Celiac.com 11/22/2013 - Timing of gluten introduction has been associated with the risk of celiac disease in children, but the best time window for gluten introduction had remained unknown.

Photo: CC--barekimIn order to determine the optimal time window for gluten introduction in children, a team of researchers recently set out to assess the effect of age at first gluten consumption on the risk of celiac disease, and to adjust their data for continued breastfeeding.

The research team included Ketil Størdal, MD, PhD, Richard A. White, PhD, and Merete Eggesbø, MD, PhD. They are variously affiliated with the Norwegian Institute of Public Health, Oslo, Norway; and Østfold Hospital Trust in Fredrikstad, Norway.

For their study, the team used the Norwegian Mother and Child Cohort Study, a prospective birth cohort including 107 000 children, questionnaires to identify celiac disease, and linkage to the Norwegian Patient Register.

They recorded results of reported gluten introduction monthly from 0 to 6 months of age, and breastfeeding from 0 to 18 months.

After exclusion of cases with insufficient information, they found 324 children with celiac disease from a group of 82,167 useful for their analyses.

Gluten was introduced before or at 4 months in 8.0%, 5 to 6 months in 45.3%, and after 6 months in 46.6%, whereas continued breastfeeding was stable at ∼78% at 6 months age.

They found celiac disease in 3.68 per 1000 infants with gluten introduction at 5 to 6 months compared with 4.15 per 1000 with late and 4.24 per 1000 with early gluten introduction.

After adjustment for the child’s age and gender, breastfeeding, and maternal celiac disease, delayed gluten introduction was associated with an increased risk of celiac disease (adjusted odds ratio, 1.27 [95% confidence interval, 1.01–1.65], P = .045).

Breastfeeding >12 months was also associated with increased risk (adjusted odds ratio, 1.49 [95% confidence interval, 1.01–2.21], P = .046).

Overall, the team found an increased risk of celiac disease in children introduced to gluten after 6 months, and a higher risk in children breastfed beyond 12 months of age.

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