Eating gluten-free has become somewhat of a joke to the general public, as people adopt the lifestyle believing it to be healthier and a weight-loss solution — but many of them don’t even know what gluten is. For the roughly three million Americans with celiac disease, however, eating gluten-free isn’t a fad — consuming the protein found in wheat, barley, rye, and other grains can lead to dangerous malnutrition. Finding the disease early is critical to ensuring that kids don’t suffer from developmental delays and stunted growth. A new study funded by the National Institutes of Health (NIH) has now identified specific genetic variants that may indicate a child’s celiac risk.

The study, published in the New England Journal of Medicine, was called The Environmental Determinants of Diabetes in Youth (TEDDY) consortium, and looked at both type 1 diabetes and celiac disease in kids. Nearly six percent of all people with type 1 diabetes also have celiac disease because they are both autoimmune disorders with similar genetic risk factors. That genetic risk come from variants of the HLA gene, which affects how gluten is tolerated by the immune system.

The researchers found that children with two copies of the HLA-DR3-DQ2 variant had the highest chance of developing celiac disease. Twenty-six percent of children with the variant developed celiac disease autoimmunity (CDA) — an early sign of the disease — by the time they turned 5 years old, while 12 percent developed full-blown celiac disease. Among children with a single copy of the variant, the risks of CDA and celiac disease by age 5 were 11 percent and three percent, respectively.

“By looking at the genes of the children who participated in TEDDY, we can now identify who among them is at highest risk for celiac disease, and their parents and health care providers can monitor these children to detect the disease early,” said Dr. Beena Akolkar, project scientists for TEDDY at the NIH’s National Institute of Diabetes and Digestive and Kidney Diseases, in a press release. The results were especially promising because 90 percent of kids with celiac disease had the HLA-DR3-DQ2 variant.

TEDDY was carried out in Sweden, the U.S., Finland, and Germany. For the celiac study, 6,403 newborns with either HLA-DR3-DQ2 or HLA-DR4-DQ8 were followed until age 5 to determine how many would go on to develop celiac disease or CDA. In all, 291 kids developed celiac disease and 786 developed CDA.

Interestingly, almost twice as many kids in Sweden were diagnosed with celiac disease than in the U.S. Sweden also had higher rates of celiac disease among kids than Germany and Finland — the researchers were clueless as to why but plan on studying the cause further. “TEDDY’s unique structure of having the same protocol in several countries enables us to search for factors that trigger the disease,” said senior author Dr. Daniel Agardh of Lund University, Sweden, in the release. “By studying similarities and differences between genes and environmental factors in these countries, we hope to pinpoint risk factors for the disease.”

Celiac disease affects the body’s ability to digest food properly. People with the disease who eat gluten experience immune reactions in the small intestine’s villi — small protrusions that catch nutrients and absorb them into the body. Gluten slowly destroys the villi, preventing the body from absorbing other nutrients into the bloodstream. Eventually, this leads to malnutrition and can cause complications in the brain, nervous system, bones, liver, and other organs, according to Mayo Clinic. Genetics certainly contribute to the disease’s risk. But some experts believe the environment also plays a part as prevalence rises, suggesting that the over-sterilization of the modern world and an abundance in processed foods are to blame, among other things.

Source: Agardh D, Alkokar B, et al. New England Journal of Medicine. 2014.