Gluten Introduction to Infant Feeding and Risk of Celiac Disease: Systematic Review and Meta-Analysis

December 2, 2015

Gluten Introduction to Infant Feeding and Risk of Celiac Disease: Systematic Review and Meta-Analysis


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Several studies have been conducted to examine a possible connection between the time of gluten introduction to infants and the risk of developing celiac disease.

A team of researchers with The Journal of Pediatrics conducted a systematic review of 15 previous studies related to the topics of gluten introduction to infants, gluten consumption at weaning (transition from liquid to solid food in infants) and the effect of breastfeeding on celiac disease.

To date, the recommended age of gluten introduction has been between 4 and 6 months of life, with late introduction defined as over 6 months. The results of the review found that there was a 25 percent increase in the risk of developing celiac disease with late gluten introduction. It was found, however, that there was no effect of breastfeeding versus not breastfeeding on celiac disease risk.

There is currently no evidence to support that early introduction of gluten increases the risk of celiac disease and more studies will need to be conducted in order to better understand this relationship.

NFCA hosted a webinar on this topic, titled “What Wikipedia Can’t Tell You About Celiac Disease Prevention: Hear it from the Experts,” featuring Doctors Alessio Fasano, Carlo Catassi and Sabine Vriezinga. Listen to the recording and learn more here.

To learn more about this topic we contacted one of the authors of this study, Stefano Guandalini, MD,
Department of Pediatrics, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago.

Question 1

Q. Given this review, what are the breastfeeding and gluten introduction recommendations for families with celiac disease? Do recommendations differ based on which family member is diagnosed with celiac disease?

A. In reality, there is not much change in the current recommendations. In fact, even though we have no hard evidence that early introduction may be detrimental, good common sense still advises for an introduction not before the 5th month of life. And since a relatively small 25% increase was found in introduction of gluten beyond 6 month, as you see we end up by having our best shot at identifying 5-6 months of age as the likely best time (not a surprise, since Mother Nature has the first teeth appear at exactly that age!).

As for breast feeding, even though our analysis failed to show a significant protective effect toward celiac disease, we should never forget the solid evidence for the high value of breast feeding in a Million other areas, so please do breast feed your babies!

Question 2

Q. Are there any other health complications related to late introduction of gluten, aside from increased risk of celiac disease?

A. Not that we know. However, keep in mind that the most recent evidence for prevention of allergy favors an early, rather than late, introduction of potentially allergenic foods, so perhaps in this line of thoughts one wants to avoid an excessively late exposure to wheat.

Question 3

Q. What would you say to parents who are thinking about not introducing any gluten at all because celiac disease runs in their families and they are nervous/scared?

A. I would recommend checking the child’s genetic asset for celiac disease; if the baby has not celiac-related HLA haplotypes, then obviously gluten ceases to be an issue; on the other hand, if the baby has a genetic predisposition, then I would not recommend avoiding completely gluten introduction: sooner or later the child will be eating gluten-containing foods anyway, and this is better done in “regular” times and amounts, so any untoward effect can be soon identified, monitored and properly addressed.

Question 4

Q. Do you have anything else to add on this topic that you think the readers should know?

A. Perhaps the only other thing to add would be to be extra-careful when monitoring a baby girl born in a family at risk: in fact, the study by Vriezinga et al (the large an important “PreventCD” cohort study published in 2014) showed that girls who were HLA-DQ2 homozygous and were exposed to gluten at 4 months had a much higher probability of developing celiac disease at an early age. Thus, such infants should definitely not be exposed to gluten so soon, and in any case they should be followed more closely for the possible development of celiac autoimmunity, so to achieve an early as possible diagnosis.

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