1. The early introduction of the gluten into the diet of infants was associated with a lower incidence of celiac disease at age 3 years.
Evidence Level Rating: 2 (Good)
The Enquiring About Tolerance (EAT) Study, a randomized controlled trial published in 2016, assessed whether introducing allergenic foods to infants’ diet from age 4 months alongside breastfeeding (early introduction group [EIG]) compared with continuation of exclusive breastfeeding and avoidance of allergenic foods until age 6 months (standard introduction group [SIG]) had any impact on food allergy prevention. This study represents a prespecified analysis of EAT, evaluating whether early introduction of gluten is associated with a reduced prevalence of celiac disease at age 3 years. A total of 1,303 infants were enrolled in EAT. One of the six allergenic foods introduced to the EIG was wheat; the minimum recommended gluten dose was 3.2 g/wk or 500 mg/d, corresponding to 4 g of wheat protein given as two wheat-based cereal biscuits throughout the week. Serum anti-transglutaminase type 2 (anti-TG2) antibodies were tested at three years to assess for the development of celiac disease. For this analysis, a total of 1,004 infants were tested for anti-TG2 antibodies, 488 in the EIG and 516 in the SIG. At three years, nine children, seven in the SIG and 2 in the EIG, had sufficiently elevated anti-TG2 antibodies and were referred for further investigation. Ultimately, all seven infants in the SIG received a diagnosis of celiac disease, confirmed by a pediatric gastroenterologist; in contrast, none of the infants in the EIG received a diagnosis (p = 0.02). These findings are in contrast to several other similar studies, which found no association between the timing of gluten introduction and celiac disease. Overall, it is clear that dedicated randomized controlled trials are needed to further investigate these data. However, this study suggests that early dietary introduction of gluten may have a role in the primary prevention of celiac disease among children.
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