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Dietary Gluten Intake and Risk of Microscopic Colitis Among US Women without Celiac Disease: A Prospective Cohort Study.
Am J Gastroenterol. 2019 01; 114(1):127-134.AJ

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).

CONCLUSIONS

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

Authors+Show Affiliations

Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. Harvard Medical School, Boston, MA, USA.Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. South Australian Health and Medical Research Institute, Infection and Immunity Theme, School of Medicine, Flinders University, Adelaide, SA, Australia.Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. Harvard Medical School, Boston, MA, USA.Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. Harvard Medical School, Boston, MA, USA.Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden.Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Broad Institute of MIT and Harvard, Cambridge, MA, USA. Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. Harvard Medical School, Boston, MA, USA. Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30181535

Citation

Liu, Po-Hong, et al. "Dietary Gluten Intake and Risk of Microscopic Colitis Among US Women Without Celiac Disease: a Prospective Cohort Study." The American Journal of Gastroenterology, vol. 114, no. 1, 2019, pp. 127-134.
Liu PH, Lebwohl B, Burke KE, et al. Dietary Gluten Intake and Risk of Microscopic Colitis Among US Women without Celiac Disease: A Prospective Cohort Study. Am J Gastroenterol. 2019;114(1):127-134.
Liu, P. H., Lebwohl, B., Burke, K. E., Ivey, K. L., Ananthakrishnan, A. N., Lochhead, P., Olen, O., Ludvigsson, J. F., Richter, J. M., Chan, A. T., & Khalili, H. (2019). Dietary Gluten Intake and Risk of Microscopic Colitis Among US Women without Celiac Disease: A Prospective Cohort Study. The American Journal of Gastroenterology, 114(1), 127-134. https://doi.org/10.1038/s41395-018-0267-5
Liu PH, et al. Dietary Gluten Intake and Risk of Microscopic Colitis Among US Women Without Celiac Disease: a Prospective Cohort Study. Am J Gastroenterol. 2019;114(1):127-134. PubMed PMID: 30181535.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dietary Gluten Intake and Risk of Microscopic Colitis Among US Women without Celiac Disease: A Prospective Cohort Study. AU - Liu,Po-Hong, AU - Lebwohl,Benjamin, AU - Burke,Kristin E, AU - Ivey,Kerry L, AU - Ananthakrishnan,Ashwin N, AU - Lochhead,Paul, AU - Olen,Ola, AU - Ludvigsson,Jonas F, AU - Richter,James M, AU - Chan,Andrew T, AU - Khalili,Hamed, PY - 2018/9/6/pubmed PY - 2019/11/13/medline PY - 2018/9/6/entrez SP - 127 EP - 134 JF - The American journal of gastroenterology JO - Am J Gastroenterol VL - 114 IS - 1 N2 - 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). CONCLUSIONS: Dietary gluten intake during adulthood was not associated with risk of microscopic colitis among women without celiac disease. SN - 1572-0241 UR - https://www.unboundmedicine.com/medline/citation/30181535/Dietary_Gluten_Intake_and_Risk_of_Microscopic_Colitis_Among_US_Women_without_Celiac_Disease:_A_Prospective_Cohort_Study_ L2 - https://Insights.ovid.com/pubmed?pmid=30181535 DB - PRIME DP - Unbound Medicine ER -