断奶后饮食与儿童乳糜泻风险相关

gastroenterology（2018）

DOI: https://doi.org/10.1053/j.gastro.2018.02.024

Dietary Patterns After the Weaning and Lactation Period Are Associated With Celiac Disease Autoimmunity in Children

对近2000名儿童进行跟踪随访，发现1岁时的饮食模式与6岁时的乳糜泻相关自身免疫反应相关，断奶期后摄入更多的蔬菜、植物油、意大利面、谷物，少摄入精致谷物、含糖饮料，或可降低儿童乳糜泻风险。

论文摘要

Celiac disease is a chronic immune-mediated disorder triggered by the ingestion of gluten and related prolamins in genetically predisposed individuals carrying HLA-DQ2 or HLA-DQ8 alleles.1 Exposure to specific gluten peptides elicits innate and adaptive immune responses, the production of autoantibodies, and the chronic inflammation of the small intestinal mucosa. Among the autoantibodies produced, anti-tissue transglutaminase 2 (TG2A) is highly specific for celiac disease and its serum concentrations strongly correlate with the degree of mucosal inflammation and villous atrophy,2 justifying the widespread use of this marker in the screening of this disease.3

Although originally considered a pediatric malabsorption syndrome, celiac disease is now recognized as a common autoimmune systemic disorder affecting approximately 1%–3% of the general population.4 The incidence of celiac disease is rapidly increasing worldwide,5 which has partly been ascribed to increased global availability of gluten-containing foods4 and changes in early-life eating habits, particularly lactation and weaning practices.6 Early observational studies suggested a protective effect of prolonged breastfeeding and of breastfeeding at the time of introduction to gluten.7 However, 2 recent large, randomized controlled trials found no effect of breastfeeding or gluten introduction modalities on the development of celiac disease during childhood.8, 9 To our knowledge, no attention has been paid, in this context, to the role of overall diets of young children after the lactation and weaning periods.

In recent years, the analysis of overall dietary patterns, rather than single food or nutrient studies, has provided important insights into the relationship between different dietary habits and the development of multiple chronic and metabolic diseases.10 In particular, Western-like diets —mainly characterized by high intake of red and processed meats, refined grains, simple sugars, and saturated fats, and low intake of fruits, vegetables, and whole grains— have been associated with low-grade chronic inflammation, which is involved in the etiology of inflammatory conditions and autoimmune disorders.11 Conversely, Mediterranean-like and plant-based diets —with characteristically high intake of vegetables, fruits, unrefined grains, and vegetable oils, and low intake of red meat products and processed foods —have been linked to reduced risk of various chronic inflammatory diseases.12, 13

实验综述

① 记录1997名荷兰儿童在1岁时的饮食，通过测定6岁时血清中的谷氨酰胺转移酶-2浓度，分析饮食与乳糜泻的关联；

② 根据饮食中的蔬菜、水果、面包及谷物、米饭、意大利面、土豆、豆类、乳制品、肉蛋、鱼、油及脂肪、糖果及零食、含糖饮料，将饮食模式分为5种类型；

③ 1岁时摄入较多的蔬菜、植物油、意大利面、谷物，并较少摄入精致谷物及含糖饮料，与6岁时较低的乳糜泻相关自身免疫反应相关；

④ 其它4种饮食模式与乳糜泻自身免疫反应无显著关联。