Longitudinal Micronutrient Exposure Reveals Country-Specific Associations with Risk of Celiac Disease in Genetically Susceptible Children: The Prospective TEDDY Cohort: Nutrient Intake and Risk of Celiac Disease - Centre for Population Health Research (POPC) - A joint centre by the University of Turku and the municipal authority of the Hospital District of Southwest Finland. The goal of Centre for Population Health Research is to promote health and well-being of society by enhancing research and development work on clinical-epidemiological population research.

Am J Clin Nutr. 2026 Mar 16:101276. doi: 10.1016/j.ajcnut.2026.101276. Online ahead of print.

ABSTRACT

BACKGROUND: The role of nutrient intake in celiac disease pathogenesis is poorly understood.

OBJECTIVE: To examine whether longitudinal childhood intake of selected vitamins and minerals is associated with celiac disease autoimmunity (CDA, primary outcome) and celiac disease (secondary outcome) in genetically at-risk children.

METHODS: A total of 6,520 HLA-conferred at-risk children in the observational TEDDY study were prospectively screened for tissue transglutaminase autoantibodies (tTGA) annually from ages 2 to 13 years. CDA was defined as persistent tTGA positivity in two samples ≥3 months apart. Celiac disease was defined by biopsy-confirmed Marsh score ≥2 or mean tTGA ≥100 U/mL in two consecutive samples. Micronutrient intake was assessed via repeated 3-day food records, and adjusted hazard ratios (HRs) were estimated using time-dependent Cox proportional hazards and Bayesian joint models.

RESULTS: Out of 6,520 children, 1,268 (19%) developed CDA and 479 (7.8%) were diagnosed with celiac disease. Results from both models suggested heterogeneity in associations by country as nutrients such as folate showing sporadic associations in the same or opposite direction across ages. Higher vitamin D intake (every 5 μg/1000 kcal) at multiple ages was associated with increased risk of CDA and celiac disease in Sweden, with the strongest at age 5 years for CDA (HR: 1.23, 95%CI: 1.11, 1.37; p<0.001) and at age 4 years for celiac disease (HR: 1.20, 95%CI: 1.03, 1.40; p=0.021). Higher iron intake (every 5 mg/1000 kcal) was also associated with increased risks of CDA and celiac disease in Sweden, with the highest observed up to age 5 years (HR: 1.70, 95%CI: 1.39, 2.08; p<0.001 for CDA and HR:1.80, 95%CI: 1.37, 2.36; p<0.001 for celiac disease).

CONCLUSIONS: Modest country-specific associations were found between childhood micronutrient intake with the risk of CDA and celiac disease, potentially reflecting influence from regional dietary practices, fortification policies, and host factors in disease pathogenesis.

PMID:41850488 | DOI:10.1016/j.ajcnut.2026.101276