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

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

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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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5 Responses:

 
Lori
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said this on
15 Oct 2012 8:46:31 AM PDT
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 GF for over a decade now!

 
Megan
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said this on
20 Oct 2012 6:20:51 AM PDT
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.

 
sed
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said this on
15 Oct 2012 10:50:24 AM PDT
Thanks, as a celiac with a newborn, this was a clear and helpful synopsis of the data.

 
Wendy
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said this on
16 Oct 2012 6:04:05 AM PDT
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?

 
Mary
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said this on
04 Nov 2012 5:35:01 AM PDT
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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Vegetarian here too, celiac really makes it tough as all the Quorn meat replacement products bar the odd one or two are out Then there's all the scare sites saying only paleo type diets will repair your insides but guess what they're all heavily meat / fish based. @Ennis_TX has some good ideas for meals

Wow guys just read all the replies Thankyou all so much!!! There are so many things you've all said that has triggered a light bulb in my little head! The glasses may not be clean!! I will put this to a test. One night I'll stick to bottles of cider (double checked are gluten-free) another I'll try the Gin or William chase vodka if I can find it! And see the effects. if I loose many days due to these not working I'll see a practitioner and see what the deal is! Before I was diagnosed at Coeliac... I went to a herbalist who did a test and said corn is funny on my body!!! But then 18months later (when I became incontinant and lost a lot of weight) my bloods came back positive (after begging the docs and telling them it wasn't IBS) i don't tend to snack at bars on food but I must admit I never thought it could be the way it's served!! The humour and information has made me feel so much better thanks all xxx

Hey Matt thanks for your reply fellow Brit! I this is very interesting... I am very sensitive to cross contamination... e.g. A sieve wasn't washed properly when I lived at my mums so when I had drained my gluten-free pasta .. I hadn't even eaten the dish before I started to pass out and go dizzy and hot .. calling for my bf and mum ( they had a great team going when I would have an episode) it's horrendous! The fatigue is something I imagine every coeliac suffers with! I have to nap a lot. Ok so the booze I drink most of is -processo -amaretto -vodka, wine, cider (very rarely) when I drink at home I'm fine!!! I wonder if it's cross contamination from the bar or the level of alcohol?! I also had a jger bomb shot on Friday (looked it up and a lot of people say it's gluten-free) it's a hard live but someone's got to do it!! Thanks for the reply! When you get poorly from gluten (and the other evil candidates) are you so bad you can't function and feel your body is about to snap? Kind regards steph

Hi Steph and welcome I'm yet another Brit, funny how the alcohol threads flush us out I don't drink now but after a big night I used to get truly savage all day hangovers, much worse than those of my friends. They could include splitting headaches, vomiting, nausea, a 'fuzziness' in my head, sweats etc. After I put the pieces together and went gluten free I had a 'big night' on cider only and the next day was a revelation. What I'd thought was a 'normal' hangover was, for me at least, anything but. With gluten out of the equation hangovers were a breeze! The difference was mind blowing and just one more example of how gluten had been messing with me over the years. So when I read your post my first thought was that there was some trace gluten contamination going on. However: Obviously you've been at the diet for some considerable time now and know the score. I know Coeliac UK are firmly of the opinion that all spirits are safe but some (note some this a contentious one :D) members here will tell you they react to gluten based grain spirits for instance which distillation should render safe. Then there's the dangers of shared lines if you're drinking say Strongbow in a pub as alluded to above. Lastly it its wine, there's the often cited but maybe apocryphal these days 'flour to seal the casks' possibility. Finally there's bar snacks, maybe a brand of nuts etc that you snack on that may have changed their production process? I'm sure you've thought of these already, but it may be useful if you post your alcoholic drink choices / bar snack of choice up here maybe someone will have some input?. The second thing which leapt out was: Would you class yourself as super sensitive to cross contamination etc? Firstly that would make the cross contamination theory more compelling. You could test that out by having a drink at home under controlled circumstances to see whether the same issue arises? That could also answer the quantity question. Does one safe drink trigger it, two, three etc? Finally, and this is one that I find difficult, knowing you have the gluten issue may lead you to assume it's that when it could be something else. I tend to attribute EVERYTHING in the world to gluten these days due to it being able to affect me in so many different ways. Crisis in Korea? Gluten. Russian tanks massing on the Ukrainian border? Check their wheat intake. Global warming? etc. So it may make sense to pursue some other ideas at the same time. Try: http://goaskalice.columbia.edu/answered-questions/suddenly-drinking-alcohol-makes-me-sick http://www.steadyhealth.com/topics/very-abnormal-hangovers-thinking-it-could-be-allergy-to-alcohol and a doctor's answer: http://www.steadyhealth.com/medical-answers/abnormal-reactions-to-alcohol Cheers Sorry, best of luck! Matt

Similarly, I've been vegetarian for 25+ years. A 2015 Nature study connecting emulsifiers with microbiome changes has me wondering about the processed foods that I ate in the past, and I wonder about the wisdom of eating as much seitan as I did. I mostly prefer my post-diagnosis diet since it forces me to consider every ingredient and to cook from scratch more.