Intervention strategies in early childhood to prevent celiac disease—a mini-review

Aronsson, Carin Andrén; Agardh, Daniel

doi:10.3389/fimmu.2023.1106564

Cited by 6 publications

(6 citation statements)

References 45 publications

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“…Since a 2023 systematic review, seven newly identified articles were considered relevant, and full papers were retrieved. [4][5][6][7][8][9][10][11][12][13] Among these, the only study contributing new data was a retrospective case-control study from Iran. 10 This study compared 186 children diagnosed with CD (mean age: 4.8 years) from a single centre with 186 non-CD controls (mean age: 4.1 years).…”

Section: Q6 Gluten Intake By the Mother During Pregnancy And Lactationmentioning

confidence: 99%

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Early diet and the risk of coeliac disease. An update 2024 position paper by the ESPGHAN special interest group on coeliac disease

Szajewska,

Shamir,

Auricchio

et al. 2024

J. pediatr. gastroenterol. nutr.

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This position paper by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Special Interest Group on Coeliac Disease (SIG‐CD) presents an update to the 2016 recommendations concerning early diet and the risk of coeliac disease (CD). This update adheres to the policy that mandates reviewing guidelines every 5 years, particularly when new data emerge. The 2024 statements and recommendations are essentially similar to the 2016 recommendations. Breastfeeding, whether any amount, exclusive, or of any duration, does not reduce the risk of developing CD. Introducing gluten into an infant's diet at any time between completed 4 months (≥17 weeks) and 12 months of age does not affect the cumulative incidence of CD, although earlier introduction may lead to earlier seroconversion and CD. In observational studies involving cohorts with a known risk for CD, consuming a high amount of gluten compared to a low amount during weaning and in the subsequent childhood years—specifically the first 2–3 years, and even up to 5 years in some studies—was associated with an increased risk for CD. However, the specific optimal amounts of gluten consumption remain undetermined due to insufficient evidence on safe thresholds, and the impact of restricting gluten in the diet of healthy children of unknown risk for CD is unknown. Thus, any recommendation on the gluten amount is currently unjustifiable for the general population and infants with known HLA risk types. There is no specific guidance on the type of gluten‐containing foods to be introduced at weaning.

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Section: Q6 Gluten Intake By the Mother During Pregnancy And Lactationmentioning

confidence: 99%

“…Since a 2023 systematic review, seven newly identified articles were considered relevant, and full papers were retrieved 4‐13 . Among these, the only study contributing new data was a retrospective case‐control study from Iran 10 .…”

Section: Statements and Recommendationsmentioning

confidence: 99%

Early diet and the risk of coeliac disease. An update 2024 position paper by the ESPGHAN special interest group on coeliac disease

Szajewska,

Shamir,

Auricchio

et al. 2024

J. pediatr. gastroenterol. nutr.

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“…Two ongoing clinical trials are evaluating the outcome of a late introduction of gluten/a restricted gluten intake up to an age of three and five years old, respectivley. The researchers behind these studies aim to obtain CD prevention, or at least to delay the disease onset to an older age, in children at genetic risk [74]. Furthermore, the Prevention Celiaki i Skåne (PreCiSe) study evaluated whether the intake of a daily probiotic during the first 3 years of life would prevent CD onset up to the age of seven, in comparison with keeping a GFD, or with no dietary intervention.…”

Section: Prevention Strategiesmentioning

confidence: 99%

“…On several occasions, it has been suggested that viral infectious episodes during the period of inducing tolerance to gluten could have a significant impact on the risk of developing CD [74]. Although the pathophysiologic mechanism that stands behind the viral immune activation of T cells against gluten peptides and the activation of B cells to produce tTGA has not currently been brought to light, there is proof of a strong correlation between viral exposure and celiac disease autoimmunity (CDA) development.…”

