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. 2025 Jun 23;184(7):436.
doi: 10.1007/s00431-025-06257-8.

Daily gluten consumption of pediatric first-degree relatives of coeliac patients, is it so low that we miss diagnoses?

C Wagenvoort  1 , G D Hopman  2 , E A Roovers  3 , M M S Wessels  4
Affiliations

Daily gluten consumption of pediatric first-degree relatives of coeliac patients, is it so low that we miss diagnoses?

C Wagenvoort et al. Eur J Pediatr. .

Abstract

This cross-sectional study was aimed to determine the daily gluten consumption of pediatric first-degree relatives (FDRs) and compare it with the general population and the recommended daily intake used in gluten challenges. Additionally, it aimed to identify predictors of a possible lower daily gluten consumption in FDRs. Gluten consumption in FDRs was assessed using the FQ-gluten18 (a food frequency questionnaire consisting only gluten containing products), and compared with the mean gluten intake of the general Dutch population using the results of the Dutch National Food Consumption Survey (DNFCS). Multivariable linear regression analyses were performed to assess differences in daily gluten consumption between FDRs and the general population, and to identify predictors of the daily gluten consumption. Out of 159 eligible families, 58 completed the FQ-gluten18 (36%). The mean daily gluten consumption of FDRs was not significantly different from that of the general population (12.9 ± 4.8 g/day vs 12.5 ± 5.8 g/day; P = 0.603). Eleven FDRs (18.3%) did not attain the ≥ 10 g/day recommendation used in gluten challenges. Only gluten free pasta variants eaten by everyone within the household was significantly associated with a lower daily gluten consumption.

Conclusions: The daily gluten consumption of pediatric FDRs is similar to that of the general population. Special attention has to be paid to FDRs who are regularly consuming the gluten free pasta variants, as they are at risk of a lower gluten intake, possibly leading to an under recognition of Coeliac Disease (CD) diagnoses.

What is known: • First-degree relatives (FDRs) of coeliac patients are at increased risk of developing Coeliac Disease (CD), and adequate daily intake is essential for reliable diagnosis. • A minimum daily intake of ≥10 grams gluten per day is currently recommended during gluten challenges to ensure diagnostic accuracy for CD.

What is new: • The daily gluten consumption of pediatric FDRs is, on average, comparable to that of the general Dutch pediatric population. • Regular consumption of gluten free pasta variants by FDRs may lead to an insufficient gluten intake, possibly resulting in underdiagnosis of CD.

Keywords: Coeliac Disease; First-degree relatives; Gluten consumption; Screening.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

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