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Dietary Gluten Intake and Risk of Microscopic Colitis Among US Women without Celiac Disease: A Prospective Cohort Study

The American Journal of Gastroenterology (2018) | Download Citation

Subjects

Abstract

Objective

Microscopic colitis is a common cause of chronic watery diarrhea among the elderly. Although the prevalence of celiac disease appears to be higher in patients with microscopic colitis, the relationship between dietary gluten intake and risk of microscopic colitis among individuals without celiac disease has not been explored.

Methods

We conducted a prospective study of 160,744 US women without celiac disease enrolled in the Nurses’ Health Study (NHS) and the NHSII. Dietary gluten intake was estimated using validated food frequency questionnaires every 4 years. Microscopic colitis was confirmed through medical records review. We used Cox proportional hazard modeling to estimate the multivariable-adjusted hazard ratio (HR) and 95% confidence interval (CI).

Results

We documented 219 incident cases of microscopic colitis over more than 20 years of follow-up encompassing 3,716,718 person-years (crude incidence rate: 5.9/100,000 person-years) in NHS and NHSII. Dietary gluten intake was not associated with risk of microscopic colitis (Ptrend = 0.88). Compared to individuals in the lowest quintile of energy-adjusted gluten intake, the adjusted HR of microscopic colitis was 1.18 (95% CI: 0.77–1.78) for the middle quintile and 1.03 (95% CI: 0.67–1.58) for the highest quintile. Additional adjustment for primary dietary sources of gluten including refined and whole grains did not materially alter the effect estimates (All Ptrend ≥ 0.69). The null association did not differ according to lymphocytic or collagenous subtypes (Pheterogeneity = 0.72) and was not modified by age, smoking status, or body mass index (All Pinteraction ≥ 0.17).

Conclusion

Dietary gluten intake during adulthood was not associated with risk of microscopic colitis among women without celiac disease.

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Acknowledgements

We would like to thank the participants and staff of the NHS and NHS2 for their valuable contributions.

Author information

Affiliations

  1. Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    • Po-Hong Liu MD, MPH
    • , Kristin E. Burke MD
    • , Ashwin N. Ananthakrishnan MBBS, MPH
    • , Paul Lochhead MBChB, PhD
    • , Andrew T. Chan MD, MPH
    •  & Hamed Khalili MD, MPH
  2. Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA

    • Benjamin Lebwohl MD, MS
  3. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA

    • Benjamin Lebwohl MD, MS
  4. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    • Kristin E. Burke MD
    • , Ashwin N. Ananthakrishnan MBBS, MPH
    • , Paul Lochhead MBChB, PhD
    • , James M. Richter MD
    • , Andrew T. Chan MD, MPH
    •  & Hamed Khalili MD, MPH
  5. Harvard Medical School, Boston, MA, USA

    • Kristin E. Burke MD
    • , Ashwin N. Ananthakrishnan MBBS, MPH
    • , Paul Lochhead MBChB, PhD
    •  & Hamed Khalili MD, MPH
  6. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    • Kerry L. Ivey PhD
    •  & Andrew T. Chan MD, MPH
  7. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    • Kerry L. Ivey PhD
  8. South Australian Health and Medical Research Institute, Infection and Immunity Theme, School of Medicine, Flinders University, Adelaide, SA, Australia

    • Kerry L. Ivey PhD
  9. Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden

    • Ola Olen MD, PhD
    •  & Hamed Khalili MD, MPH
  10. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    • Jonas F. Ludvigsson MD, PhD
  11. Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden

    • Jonas F. Ludvigsson MD, PhD
  12. Broad Institute of MIT and Harvard, Cambridge, MA, USA

    • Andrew T. Chan MD, MPH
  13. Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    • Andrew T. Chan MD, MPH
  14. Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    • Andrew T. Chan MD, MPH

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Guarantor of the article

Dr. Hamed Khalili, MD, MPH.

Specific author contributions

P-HL and HK have full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: P-HL, OO, JFL, ATC, HK. Acquisition of data: BL, KEB, ANA, PL, ATC, HK. Analysis and interpretation of data: all coauthors. Drafting of the manuscript: P-HL, HK. Critical revision of the manuscript for important intellectual content: all coauthors. Obtained funding: ATC, HK. Administrative, technical, or material support: ATC, HK. Study supervision: ATC, HK.

Financial support

KEB is supported by F32 DK115134. HK is supported by K23 DK099681. PL is supported by a career development award from the Crohn’s and Colitis Foundation. ATC is supported by K24 DK098311, a Crohn’s and Colitis Foundation Senior Investigator Award, and a Stuart and Suzanne Steele MGH Research Scholars Award. The Nurses’ Health Study and Nurses’ Health Study II are supported by UM1 CA186107 and UM1 CA176726, respectively. The salary of KLI is supported by a National Health and Medical Research Council early career fellowship.

Potential competing interests

HK receives consulting fees from Abbvie, Takeda, and Samsung Bioepis. HK also receives funding from Takeda. BL receives consulting fees from Takeda. ANA serves on the scientific advisory board of Abbvie, Takeda, and Merck. ATC receives consulting fees from Pfizer Inc., and Bayer A.G. The remaining authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Hamed Khalili MD, MPH.

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DOI

https://doi.org/10.1038/s41395-018-0267-5