Section: Prevention Strategiesmentioning

confidence: 99%

Advances in Understanding the Human Gut Microbiota and Its Implication in Pediatric Celiac Disease—A Narrative Review

et al. 2023

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Celiac disease (CD) is a multifactorial disorder, defined by a complex interplay of genetic and environmental factors. Both genetic predisposition and dietary exposure to gluten are essential factors in triggering CD. However, there is proof that their presence is necessary, but not sufficient, for disease development. Through gut microbiota modulation, several additional environmental factors have shown their potential role as co-factors in CD pathogenesis. The aim of this review is to illustrate the possible mechanisms that stand behind the gut microbiota’s involvement in CD pathogenesis. Furthermore, we discuss microbiota manipulation’s potential role as both a preventative and therapeutic option. The available literature provides evidence that even before CD onset, factors including cesarean birth and formula feeding, as well as intestinal infection exposure, amplify the risk of CD in genetically predisposed individuals, due to their influence on the intestinal microbiome composition. Active CD was associated with elevated levels of several Gram-negative bacterial genera, including Bacteroides, Escherichia, and Prevotella, while beneficial bacteria such as lactobacilli and bifidobacteria were less abundant. Viral and fungal dysbiosis has also been described in CD, evidencing specific taxa alteration. A gluten-free diet (GFD) may improve the clinical symptoms and duodenal histopathology, but the persistence of intestinal dysbiosis in CD children under a GFD urges the need for additional therapy. Probiotics, prebiotics, and fecal microbial transplant have demonstrated their efficacy in restoring gut microbiota eubiosis in adult CD patients; however, their efficacy and safety as adjunctive therapies to a GFD in pediatric patients needs further investigation.

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“…Nevertheless, the available evidence regarding the relationship between CD and breast milk remains inconclusive. Extended breastfeeding and, notably, breastfeeding at the time of gluten introduction seem to decrease the risk of developing CD or at least postpone its onset [11,12]. However, conflicting findings persist, as some studies have been unable to establish breastfeeding as protective against the development of CD [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Exploring the secretion of immunogenic gluten peptides in breast milk from celiac and non celiac mothers

Ruiz-Carnicer,

Segura,

de Lourdes Moreno

et al. 2024

Preprint

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Background: Exposure to antigens is crucial for child immune system development, aiding disease prevention and promoting infant health. Some common food antigen proteins are found in human breast milk. However, it is unclear whether gluten antigens linked to celiac disease (CD) are transmitted through breast milk, potentially impacting the development of the infant's immune system. Objective: This study aimed to analyze the passage of gluten immunogenic peptides (GIP) into human breast milk. We evaluated the dynamics of GIP secretion after lactating mothers adopted a controlled gluten-rich diet. Methods: We prospectively enrolled 96 non-CD and 23 CD lactating mothers, assessing total proteins and casein in breast milk, and GIP levels in breast milk and urine. Subsequently, a longitudinal study was conducted in a subgroup of 12 non-CD lactating mothers who adopted a controlled gluten-rich diet. GIP levels in breast milk and urine samples were assayed by multiple sample collections over 96 hours. Results: Analysis of a single sample revealed that 24% of non-CD lactating mothers on a regular unrestricted diet tested positive for GIP in breast milk, and 90% tested positive in urine, with significantly lower concentrations in breast milk. Nevertheless, on a controlled gluten-rich diet and the collection of multiple samples, GIP were detected in 75% and 100% of non-CD participants in breast milk and urine, respectively. The transfer dynamics in breast milk samples were long-enduring and GIP secretion persisted from 0 to 72 h. In contrast, GIP secretion in urine samples was limited to the first 24 h, with inter-individual variations. In the cohort of CD mothers, 82.6% and 87% tested negative for GIP in breast milk and urine, respectively. Conclusions: This study definitively established the presence of GIP in breast milk, with substantial inter-individual variations in secretion dynamics. Our findings provide insights into distinct GIP kinetics observed in sequentially collected breast milk and urine samples, suggesting differential gluten metabolism patterns depending on the organ or system involved. Future research is essential to understand whether GIP functions as sensitizing or tolerogenic agents in the immune system of breastfed infants.

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Intervention strategies in early childhood to prevent celiac disease—a mini-review

Cited by 6 publications

References 45 publications

Early diet and the risk of coeliac disease. An update 2024 position paper by the ESPGHAN special interest group on coeliac disease

Early diet and the risk of coeliac disease. An update 2024 position paper by the ESPGHAN special interest group on coeliac disease

Advances in Understanding the Human Gut Microbiota and Its Implication in Pediatric Celiac Disease—A Narrative Review

Exploring the secretion of immunogenic gluten peptides in breast milk from celiac and non celiac mothers

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