. When the researchers adjusted for other factors, they saw that the incidence of coeliac disease by age 13 decreased by almost 40 per cent in children who ate a high-fibre diet when they were 6-12 months old. This compares to the general risk of 7.8 cases per 1,000 person-years in the study.
Just over seven per cent of the children developed coeliac disease during the follow-up, and the most common age for being diagnosed with the disease was around 3-4 years old. Increasing the intake by about three grammes of fibre per day, compared to the average intake, reduced the risk of coeliac disease later in childhood by almost 40 per cent, explains Elin Hård af Segerstad.
The Lund researchers also saw a beneficial effect in children up to two years of age, but a more moderate one corresponding to a five per cent reduction of the risk. After the age of two, fibre intake no longer seemed to play a role in the development of coeliac disease. The Lund researchers believe that the children’s gut microbiota, which is largely formed during the first two years, gets a more favourable composition with the help of dietary fibre. This, in turn, may lead to a strengthened immune system and support the gut barrier.
“That’s our theory, but it’s only speculation. It’s new and exciting to be able to point to a possible protective factor. However, this is an observational study. In order to actively make recommendations that young children should eat a lot of fibre, this needs to be tested in a clinical trial,” says Elin Hård af Segerstad.
