Influence of breastfeeding and timing of gluten introduction on the onset of celiac disease in infants (2025)

A Case-Control Study of the Effect of Infant Feeding on Celiac Disease

Annals of Nutrition and Metabolism, 2001

Aims: The aim of this study was to investigate the association between the duration of breast-feeding and the age at the first gluten introduction into the infant diet and the incidence and age at onset of celiac disease. Methods: In a case-control study, 143 children with celiac disease and 137 randomly recruited gender- and age-matched control children were administered a standardized questionnaire. Multivariate-adjusted odds ratios (OR) as estimates of the relative risk and corresponding 95% confidence intervals (95% CI) were calculated. Results: The risk of developing celiac disease decreased significantly by 63% for children breast-fed for more than 2 months (OR 0.37, 95% CI 0.21–0.64) as compared with children breast-fed for 2 months or less. The age at first gluten introduction had no significant influence on the incidence of celiac disease (OR 0.72, 95% CI 0.29–1.79 comparing first gluten introduction into infant diet >3 months vs. ≤3 months). Conclusions: A significant p...

Infant feeding and risk of developing celiac disease: a systematic review

BMJ open, 2016

To review the evidence for the association of breast feeding, breastfeeding duration or the timing of gluten introduction and the later development of celiac disease (CD). Systematic review. We searched MEDLINE, via PubMed, EMBASE and Web of Science, for studies published up to 31 August 2015 investigating the association of breastfeeding duration, breast feeding at the moment of gluten introduction or the timing of gluten introduction and the later development of CD. Prospective studies had to enrol infants/children at high risk of CD. For retrospective studies, participants had to be children or adults with CD. The paper quality was assessed by means of a GRADE score and the bias risk was assessed by the Newcastle-Ottawa Scale (for observational cohort studies) and Cochrane Collaboration's tool (for randomised trials). Out of 149 retrieved papers, 48 were considered in depth and 16 were included in this review (9 were prospective and 2 were interventional). We found that neith...

Influence of Early Feeding Practices on Celiac Disease in Infants

Croatian Medical Journal, 2010

Aim To investigate whether duration of breastfeeding and timing of gluten introduction influence the age at diagnosis and severity of celiac disease.

Breastfeeding Duration and Gluten Introduction Among Mothers With Celiac Disease

Journal of Pediatric Gastroenterology and Nutrition, 2014

Objectives: Both breast-feeding duration and age at gluten introduction have been implicated in the pathogenesis of celiac disease (CD). We hypothesized that parental CD affects the feeding pattern of the offspring, mediated by parental health awareness increasing adherence to infant feeding guidelines. Methods: Prospectively collected infant feeding data were obtained through the All Babies in Southeast Sweden study. Information regarding infant feeding was available in 9414 children. Twenty-two mothers had a history of biopsy-verified CD before delivery of a child in the study, and 9392 mothers had no diagnosis of CD before birth and thus constituted the unexposed or control population. Cox regression was used to compare the risk of early weaning and gluten introduction according to parental CD status, and logistic regression to assess whether mothers with CD were more likely to breast-feed their children at gluten introduction. Results: Some 63% of children were breast-fed for at least 9 months. We found no association between maternal CD and early weaning (adjusted hazard ratio [HR] 1.0, 95% confidence interval [CI] 0.6-1.7), or between paternal CD and early weaning (HR 0.5, 95% CI 0.1-1.9). Sixty percent of children were introduced to gluten in months 5 and 6. Maternal CD was not associated with age at gluten introduction (adjusted HR 0.8, 95% CI 0.6-1.3). There was no statistically significant association between maternal CD and breast-feeding at the time of gluten introduction (odds ratio 1.4, 95% CI 0.4-4.7). Conclusions: Feeding patterns do not seem to vary between offspring and mothers with CD and those without.

Early Infant Feeding Practices May Influence the Onset of Symptomatic Celiac Disease

Pediatric Gastroenterology, Hepatology & Nutrition, 2016

To study whether breastfeeding and breastfeeding status during gluten introduction influences the age at diagnosis of celiac disease (CD). In addition to study, whether the timing of gluten introduction influences the age at diagnosis of CD. Methods: It was a hospital based observational study. Total 198 patients diagnosed with CD as per modified European Society of Pediatric Gastroenterology, Hepatology and Nutrition (2012) criteria, aged between 6 months to 6 years were included. Detail history taken with special emphasis on breastfeeding and age of gluten introduction. Standard statistical methods used to analyze the data. Results: Mean±standard deviation age of onset and diagnosis of CD in breastfed cases was 2.81±1.42 years and 3.68 ±1.55 years respectively as compared to 1.84±1.36 years and 2.70±1.65 years respectively in not breastfed cases (p＜0.05). Those who had continued breastfeeding during gluten introduction and of longer duration had significantly delayed onset of disease. The age at onset of CD was under one year in 40.42% of the cases, who had started gluten before 6 months of age compared to only 12.58% of those who had started gluten later (p＜0.001). The proposed statistical model showed that two variables, i.e., breast feeding status during gluten introduction and age at gluten introduction positively influencing the age at diagnosis of CD. Conclusion: Delayed gluten introduction to infant's diet along with continuing breastfeeding, delays symptomatic CD. However, it is not clear from our study that these infant feeding practices provide permanent protection against the disease or merely delays the symptoms.

