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David in Seattle

Introducing Gluten During Infection Does Not Increase The Risk Of Celiac Disease

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From Pediatrics 2010;125:e530-e536

NEW YORK (Reuters Health) Mar 03 - Introducing gluten to a baby's diet during a period of infection does not increase the risk of celiac disease, Swedish researchers report in the March issue of Pediatrics.

Using data from the population-based All Infants in Southeast Sweden study, Dr. Jonas F. Ludvigsson of Karolinska Institute in Stockholm and colleagues looked for independent associations of childhood infections with the risk of developing celiac disease.

Parents kept diaries on diet and infectious disease in their child's first year of life, including dates when breastfeeding started and stopped, and dates of first gluten-containing foods.

The 9408 children in the study had 42,826 parent-reported episodes of infectious disease in the first year of life, including 4003 episodes of gastroenteritis.

Forty-four of the children developed biopsy-verified celiac disease after their first birthday, including 18 of 2528 who had infection at the time of gluten introduction and 26 of 6880 without infection (p = 0.035).

Out of 167 children with gastroenteritis during gluten introduction, one child developed celiac disease, compared to 43 of 9241 without gastroenteritis (p = ns).

After adjustment for age at gluten introduction, age at breastfeeding cessation, and age at infection, there was no significant association between infection or gastroenteritis at the time of gluten introduction and the subsequent development of celiac disease.

The researchers caution that a limitation of their study is the lack of data on type of infection. "We cannot rule out the possibility that specific pathogens constitute risk factors for celiac disease, because risk estimates for infection at the time of gluten introduction were of borderline significance," they said, pointing out in addition that the study design precluded identification of subclinical infections.

Also, they note, "because celiac disease is increasingly diagnosed in adulthood, screening...and a longer follow-up period would be required for complete elucidation of the possible relationship between infections and celiac disease."

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