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    Can Breast Feeding During Infancy Lower the Risk for Celiac Disease?


    Jefferson Adams
    Can Breast Feeding During Infancy Lower the Risk for Celiac Disease?
    Image Caption: Photo: CC--shingleback

    Celiac.com 10/12/2012 - What is the relationship between breastfeeding, the age of gluten introduction and rates of celiac disease?

    A number of studies have shown that increased breastfeeding may provide some protection against celiac disease. However, one study found no change in the overall prevalence of celiac disease in breastfed infants compared to controls, suggesting that breastfeeding may only delay the presentation of the disease but, does not prevent it. Other studies show no significant difference in the prevalence of celiac disease between breastfed and non-breastfed patients.

    Photo: CC--shinglebackData from the Swedish celiac disease epidemic suggest a 3% prevalence of celiac disease in the children born during the epidemic. An analysis by Ivarsson et al. of children born during the epidemic, found that children under 2 years of age had a lower risk of celiac disease if they were still being breastfed when dietary gluten was introduced (odds ratio 0.59, 95, with a confidence interval 0.42–0.83). Children who continued breastfeeding after gluten was introduced to their diet showed a further decrease in the risk for celiac disease (OR 0.36, 95% CI 0.26–0.51).

    A meta-analysis that included the Ivarsson data, showed celiac disease risk was significantly lower in infants who were breastfed at the time of gluten introduction (pooled OR 0.48, 95% CI 0.40–0.59), compared to infants who were not breastfed at the time of first gluten exposure.

    A later study, by Akobeng and others, estimated that breastfeeding all babies in the UK at the time of gluten introduction, would prevent 2500 cases of celiac disease every year.

    The best data currently available on celiac disease and the age of gluten introduction comes from a prospective study by Norris et al. The study followed 1560 children in Denver between 1994 and 2004. This study showed that children exposed to gluten in the first 3 months of life had a fivefold increased risk of having celiac disease than children exposed to gluten between 4 and 6 months of age, while children exposed to gluten at 7 months old or later had an almost twofold increased risk compared with those exposed at 4 to 6 months (hazard ratio 1.87, 95% CI 0.97–3.60).

    When the analysis was limited to biopsy-diagnosed celiac disease, the hazard ratio was 23.97 (95% CI 4.55–115.9) for children exposed to gluten during the first 3 months of life compared to the 4–6 months exposure group, and 3.98 (95% CI 1.18–13.46) in the group exposed at 7 months or later

    What remains unclear, is whether breastfeeding and the age of introduction of gliadin prevent celiac disease or merely delay its onset.

    To clarify the relationship between breastfeeding, the age at which gluten is introduced into the diet, and celiac disease, the EU has funded a prospective study, called PREVENTCD, FP6, in 10 European centers. The PREVENTCD study recruited pregnant women with a family history of celiac disease, and determined HLA4 of the newborn at birth.

    By the end of December 2010, researchers had recruited a total of 1345 children at birth and enrolled 986 with positive HLA DQ status.

    Researchers instructed mothers to breastfeed for 6 months, if possible. Beginning at the age of 4 months, the researchers placed the infants into randomized study groups, and fed them 100 mg of gliadin or a non-gliadin placebo every day.

    The full data won't be available until all children reach the age of 3 years of age, but the researchers hope that the study will offer definitive answers on the relationship between breastfeeding and the age of gluten introduction and rates of celiac disease.

    Until new information become available, the ESPGHAN Committee on Nutrition recommendations remain in effect. This recommendations state that gluten should be introduced to infants no earlier than 4 months of age, and no later than 7 months, and that the introduction should be gluten be made while the infant is still being breastfed.

    This information was compiled by researcher R. Shamir of the Institute for Pediatric Gastroenterology, Nutrition and Liver Diseases, at the Schneider Children's Medical Center of Israel, Petah Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University in Ramat Aviv, Israel.

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    A very complicated theory to pursue. One vital point missing, in my opinion, is the diet of the mother. if the mother is undiagnosed (or boarderline) reactive to gluten and dairy, then the breastmilk may contain offending proteins. This was definitely the case for me and my daughter. Thankfully we figured things out by the time she was 7 years old. The whole family of 4 is gluten-free for over a decade now!

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    Thanks, as a celiac with a newborn, this was a clear and helpful synopsis of the data.

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    All these different studies are frustrating. I have celiac disease and I kept all of my 3 children gluten-free for the first year of their lives, as studies at THAT time showed that it could reduce risk. Now, I should have introduced it between 4-6 months for a reduced risk? Arrrrg. What's next?

