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  • Jefferson Adams
    Jefferson Adams

    Introducing Gluten Gradually During Breastfeeding Can Lower Risk of Childhood Celiac Disease

    Caption: Photo: CC--angusleonard

    Celiac.com 04/12/2013 - A number of studies have suggested a connection between infant feeding patterns and the development or clinical expression of celiac disease. However, until recently, it remained unclear whether infant feeding actually affects the occurrence and/or the clinical presentation of celiac disease.

    Photo: CC--angusleonardA recent study that shows important differences in celiac disease rates between two groups of 12-year-olds indicates a possible strategy for preventing celiac disease.

    The notable difference between the two groups was simple infant feeding practices. The study findings suggest that gradual introduction of gluten in small amounts during ongoing breastfeeding provides protection against celiac disease.

    The study was conducted by Anneli Ivarsson, MD, PhD; Anna Myléus, MD, PhD; Fredrik Norström, PhD; Maria van der Pals, MD; Anna Rosén, MD, PhD; Lotta Högberg, MD, PhD; Lars Danielsson, MD; Britta Halvarsson, MD, PhD; Solveig Hammarroth, MD; Olle Hernell, MD, PhD; Eva Karlsson, MD; Lars Stenhammar, MD, PhD; Charlotta Webb, MD; Olof Sandström, MD, PhD; and Annelie Carlsson, MD, PhD.

    They are variously affiliated with the Departments of Public Health and Clinical Medicine, Epidemiology and Global Health, Medical Biosciences, Clinical and Medical Genetics, and Clinical Sciences, Pediatrics at Umeå University in Umeå, Sweden; the Department of Pediatrics in Clinical Sciences at Skånes University Hospital at Lund University, in Lund, Sweden; the Pediatric Clinic of Norrköping Hospital in Norrköping, Sweden, the Department of Clinical and Experimental Medicine in the Division of Pediatrics at Linköping University in Linköping, Sweden; the Pediatric Clinic of Norrtälje Hospital in Norrtälje, Sweden; the department of Pathology and Cytology of Aleris Medilab in Täby, Sweden; and the Pediatric Clinic of Växjö Hospital in Växjö, Sweden.

    To accomplish their goal, the team crafted a 2-phase cross-sectional screening study of 13,279 children from two separate birth groups: the first born during the Swedish celiac disease epidemic of 1993, and the second born in 1997, after the epidemic ended.

    The team investigated and compared the overall rates of celiac disease in the two groups, each at twelve years old, and compared the results against each group's ascertained infant feeding patterns.

    To report and confirm all previously diagnosed cases of celiac disease, they analyzed blood samples for serological markers of celiac disease, and referred all children with positive values for small intestinal biopsy.

    The team used questionnaires to determine infant feeding practices for both groups. They expressed prevalence comparisons as prevalence ratios, and found that the total prevalence of celiac disease was 29 in 1000 for the 1993 group, and and 22 in 1000 1997 group.

    Children born in 1997 substantially less likely to develop celiac disease compared with those born in 1993 (prevalence ratio: 0.75; 95% conï¬dence interval: 0.60–0.93; P = .01).

    Again, the difference between the groups was in infant feeding patterns. Specifically, the groups differed in the percentages of infants introduced to dietary gluten in small amounts during ongoing breastfeeding. Many more children in the 1997 group had gluten introduced into their diets in small amounts during ongoing breastfeeding, as compared to the 1993 group.

    Overall, the signiï¬cantly lower rates of celiac disease in the 1997 group indicate that gradual introduction of gluten-containing foods from 4 months of age, preferably during ongoing breastfeeding, offers a possible way to prevent or lower celiac disease risk.

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    Guest Pierre-Alexandre Giasson

    Posted

    So what should we do? My wife will give birth to our first daughter within the next few months, and I have been diagnosed with coeliac sprue about ten years ago. Even if I live well with this health situation, I'd prefer to avoid it to her. Is there any pattern to follow? I didn't find any detail about what could be considered "small amount of gluten" and how long is considered to be the "breast feeding period". If the kid is breast fed during two months or two years, should we follow the same pattern? What source of gluten should we introduce? How much? At what age?

