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  • Jefferson Adams
    Jefferson Adams

    Late Not Early-Introduction of Gluten to Infants Seems to Increase Celiac Risk

    Reviewed and edited by a celiac disease expert.

    Celiac.com 11/23/2015 - A new study looks at the impacts of introducing gluten to infants and the development of celiac disease. A research team recently set out to assess the evidence regarding the effect of time of gluten introduction and breastfeeding on the risk of developing celiac disease.

    Photo: CC--Sander Van der WelThe research team included MI Pinto-Sánchez, EF Verdu, E Liu, P Bercik, PH Green, JA Murray, S Guandalini, and P Moayyedi. Their team conducted a comprehensive review of studies from the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (Ovid); EMBASE (Ovid); and System for Information on Grey Literature in Europe (SIGLE). Two independent authors collected the data.

    Their analysis included randomized controlled trials and observational studies that assessed proper timing for introducing gluten to the infant diet, appropriate quantity of gluten consumption at weaning, and the effect of breastfeeding on celiac disease risk.

    Out of a total of 1982 studies they identified, 15 matched their criteria for data extraction. The team performed a meta-analysis on 2 randomized controlled trials, 10 cohort studies, and 1 case-control study. That analysis showed a 25% increase in celiac disease risk with gluten-introduction after 6 months, compared to the recommended 4 to 6 months (risk ratio [RR], 1.25; 95% CI, 1.08-1.45).

    There was no difference between breastfeeding vs no breastfeeding on celiac disease risk (OR, 0.55; 95% CI, 0.28-1.10), with substantial heterogeneity (I2 = 92%) among studies. There is currently no evidence to support that early introduction of gluten to the infant diet increases the risk of celiac disease.

    However, introduction of gluten after six months of age might promote an increased risk of celiac disease.

    More studies are needed that control for potential confounders and that evaluate environmental factors in low-risk families.

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    This is similar to the results of the LEAP food allergy study which addressed introduction of peanuts and egg and found that toddlers who were introduced later to these foods had a greater chance of developing food allergies.

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    The tough thing here is that an infant can't communicate specifics about how they feel, where an older child can. I know friends who had their infant tested for the "celiac genes" knowing it runs in their family. When they found their child has the genes, they decided not to introduce gluten into the child's diet until the child could use words to describe how he was feeling, This has seemed to work for them, rather than taking a risk that their child would get ill at a developmentally critical point as an infant, had they introduced gluten right away. So far the child is doing well since gluten was gradually introduced into his diet building up to moderate, but not heavy rates, since no good can come of not practicing moderation. They have the child's blood tested at his annual checkup to look for any antibodies that would indicate the celiac gene has "turned on". And the child is old enough now to tell his parents if his tummy hurts after he eats certain things.

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    Guest gluten free grandma

    Posted

    I was diagnosed with Celiac just before my 5th and last child was conceived. My first five children, dermatitis herpatiformis or gluten intolerance. I nursed all my children and ate gluten with the first 4. With My last child, I was eating gluten free through the pregnancy and while nursing and we kept her gluten-free until she went to college and decided to eat gluten.  She has been tested since, at age 25 yrs. and tests negative to Celiac and seems to tolerate wheat fine.  I don't think the scientists know at all. and I agree, keep them off gluten until they can verbalize how they feel. 

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  • About Me

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He 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, science, and advanced research, and scientific methods. He previously served as SF Health News Examiner for Examiner.com, and devised 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 "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

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