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  3. Long term gluten consumption in adults without celiac disease and risk of coronary heart disease: prospective cohort study
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Research

Long term gluten consumption in adults without celiac disease and risk of coronary heart disease: prospective cohort study

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1892 (Published 02 May 2017) Cite this as: BMJ 2017;357:j1892
  1. Benjamin Lebwohl, assistant professor1 2,
  2. Yin Cao, instructor3 4 5,
  3. Geng Zong, postdoctoral fellow5,
  4. Frank B Hu, professor5 6,
  5. Peter H R Green, professor1,
  6. Alfred I Neugut, professor1 2,
  7. Eric B Rimm, professor5 6 7,
  8. Laura Sampson, senior research dietitian5,
  9. Lauren W Dougherty, research dietitian5,
  10. Edward Giovannucci, professor5 6 7,
  11. Walter C Willett, professor5 6 7,
  12. Qi Sun, assistant professor5 6,
  13. Andrew T Chan, associate professor3 4 6
  1. 1Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
  2. 2Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
  3. 3Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
  4. 4Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
  5. 5Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
  6. 6Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
  7. 7Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
  1. Correspondence to: A T Chan ACHAN{at}mgh.harvard.edu
  • Accepted 4 April 2017

Abstract

Objective To examine the association of long term intake of gluten with the development of incident coronary heart disease.

Design Prospective cohort study.

Setting and participants 64 714 women in the Nurses’ Health Study and 45 303 men in the Health Professionals Follow-up Study without a history of coronary heart disease who completed a 131 item semiquantitative food frequency questionnaire in 1986 that was updated every four years through 2010.

Exposure Consumption of gluten, estimated from food frequency questionnaires.

Main outcome measure Development of coronary heart disease (fatal or non-fatal myocardial infarction).

Results During 26 years of follow-up encompassing 2 273 931 person years, 2431 women and 4098 men developed coronary heart disease. Compared with participants in the lowest fifth of gluten intake, who had a coronary heart disease incidence rate of 352 per 100 000 person years, those in the highest fifth had a rate of 277 events per 100 000 person years, leading to an unadjusted rate difference of 75 (95% confidence interval 51 to 98) fewer cases of coronary heart disease per 100 000 person years. After adjustment for known risk factors, participants in the highest fifth of estimated gluten intake had a multivariable hazard ratio for coronary heart disease of 0.95 (95% confidence interval 0.88 to 1.02; P for trend=0.29). After additional adjustment for intake of whole grains (leaving the remaining variance of gluten corresponding to refined grains), the multivariate hazard ratio was 1.00 (0.92 to 1.09; P for trend=0.77). In contrast, after additional adjustment for intake of refined grains (leaving the variance of gluten intake correlating with whole grain intake), estimated gluten consumption was associated with a lower risk of coronary heart disease (multivariate hazard ratio 0.85, 0.77 to 0.93; P for trend=0.002).

Conclusion Long term dietary intake of gluten was not associated with risk of coronary heart disease. However, the avoidance of gluten may result in reduced consumption of beneficial whole grains, which may affect cardiovascular risk. The promotion of gluten-free diets among people without celiac disease should not be encouraged.

Footnotes

  • We thank the participants and staff of the Nurses’ Health Study and Health Professionals Follow-up Study for their contributions and Elaine Coughlin-Gifford and Mingyang Song for statistical programming.

  • Contributors: All authors were involved in study concept and design. BL, YC, GZ, LS, LWD, and ATC were involved in acquisition of data. BL, YC, GZ, All authors analyzed and interpreted the data. BL, YC, GZ ATC did the statistical analysis. BL and ATC drafted the manuscript. All authors critically revised the manuscript for important intellectual content. All authors approved the final manuscript submitted and the authorship list. ATC is the guarantor.

  • Funding: BL is supported by the American Gastroenterological Association’s foundation research scholar award. ATC is supported by the Massachusetts General Hospital research scholars award and National Institutes of Health (NIH) grants K24 DK098311 and UM1 CA186107. WCW is supported by NIH grant UM1 CA167552, EBR by grant R01 HL035464, QS by grant R01 HL035464, and FBH by grants R01 HL060712 and R01 HL034594.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organization for the submitted work apart from the grant support noted above; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: The Institutional Review Boards of Brigham and Women’s Hospital and the Harvard T. H. Chan School of Public Health approved this study. Return of the mailed questionnaire was considered to imply informed consent. Protocol number: 1999-P-011114/154.

  • Transparency declaration: The lead author (the manuscript’s guarantor) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

  • Data sharing: Data, the statistical code, questionnaires, and technical processes are available from the corresponding author at achan@mgh.harvard.edu.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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