Two studies have shown that neither breastfeeding nor timing the start of gluten-containing foods makes a difference in development of celiac disease in children at risk.
The AP reported that the studies, published October 2 in the New England Journal of Medicine, show that there is no early window of opportunity to help sensitize a baby to gluten, and delaying its start until 1 year of age just briefly postpones the onset of symptoms.
In the first study, Elena Lionetti et al. reported findings from more than 700 infants in Italy started on gluten-containing foods when they were 6 or 12 months old. The authors showed that neither the delayed introduction of gluten nor breastfeeding modified the risk of celiac disease among at-risk infants, although later introduction of gluten was associated with a delayed onset of disease. Nonetheless, about 20% of infants in each group developed celiac disease by the age of 5 years.
In the second study, 944 European infants were given either small amounts of gluten or a placebo every day, from the time they were 4 months old until they were 6 months old. Sabine L. Vriezinga et al. concluded that compared with placebo, the introduction of small quantities of gluten from 16 to 24 weeks of age did not reduce the risk of celiac disease by 3 years.
Children in both studies were determined to be at high risk for celiac disease based on HLA genotype and having at least 1 first-degree relative with celiac disease. Those that developed celiac disease were identified by serologic and intestinal biopsy analyses.
The Los Angeles Times Science Now blog explained that parents with celiac disease receive much complicated information about how best to feed their infants and when to introduce foods containing gluten, but the NEJM studies now show that it doesn’t really matter.
In an editorial that accompanied the articles. Jonas F. Ludvigsson and Peter H.R. Green explain that many clinicians have recommended the administration of small amounts of gluten during a small window of opportunity— at 4 to 6 months of age—preferably while maintaining breast-feeding.
Ludvigsson and Green say that the findings from the studies should be a relief for people who think they did something wrong, or were not able to breastfeed. The editorialists state that it will now be hard to continue to recommend the introduction of gluten specifically at the age of 4−6 months.
The Boston Globe Daily Dose blog reported that whereas children who inherit 1 of the risk genes (HLA-DQ2 or HLA-DQ8) have a 20% risk of developing celiac disease by the time they are 5 years old, the risk is nearly 40% in children who inherit both genes.
“The practical advice we can give to families is that if you have a close family member with celiac disease, the rest of the household needs to be screened,” Fasano told the Boston Globe.
Most people with celiac disease go undiagnosed for years or even decades because the symptoms (weight loss, diarrhea, headaches, abdominal pain, and fatigue) are similar to those of many other conditions. A routine blood test can screen for the disease, which is then confirmed by intestinal biopsy.
Ludvigsson and Green wrote that further studies are needed to evaluate the role of the intestinal microbiome and other environmental factors in risk for celiac disease.