Early nutrition doesn’t prevent celiac disease

A three-year study3 followed 700 newborns genetically at risk for celiac disease in seven European countries and Israel. From 4 to 6 months of age, the children were randomly assigned to receive either 100 milligrams (mg) of gluten daily or a placebo. Parents reported their breastfeeding practices, and they were advised to introduce the infants to a normal gluten-containing diet after six months. At 3 years of age, 5.2 percent of all these at-risk children had been diagnosed with celiac disease. Neither early gluten nor breastfeeding affected the outcome.

In another U.S. and Italian study4, 500 children at risk of developing celiac disease started eating a full gluten-containing diet at different times during their first year of life. Researchers assigned half to receive normal gluten-containing foods, such as pasta, beginning at 6 months and assigned the rest to wait until they were 12 months old. Researchers periodically screened the children for five years. At age 2, the children in the first group showed a higher risk for celiac disease, but the late starters soon caught up. By age 5, 16 percent of children in both groups had celiac disease.

The authors suggest that postponing gluten could reduce development issues associated with earlier onset of celiac disease. However, these findings overturn previous speculation that introducing gluten at a certain time in infancy could reduce a person’s long-term risk of developing celiac disease. Genetics is the most important factor, so physicians should screen children with a family history of the disease.

3  Vriezinga, S.L.; Auricchio, R.; Bravi, E.; Castillejo, G.; Chmielewska, A.; Crespo Escobar, P.; Kolaček, S.; Koletzko, S.; Korponay-Szabo, I.R.; Mummert, E.; Polanco, I.; Putter, H; Ribes-Koninckx, C; Shamir, R.; Szajewska, H.; Werkstetter, K.; Greco, L.; Gyimesi, J.; Hartman, C.; Hogen Esch, C.; Hopman, E.; Ivarsson, A.; Koltai, T.; Koning, F.; Martinez-Ojinaga, E.; te Marvelde, C.; Mocic Pavic, A.; Romanos, J.; Stoopman, E.; Villanacci, V.; Wijmenga, C.; Troncone, R.; and Mearin, M.L., “Randomized feeding intervention in infants at high risk for celiac disease,” The New England Journal of Medicine, Oct. 2, 2014, 371:1304-15.; doi:10.1056/NEJMoa1404172.

 

4 Lionetti, E.; Castellaneta, S.; Francavilla, R.; Pulvirenti, A.; Tonutti, E.; Amarri, S.; Barbato, M.; Barbera, C.; Barera, G.; Bellantoni, A.; Castellano, E.; Guariso, G.; Limongelli, M.G.; Pellegrino, S.; Polloni, C.; Ughi, C.; Zuin, G.; Fasano, A.; and Catassi, C., “Introduction of gluten.; HLA status.; and the risk of celiac disease in children”.; . The New England Journal of Medicine, Oct. 2, 2014, 371:1295-303; doi:10.1056/NEJMoa1400697.