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    A very complicated theory to pursue. One vital point missing, in my opinion, is the diet of the mother. if the mother is undiagnosed (or boarderline) reactive to gluten and dairy, then the breastmilk may contain offending proteins. This was definitely the case for me and my daughter. Thankfully we figured things out by the time she was 7 years old. The whole family of 4 is gluten-free for over a decade now!

    I think Lori makes a good point. My four-year-old son was EBF until six months, and breast fed until 15 months. At that time I was undiagnosed celiac and consuming gluten. From two months on, his weight dropped markedly. Though he had some screening for celiac early on for small stature, we're only now approaching a diagnosis now that I'm diagnosed.

     

    What I think is really key in Sweden is that they probably have many fewer undiagnosed mothers. I really think we should push OBs and REs to be screening for celiac much better. My untreated celiac may have stunted my first son's growth and probably is the reason I required fertility treatments to get pregnant a second time.

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    Excellent and interesting information; I was misdiagnosed for many years and most likely was a celiac throughout all three pregnancies. I breastfed all three children for at least 9 months, and introduced foods as normally scheduled while still breastfeeding. My daughters are now 32, 31, and 26, and none are celiacs, so far. However, one has been diagnosed with Crohn's Disease and one has digestive issues that her doctors have not yet been able to diagnose.

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  • About Me

    Jefferson Adams earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, and science. He previously served as Health News Examiner for Examiner.com, and provided health and medical content for Sharecare.com.

    Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book Dangerous Grains by James Braly, MD and Ron Hoggan, MA.

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    Scott Adams
    Am J Clin Nutr 2002;75:914-921.
    Celiac.com 06/06/2002 - Results of a recent study conducted by Anneli Ivarsson and colleagues at Umea University in Sweden suggest that continuing to breast-feed infants while they are being introduced to new foods may reduce their risk of getting celiac disease. Dr. Ivarssons study suggests that the cause of celiac disease may include environmental factors, and not just be limited to genetic factors. Their study evaluated the breast-feeding habits of 627 children with celiac disease and 1,254 healthy children, and specifically looked at their responses to newly introduced foods. The results, published in the May issue of the American Journal of Clinical Nutrition, indicate that dietary patterns of infants may have a strong influence on the bodys immune responses, and certain dietary patterns could lead to lifelong food intolerances. Children under 2 years of age who were still being breast-fed when they were introduced to dietary gluten had a 40% lower incidence of celiac disease.
    Another important factor was the overall amount of gluten in an infants diet, and a direct correlation was found between increased gluten consumption and an increased incidence of celiac disease. According to the researchers, the protective effect of breast feeding was even more pronounced in infants who were breast-fed beyond the introduction of gluten. Ultimately the teams findings indicate that breast feeding infants through the period of gluten introduction can significantly lower their risk of getting celiac disease. More research needs to be done to determine if this protective effect will extend over a lifetime.

    Jefferson Adams
    Celiac.com 03/23/2010 - Introducing gluten to a baby's diet during a period of infection does not increase the risk of the child developing celiac disease later on, according to a study by Swedish researchers.
    The team of researchers, led by Dr. Jonas F. Ludvigsson of Sweden's Karolinska Institute, used data from the population-based All Infants in Southeast Sweden study to search for independent associations of childhood infections with the risk of developing celiac disease.
    The team had parents chronicle their children's diet and infectious diseases in their first year of life, including breastfeeding start and stop dates, and dates the babies first ate gluten-containing foods.
    They enrolled a total of 9,408 children, and logged a total of 42,826 reports of infectious disease in the first year of life, including 4,003 episodes of gastroenteritis.
    Of 2,528 children who suffered infection at the time of gluten introduction, 18 developed celiac disease, while 26 of 6,880 children without infection developed celiac disease; for a total of 44 biopsy-proven cases of celiac disease after the children's first birthday  (p = 0.035). 167 children suffered from gastroenteritis during gluten introduction, but just one child developed celiac disease, compared to 43 of 9,241 with no gastroenteritis during gluten introduction (p = ns).
    Once adjusted for age at gluten introduction, age at breastfeeding termination, and age at infection, the results showed no significant connection between infection or gastroenteritis at the time of gluten introduction and the later development of celiac disease.
    The team pointed out that they lack data on specific infection types, which limits the scope of their conclusions, and that further study is warranted.
    "We cannot rule out the possibility that specific pathogens constitute risk factors for celiac disease, because risk estimates for infection at the time of gluten introduction were of borderline significance," they said, noting that the study design precluded identification of subclinical infections.
    The added that "because celiac disease is increasingly diagnosed in adulthood, screening...and a longer follow-up period would be required for complete elucidation of the possible relationship between infections and [the development of] celiac disease."
    Source:

    Pediatrics 2010;125:e530-e536.

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