Avoiding Cow Milk-based Formula Does Not Help At-risk Infants Dodge Celiac Disease

Celiac.com 08/03/2017 - Some evidence indicates that feeding in the first months of life might have an impact on the risk of later celiac disease.

Numerous patients with celiac disease or type 1 diabetes show high levels of antibodies against cow milk proteins. For infants with genetic susceptibility for type 1 diabetes, avoiding of cow’s milk-based formula can lower the levels of diabetes-associated autoantibodies.

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Could the same be true for celiac disease? To find out if weaning to an extensively hydrolyzed formula lowered the risk of celiac disease of celiac disease autoimmunity, a research team performed a randomized controlled trial.

The research team included Mila Hyytinen, Erkki Savilahti, Suvi M. Virtanen, Taina Härkönen, Jorma Ilonen, Kristiina Luopajärvi, Raivo Uibo, Outi Vaarala, Hans K. Åkerblom, and Mikael Knip for the Finnish TRIGR Pilot Study Group.

For their double-blind controlled trial, they enrolled 230 infants with HLA-defined predisposition to type 1 diabetes and at least 1 family member with type 1 diabetes. The infants were randomly assigned to groups, with 113 fed a casein hydrolysate formula, and 117 receiving a conventional formula whenever breastmilk was not available during the first 6–8 months of life.

The team collected serum samples over an average of 10 years, and screened for antibodies to tissue transglutaminase (anti-TG2A) using a radiobinding assay, to endomysium using an immunofluorescence assay, and antibodies to a deamidated gliadine peptide using an immunofluorometry assay.

In patients with anti-TG2A levels over 20 relative units, the team conducted duodenal biopsy. They measured cow’s milk antibodies during the first 2 years of life. Their results showed that about 13% of the 189 participants they analyzed for antiTG2A 25 tested positive. Just ten of the 230 study participants were diagnosed with celiac disease.

The team found no significant differences in total cases of anti-TG2A positivity (hazard ratio, 1.14; 95 % CI, 0.51–2.54) or celiac disease (hazard ratio, 4.13; 95% CI, 0.81–21.02) between the casein hydrolysate and cow's milk group.

Interestingly, children who developed celiac disease did show higher levels of cow's milk antibodies before the appearance of anti-TG2A or celiac disease.

This study of infants with genetic risk factors for celiac disease showed evidence that weaning to a diet of extensively hydrolyzed formula compared with cow’s milk-based formula would lower the risk for celiac disease later in life.

Elevated levels of cow's milk antibody before anti-TG2A and celiac disease indicates that many people may experience increased intestinal permeability before they develop celiac disease.

Source:

• GASTROENTEROLOGY