Intake of marine fatty acids in early life and risk of celiac disease

Abstract

Background: About 1% of the European population are affected by celiac disease (CD). Intake of omega-3 fatty acids in early life has been associated with lower risk of other immune-mediated diseases in children, but there are limited studies on CD. The primary aim of this thesis was to investigate if maternal intake of EPA and DHA during pregnancy, from food and/or supplements, was associated with risk of CD in the offspring. The secondary aim was to investigate if children`s use of cod liver oil, at 6 months and at 18 months, was associated with risk of CD.

Material and methods: In the analysis of maternal intakes, 85,592 children from The Norwegian Mother, Father and Child Cohort Study (MoBa) were included. Intakes of EPA and DHA had been calculated from a food frequency questionnaire in mid-pregnancy. In the analyses of children`s use of cod liver oil, at 6 months and at 18 months, 87,056 and 72,188 children from MoBa were included, respectively. Information about use of cod liver oil was obtained from questionnaires. CD status was obtained from the Norwegian Patient Registry and questionnaires. Binary log-linear regression was used to estimate relative risks (RR) with 95% confidence intervals (CI) for associations with CD.

Results: Of the children included in the analysis of maternal intakes, 965 (1.1%) were diagnosed with CD. Median maternal intakes of EPA and DHA were 0.22 and 0.34 g/day, respectively, and 68% used supplements containing EPA and DHA. Use of supplements was significantly associated with increased risk of CD in the offspring (adjusted RR: 1.18, 95% CI: 1.02–1.37). Intake of EPA and DHA from food was significantly associated with reduced risk of CD in the offspring, per g/d increase in intake, in the unadjusted analysis (RR: 0.82, 95% CI: 0.68-0.99), but the association did not remain significant after adjustment. Total intake (food and supplements) of EPA and DHA was not associated with risk of CD in the offspring. Of the children included in the analyses of use of cod liver oil, at 6 months and at 18 months, 976 (1.1%) and 832 (1.2%) were diagnosed with CD, respectively. At 6 months of age, 53% used cod liver oil, and 56% used it at 18 months of age. No associations were observed between children`s use of cod liver oil and risk of CD.

Conclusion: Maternal use of supplements containing EPA and DHA during pregnancy was significantly associated with increased risk of CD in the offspring. However, the observed effect was small and due to this, the clinical relevance is limited. Further research on the potential relationship between intake of EPA and DHA in early life and risk of CD are needed.