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A new study indicates that introducing gluten gradually during breastfeeding can lower risk of childhood celiac disease.
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.
A 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% conﬁdence 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 signiﬁcantly 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.