Adherence to a gluten-free diet is the only effective treatment for those diagnosed with celiac disease, which comprises only about 1% of the general Western population. However, in healthy subjects without celiac disease, gluten-free and -limited diets are becoming increasingly popular. This may be due to evidence that all-cause mortality decreases among celiac disease patients with strict adherence to a gluten-free diet. However, no study has so far reported an association between gluten intake and mortality in subjects not affected by celiac disease.
To address this point, Inken Behrendt (Justus-Liebig University of Giessen) and colleagues assessed the association between dietary gluten intake and all-cause and cause-specific mortality in people not affected by celiac disease. Data from a large, well-characterized population of UK Biobank participants were utilized in the present study. UK Biobank is a large multicenter, prospective cohort study initiated in 2006, with over 500,000 participants. Baseline assessment included a personal interview, physical measures, and completion of a dietary questionnaire. Gluten intake was estimated by determining consumption of foods containing wheat, rye, or barley. Health Service records were assessed to collect mortality data and information pertaining to the underlying primary cause of death.
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While evidence exists that the link between celiac disease and mortality is influenced by compliance with a gluten-free diet, this was not the case in non-celiac disease participants. In total, 6259 participants of >159,000 participants included in the study, died between their baseline visit and 31 August 2020. The association between daily gluten intake and all-cause mortality in participants without a history of celiac disease was not significant. In addition, gluten intake was not related to cancer or noncancer mortality. However, within cardiovascular disease, there was a significant and positive association between gluten intake and ischemic heart disease mortality. It was estimated that an increase in gluten intake by 1 gram per day, equivalent to half a slice of bread, was statistically related to a 2.3% higher ischemic heart disease mortality risk. In contrast, gluten intake was not significantly associated with stroke mortality and overall cardiovascular disease mortality.
This study indicates that gluten intake is not a major contributor to cancer and noncancer mortality in adults without celiac disease. Therefore, limiting gluten intake is unlikely to provide overall survival benefits in a non-celiac population.
Behrendt I, Fasshauer M, Eichner G. Gluten Intake and All-Cause and Cause-Specific Mortality: Prospective Findings from the UK Biobank. The Journal of Nutrition, Volume 151, Issue 3, March 2021, Pages 591–597, https://doi.org/10.1093/jn/nxaa387.
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