Age at Gluten Introduction and Risk of Celiac Disease

Abstract

OBJECTIVES: The goal of this study was to determine whether age at introduction to gluten was associated with risk for celiac disease (CD) in genetically predisposed children. METHODS: TEDDY (The Environmental Determinants of Diabetes in the Young) is a prospective birth cohort study. Newborn infants (N = 6436) screened for high-risk HLA-genotypes for CD were followed up in Finland, Germany, Sweden, and the United States. Information about infant feeding was collected at clinical visits every third month. The first outcome was persistent positive for tissue transglutaminase autoantibodies (tTGA), the marker for CD. The second outcome was CD, defined as either a diagnosis based on intestinal biopsy results or on persistently high levels of tTGA. RESULTS: Swedish children were introduced to gluten earlier (median: 21.7 weeks) compared with children from Finland (median: 26.1 weeks), Germany, and the United States (both median: 30.4 weeks) (P < .0001). During a median follow-up of 5.0 years (range: 1.7–8.8 years), 773 (12%) children developed tTGA and 307 (5%) developed CD. Swedish children were at increased risk for tTGA (hazard ratio: 1.74 [95% CI: 1.47–2.06]) and CD (hazard ratio: 1.76 [95% CI: 1.34–2.24]) compared with US children, respectively (P < .0001).Gluten introduction before 17 weeks or later than 26 weeks was not associated with increased risk for tTGA or CD, adjusted for country, HLA, gender, and family history of CD, neither in the overall analysis nor on a country-level comparison. CONCLUSIONS: In TEDDY, the time to first introduction to gluten introduction was not an independent risk factor for developing CD.

Primary Prevention of Celiac Disease: Environmental Factors with a Focus on Early Nutrition

“…However, it was unclear whether it provided long-term prevention against CD or only delayed the onset of the disease [24,[35][36][37] . Results of the recently published cohort studies did not confirm the protective effect of breastfeeding at the time of gluten introduction on developing CD [31,38] . Also, the pooled results for 7 observational studies showed that breastfeeding at the time of gluten introduction has no effect on the risk of developing CD compared with formula feeding (OR 0.88, 95% CI 0.52-1.51) [10] .…”

At-Risk Screened Children with Celiac Disease are Comparable in Disease Severity and Dietary Adherence to Those Found because of Clinical Suspicion: A Large Cohort Study

“…[1][2][3] However, due to the plethora of unspecific gastrointestinal and extra-intestinal symptoms involved, the great majority of affected children remain unrecognized. 1,2 Since screening for the disease is simple by modern antibody tests, it has been suggested that for increased diagnostic efficiency we should screen either known at-risk groups [4][5][6] or even the whole population. 7 However, although celiac disease fulfils several WHO criteria for screening, the overall benefits of this approach remain controversial.…”

Inicio De Alimentación Complementaria Y Riesgo De Enfermedad Celíaca Y Alergia Alimentaria. ¿de Qué Evidencia Disponemos?

“…En una cohorte noruega (26), el inicio de ingesta de gluten después de los 6 meses se asoció a un mayor riesgo de EC, lo cual concuerda con estudios previos de Norris (18). Hasta ahora la recomendación general ha sido iniciar el gluten entre los 4 y 6 meses, preferentemente mientras el niño aún esté con lactancia materna (11,13,19,27). Hay que tomar en cuenta que estas recomendaciones se basan en un número limitado de estudios y los resultados han sido obtenidos en poblaciones de características muy distintas.…”