Randomized Feeding Intervention in Infants at High Risk for Celiac Disease

New England Journal of Medicine, 2014

BACKGROUND A window of opportunity has been suggested for reducing the risk of celiac disease by introducing gluten to infants at 4 to 6 months of age. METHODS We performed a multicenter, randomized, double-blind, placebo-controlled dietaryintervention study involving 944 children who were positive for HLA-DQ2 or HLA-DQ8 and had at least one first-degree relative with celiac disease. From 16 to 24 weeks of age, 475 participants received 100 mg of immunologically active gluten daily, and 469 received placebo. Anti-transglutaminase type 2 and antigliadin antibodies were periodically measured. The primary outcome was the frequency of biopsy-confirmed celiac disease at 3 years of age. RESULTS Celiac disease was confirmed by means of biopsies in 77 children. To avoid underestimation of the frequency of celiac disease, 3 additional children who received a diagnosis of celiac disease according to the 2012 European Society for Pediatric Gastroenterology, Hepatology, and Nutrition diagnostic criteria (without having undergone biopsies) were included in the analyses (80 children; median age, 2.8 years; 59% were girls). The cumulative incidence of celiac disease among patients 3 years of age was 5.2% (95% confidence interval [CI], 3.6 to 6.8), with similar rates in the gluten group and the placebo group (5.9% [95% CI, 3.7 to 8.1] and 4.5% [95% CI, 2.5 to 6.5], respectively; hazard ratio in the gluten group, 1.23; 95% CI, 0.79 to 1.91). Rates of elevated levels of anti-transglutaminase type 2 and antigliadin antibodies were also similar in the two study groups (7.0% [95% CI, 4.7 to 9.4] in the gluten group and 5.7% [95% CI, 3.5 to 7.9] in the placebo group; hazard ratio, 1.14; 95% CI, 0.76 to 1.73). Breast-feeding, regardless of whether it was exclusive or whether it was ongoing during gluten introduction, did not significantly influence the development of celiac disease or the effect of the intervention. CONCLUSIONS As compared with placebo, the introduction of small quantities of gluten at 16 to 24 weeks of age did not reduce the risk of celiac disease by 3 years of age in this group of high-risk children. (Funded by the European Commission and others; PreventCD Current Controlled Trials number, ISRCTN74582487.

Risk of Celiac Disease Autoimmunity and Timing of Gluten Introduction in the Diet of Infants at Increased Risk of Disease

JAMA, 2005

Presentation of Pediatric Celiac Disease in the United States: Prominent Effect of Breastfeeding

Clinical Pediatrics, 2005

Childhood celiac disease (CD) is considered rare in the United States. Consequently there are few data concerning its clinical presentation. A validated questionnaire was distributed to families of children with CD. One hundred forty-one children with biopsy-proven CD were included in the study. We found significant differences in the clinical spectrum of children based on their infant feeding history. Exclusively breastfed children were significantly less likely to report failure to thrive (69% vs 88%, p<0.05) and short stature (37% vs 62%, p<0.05), and had a higher rate of "atypical" symptoms (p<0.01). Breastfeeding alters the presentation and contributes to atypical presentations of CD and diagnostic delay. Pediatricians need to be aware of the diverse manifestations of celiac disease to reduce diagnostic delay. Clin Pediatr. 2005;44:249-258

Celiac Disease in Children: What Has Changed?

International Journal of Celiac Disease, 2014

The perception of celiac disease (CD) has changed dramatically during the last two decades, with the introduction of new serological tests with high specificity and sensitivity. CD prevalence in recent years is increasing as it is for other autoimmune diseases. Due to the high prevalence of CD, it is one of the most important diseases of the digestive tract. The clinical manifestations of CD have changed significantly in the last two decades, and these are much more diverse than reported previously. The new European Society for Pediatric Gastroenterology, Hepatology, and Nutrition diagnostic criteria for CD indicate that biopsy can be avoided in strictly selected groups of pediatric patients. The first experiences with these new criteria are positive. A meta-analysis evaluating the relationship between early nutrition and the risk of CD recommends that both early (< 4 months) and late (> 7 months) introduction of gluten to the diet should be avoided, and that gluten should be introduced while the infant is still breastfeeding. The prevalence rates of CD between two cohorts with different infant feeding practice were significantly different, and the prevalence of CD in 12-year-old children were significantly reduced, suggesting that prevention of CD is possible.

The Jigsaw Puzzle of Breast Feeding and Celiac Disease

The puzzle of breast feeding effects on celiac disease development is complicated and despite numerous studies, remains unresolved. Several prospective or retrospective observational studies on the topic were reported, with contradictory results. The geoepidemiology teaches us that celiac disease incidence, in the west, is increasing, while breast feeding is decreasing, going along with the protective effect of mother's milk. But, human milk and gluten are only two in the growing list of environmental factors that affect celiac disease induction or behavior. The recent increased knowledge on gluten side effects in non-celiac populations and the fact that human milk contains gluten peptides, further complicate the breast milk-gluten-celiac disease cross-talks. Latest studies revealed that breast feeding, whether exclusive or in combination with formula intake, did not reduce the risk of CD development. More so, recent publications concluded that timing of introduction of gluten to infant diet did not influenced the risk of development of CD. It is hypothesized that local environments, nutritional habits, intestinal ecosystems or genetic background might have influenced the published results. Much more epidemiological and prospective investigational studies might clarify the jigsaw puzzle of breast feeding and celiac disease behavior.