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. 2018 Sep 19;362:k3547.
doi: 10.1136/bmj.k3547.

Association Between Maternal Gluten Intake and Type 1 Diabetes in Offspring: National Prospective Cohort Study in Denmark

Free PMC article

Association Between Maternal Gluten Intake and Type 1 Diabetes in Offspring: National Prospective Cohort Study in Denmark

Julie C Antvorskov et al. BMJ. .
Free PMC article


Objective: To examine the association between prenatal gluten exposure and offspring risk of type 1 diabetes in humans.

Design: National prospective cohort study.

Setting: National health information registries in Denmark.

Participants: Pregnant Danish women enrolled into the Danish National Birth Cohort, between January 1996 and October 2002, MAIN OUTCOME MEASURES: Maternal gluten intake, based on maternal consumption of gluten containing foods, was reported in a 360 item food frequency questionnaire at week 25 of pregnancy. Information on type 1 diabetes occurrence in the participants' children, from 1 January 1996 to 31 May 2016, were obtained through registry linkage to the Danish Registry of Childhood and Adolescent Diabetes.

Results: The study comprised 101 042 pregnancies in 91 745 women, of whom 70 188 filled out the food frequency questionnaire. After correcting for multiple pregnancies, pregnancies ending in abortions, stillbirths, lack of information regarding the pregnancy, and pregnancies with implausibly high or low energy intake, 67 565 pregnancies (63 529 women) were included. The average gluten intake was 13.0 g/day, ranging from less than 7 g/day to more than 20 g/day. The incidence of type 1 diabetes among children in the cohort was 0.37% (n=247) with a mean follow-up period of 15.6 years (standard deviation 1.4). Risk of type 1 diabetes in offspring increased proportionally with maternal gluten intake during pregnancy (adjusted hazard ratio 1.31 (95% confidence interval 1.001 to 1.72) per 10 g/day increase of gluten). Women with the highest gluten intake versus those with the lowest gluten intake (≥20 v <7 g/day) had double the risk of type 1 diabetes development in their offspring (adjusted hazard ratio 2.00 (95% confidence interval 1.02 to 4.00)).

Conclusions: High gluten intake by mothers during pregnancy could increase the risk of their children developing type 1 diabetes. However, confirmation of these findings are warranted, preferably in an intervention setting.

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at and declare: support from the Kirsten and Freddy Johansens Foundation, March of Dimes Foundation, Innovation Fund Denmark, Danish Heart Association, Sygekassernes Helsefond, and the Danish National Research Foundation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Comment in

  • Dietary gluten and type 1 diabetes.
    Miettinen ME, Virtanen SM. Miettinen ME, et al. BMJ. 2018 Sep 19;362:k3867. doi: 10.1136/bmj.k3867. BMJ. 2018. PMID: 30232119 No abstract available.

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    1. Karvonen M, Tuomilehto J, Libman I, LaPorte R, World Health Organization DIAMOND Project Group A review of the recent epidemiological data on the worldwide incidence of type 1 (insulin-dependent) diabetes mellitus. Diabetologia 1993;36:883-92. 10.1007/BF02374468 - DOI - PubMed
    1. Harjutsalo V, Sund R, Knip M, Groop PH. Incidence of type 1 diabetes in Finland. JAMA 2013;310:427-8. 10.1001/jama.2013.8399 - DOI - PubMed
    1. Svensson J, Lyngaae-Jørgensen A, Carstensen B, Simonsen LB, Mortensen HB, Danish Childhood Diabetes Registry Long-term trends in the incidence of type 1 diabetes in Denmark: the seasonal variation changes over time. Pediatr Diabetes 2009;10:248-54. 10.1111/j.1399-5448.2008.00483.x - DOI - PubMed
    1. Antvorskov JC, Josefsen K, Engkilde K, Funda DP, Buschard K. Dietary gluten and the development of type 1 diabetes. Diabetologia 2014;57:1770-80. 10.1007/s00125-014-3265-1 - DOI - PMC - PubMed
    1. Shewry PR, Halford NG, Belton PS, Tatham AS. The structure and properties of gluten: an elastic protein from wheat grain. Philos Trans R Soc Lond B Biol Sci 2002;357:133-42. 10.1098/rstb.2001.1024 - DOI - PMC - PubMed

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