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    So what should we do? My wife will give birth to our first daughter within the next few months, and I have been diagnosed with coeliac sprue about ten years ago. Even if I live well with this health situation, I'd prefer to avoid it to her. Is there any pattern to follow? I didn't find any detail about what could be considered "small amount of gluten" and how long is considered to be the "breast feeding period". If the kid is breast fed during two months or two years, should we follow the same pattern? What source of gluten should we introduce? How much? At what age?

    Unfortunately, many of your questions don't have definite answers yet. You should give this article a read: http://www.celiac.com/articles/23083/1/PREVENTCDs-Celiac-Prevention-Strategy-for-New-Mothers/Page1.html

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    Pierre: I think it is hard to translate the findings of only one study into recommendations for all people. I believe my daughter started eating small amounts of gluten by 5 months (baby biscuits), but she still developed the disease by age 3.5 (I may have it, getting tested now). Hoping for the best for your daughter!

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    Um... celiac disease is a genetic thing. It's in your genes. If you have the genes then you have celiac disease. If you don't have the genes then you don't have celiac disease. You can't prevent genes.

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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, science, and advanced research, and scientific methods. He previously served as 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.

  • Related Articles

    Jefferson Adams
    Celiac.com 11/03/2014 - Some data have suggested that introducing gluten to infants at 4 to 6 months of age can help to lower the risk of celiac disease. To get a clearer picture of any potential benefits of introducing gluten within this time period, a team of researchers performed a multi-center, randomized, double-blind, placebo-controlled dietary-intervention study.
    The research team included Sabine L. Vriezinga, M.D., Renata Auricchio, M.D., Enzo Bravi, M.S., Gemma Castillejo, M.D., Anna Chmielewska, M.D., Ph.D., Paula Crespo Escobar, B.Sc., Sanja KolaÄek, M.D., Ph.D., Sibylle Koletzko, M.D., Ph.D., Ilma R. Korponay-Szabo, M.D., Ph.D., Eckart Mummert, Ph.D., Isabel Polanco, M.D., Ph.D., Hein Putter, Ph.D., Carmen Ribes-Koninckx, M.D., Ph.D., Raanan Shamir, M.D., Ph.D., Hania Szajewska, M.D., Ph.D., Katharina Werkstetter, M.Sc., M.P.H., Luigi Greco, M.D., Ph.D., Judit Gyimesi, M.D., Corina Hartman, M.D., Caroline Hogen Esch, M.D., Ph.D., Erica Hopman, R.D., Ph.D., Anneli Ivarsson, M.D., Ph.D., Tunde Koltai, Ir., Frits Koning, Ph.D., Eva Martinez-Ojinaga, M.D., Chantal te Marvelde, B.Sc., Ana Pavic, M.D., Jihane Romanos, Ph.D., Els Stoopman, Vincenzo Villanacci, M.D., Ph.D., Cisca Wijmenga, Ph.D., Ricardo Troncone, M.D., Ph.D., and M. Luisa Mearin, M.D., Ph.D.
    For their study, the team recruited 944 children who were positive for HLA-DQ2 or HLA-DQ8, with 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.
    The team then made periodic measurements of anti–transglutaminase type 2 and antigliadin antibodies. The overall goal was to determine the frequency of biopsy-confirmed celiac disease at 3 years of age.
    The team confirmed celiac disease through biopsy in 77 children, while three more received a celiac diagnosis of based on the 2012 European Society for Pediatric Gastroenterology, Hepatology, and Nutrition diagnostic criteria for a total of 80 celiac children.
    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). Both groups also showed similar rates of elevated levels of anti–transglutaminase type 2 and antigliadin antibodies (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).
    The team also noted that breast-feeding, regardless of whether it was exclusive or whether it was ongoing during gluten introduction, had no substantial impact on the later development of celiac disease.
    Compared to the placebo, introducing small quantities of gluten to high-risk children at 16 to 24 weeks of age had no impact on rates of celiac disease at 3 years of age. So, basically, the data show that there is no need for parents to fret or worry about when their child first begins to consume gluten.
    There is no magic window or timeframe for introducing gluten to their child’s diet that will change the risk for developing celiac disease later on.
    Source:
    N Engl J Med 2014; 371:1304-1315October 2, 2014. DOI: 10.1056/NEJMoa1404172

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