Higher amounts of dietary fiber before the age of 2 may reduce later risk of celiac disease

The results of an observational study from Lund University in Sweden are clear: Up to the age of 2, a more fiber-rich diet seems to reduce the risk of celiac disease. A particularly clear link was seen when children had eaten fiber-rich foods before the age of 1.

“This is the first time the risk of celiac disease has been studied based on fiber in children’s diets. But a clinical trial is also needed to possibly confirm this connection.”

So says Elin Hård af Segerstad, a dietitian specialized 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 celiac 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 celiac disease. When we detect such antibodies, we can pinpoint when the disease debuts,” says Hård af Segerstad.

The new study, accepted for publication in the journal Gastroenterology, is the first to examine fiber intake among children. At first, the researchers thought that the type of fiber the children ate might be a factor. There are different types of dietary fiber—found in fruits, vegetables, grains and legumes.

“But when we examined each type of fiber individually, it didn’t seem to matter what kind of fiber it was. It was the proportion of fiber the children ate that seemed to influence the risk of celiac disease.”

The parents of the participating children regularly completed food records of the child’s intake of foods and drinks. Fiber intake was studied on eleven occasions. The researchers accounted for whether any of the child’s parents or siblings have celiac disease, as well as biological sex—factors that also affect the risk of the disease. celiac 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 celiac disease.

When the researchers adjusted for other factors, they saw that the incidence of celiac disease by age 13 decreased by almost 40% in children who ate a high-fiber 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 7% of the children developed celiac 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 grams of fiber per day, compared to the average intake, reduced the risk of celiac disease later in childhood by almost 40%,” explains Hård af Segerstad.

The Lund researchers also saw a beneficial effect in children up to 2 years of age, but a more moderate one corresponding to a 5% reduction of the risk. After the age of 2, fiber intake no longer seemed to play a role in the development of celiac disease.

The Lund researchers believe that the children’s gut microbiota, which is largely formed during the first two years, gets a more favorable composition with the help of dietary fiber. 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 fiber, this needs to be tested in a clinical trial,” says Hård af Segerstad.