1. In a cohort of children, delayed gluten introduction at >6 months of age was associated with a significantly increased risk of Celiac disease that was not seen in those with earlier introductions.
2. A notable, yet not statistically significant, increased risk of Celiac disease was seen in infants who were breastfed for >12 months.
Evidence Rating Level: 2 (Good)
Study Rundown: Celiac disease (CD), or gluten-sensitive enteropathy, is a disease of the small intestine that can result in discomfort, diarrhea and failure to thrive. Gluten exposure early in life is a known environmental risk factor for Celiac disease and breast-feeding has been linked with decreased risk of disease development. However, the ideal timeframe during which to introduce gluten during infancy has not been well characterized. This prospective cohort study evaluated children with CD taken from the Norwegian Mother and Child Cohort Study. Patients’ families were asked to fill out questionnaires when the children were 6 and 18 months of age that contained detailed questions regarding breastfeeding and solid food introduction. After adjusting for age, gender, maternal Celiac history, and breastfeeding a significantly increased risk for CD was seen among children who were introduced to gluten after 6 months of age. A subgroup analysis of children that were breastfed beyond 12 months of age also indicated an increased risk for the development of CD. Other factors found to be significant predictors for CD were female gender, age of the child, and maternal history of CD. While this study is limited in its reliance on parental report, the findings suggest that there may be a key window for the introduction of food antigens in the pathogenesis of CD development.
In-Depth [prospective cohort]: This study utilized the Norwegian Mother and Child Cohort Study, a national prospective-population based cohort study, to investigate the relationship between early gluten introduction and the development of CD. Data was collected by questionnaire at the ages of 6, 18 months and 3,5,7, 10, and 12 years. A total of 82167 children were evaluated, with 324 children ultimately developing CD. Analyses demonstrated that predictors for CD included maternal history of CD, child age, and female gender. When these variables were adjusted for, there was a significantly increased risk for CD among children that were introduced gluten after 6 months (adjusted odds ratio (aOR) = 1.27 [95% CI, 1.01-1.65], p = 0.045), while early introduction of gluten was not associated with an increased risk of CD. Children who were breastfed for >12 months were found to be at a not significant, increased risk of developing CD (aOR = 1.59, [95% CI, 0.96-2.62]).
By Emilia Hermann and Leah C. Carr
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