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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. Data 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 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. Source: Isr Med Assoc J. 2012 Jan;14(1):50-2.
Am J Clin Nutr 2002;75:914-921. Celiac.com 06/06/2002 - Results of a recent study conducted by Anneli Ivarsson and colleagues at Umea University in Sweden suggest that continuing to breast-feed infants while they are being introduced to new foods may reduce their risk of getting celiac disease. Dr. Ivarssons study suggests that the cause of celiac disease may include environmental factors, and not just be limited to genetic factors. Their study evaluated the breast-feeding habits of 627 children with celiac disease and 1,254 healthy children, and specifically looked at their responses to newly introduced foods. The results, published in the May issue of the American Journal of Clinical Nutrition, indicate that dietary patterns of infants may have a strong influence on the bodys immune responses, and certain dietary patterns could lead to lifelong food intolerances. Children under 2 years of age who were still being breast-fed when they were introduced to dietary gluten had a 40% lower incidence of celiac disease. Another important factor was the overall amount of gluten in an infants diet, and a direct correlation was found between increased gluten consumption and an increased incidence of celiac disease. According to the researchers, the protective effect of breast feeding was even more pronounced in infants who were breast-fed beyond the introduction of gluten. Ultimately the teams findings indicate that breast feeding infants through the period of gluten introduction can significantly lower their risk of getting celiac disease. More research needs to be done to determine if this protective effect will extend over a lifetime.
This article comes to us from Karoly Horvath, M.D., khorvath@POL.NET, who is one of the two directors of the celiac center at University of Maryland in Baltimore. Breast milk contains antibodies against all the antigens the mothers immune system has met prior to or during the pregnancy and has produced antibodies to them. This system is the wisdom of nature and this is the way that mothers milk protects babies from all the antigens (infectious agents, toxins etc.) occurring in the environment where the mother lives. These antigens without this protection may enter the body through the digestive or respiratory systems. The best example is that breast milk protects babies from bacteria causing diarrheas in the underdeveloped countries. The antibodies are produced by the cells (plasma cells) localized in the gut and the lung. These cells are migrating to the lactating breast-tissue for hormonal trigger (enteromammal plasma cell circle) and they continue producing these antibodies in the breast. These antibodies appear in the breast milk. In brief, the breast milk may contain all the antibodies the mother has in her digestive and respiratory systems. The function of these antibodies is to block the entrance of antigens infectious agents, toxins, allergens etc) across the digestive or respiratory tract of babies. In case of celiac disease, it means that if the mother has circulating antibodies to gliadin, these antibodies appear in the milk. If the breast fed baby ingests gliadin (or the mother ingests accidentally and traces of gliadin appear in the milk) the antibodies in the milk blocks the gliadin and it will not able to cross the intestinal wall and meet with the babys immunosystem. Theoretically, the breast-fed infant do not have any immunoreaction to gliadin. If the mother accidentally ingests gliadin during breast feeding it is likely that the concentration of antigliadin antibodies become higher in the breast milk. To answer the question: the antibodies in breast milk are protective and do not "trigger" celiac disease in genetically predisposed babies. There are several data showing that breast-feeding has a protective effect in case of celiac disease. Furthermore, it is well documented that breast-feeding in the first year of life decreases the risk of allergies by 50% in babies whose parents have allergies. As far as the reaction after weaning concerned: it is also known that babies may have some reaction (loose stool or spit up or discomfort) transiently after introducing a new food, however, this is a temporary symptom and not allergy or immunoreaction to the food. It is likely that their digestive system should accommodate to the new foods.