Systematic review: early feeding practices and the risk of coeliac disease. A 2022 update and revision

Abstract

Summary Background The effects of early feeding practices on the risk of coeliac disease (CD) remain debated. Aims To update evidence on these practices on the risk of CD and/or CD‐related autoimmunity (CDA), defined as anti‐transglutaminase or anti‐endomysial antibody positivity Methods We searched MEDLINE, EMBASE and the Cochrane Library to May 2022 for randomised controlled trials (RCTs) and observational studies. Results We included 36 publications (30 studies). In the population at genetic risk of developing CD (HLA DQ2/DQ8‐positive), exclusive or any breastfeeding and longer breastfeeding duration did not reduce the risk of developing CD/CDA during childhood. While a meta‐analysis of four case–control studies showed a decreased risk for CD when gluten was introduced during breastfeeding, this was not shown in RCTs and cohort studies. Age at gluten introduction was not associated with cumulative CD/CDA risk, although two RCTs suggested that earlier gluten introduction was associated with earlier CDA appearance. Evidence from six observational studies suggests that consumption of a higher amount of gluten at weaning and/or thereafter may increase CD risk. There is insufficient evidence to determine the amount of gluten associated with an increased CD/CDA risk. Regarding whether infant feeding practices modulate the risk conferred by different HLA genotypes results were inconsistent. Conclusions For the population at genetic risk of CD, breastfeeding and age at gluten introduction have no effect on its cumulative incidence during childhood. There is some evidence for an effect of the amount of gluten consumed at weaning and/or thereafter on CD/CDA risk.

Associations of dietary patterns between age 9 and 24 months with risk of celiac disease autoimmunity and celiac disease among children at increased risk

“…The dietary pattern at age 9 mo associated with the lower risk of CDA was characterized by lower intakes of both Human milk as well as Infant formula. However, neither human milk nor formula type has previously been associated with celiac disease [ [35] , [36] , [37] ]. Some food groups were included in dietary patterns with conflicting associations with the study outcomes.…”

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

“…The initial review was conducted in May 2022, using the databases PubMed, EMBASE, and the Cochrane Library. 3 Additional searches were performed from May 2022 to June 2023 to include new findings. The group reached a consensus that a targeted search in PubMed would be sufficient.…”

“…Due to the inadequate matching of cases and controls, the retrospective character of the study, a high percentage of mothers being illiterate, and potential recall bias, we did not consider this study relevant to the data or conclusions drawn from the 2023 systematic review. 3 The 2023 systematic review by Alotiby et al 11 on the role of BF in the development of immune-mediated diseases, with CD being one of them, examined a different time frame, and several recent important publications from large birth cohort studies were not included. In addition, no methodology to explore the evidence based on the quality of the included studies was applied in contrast to the 2023 review by Szajewska et al 3 Therefore, we decided to base our statements and recommendations on the more robust review findings by Szajewska et al 3 Compared to the 2016 position paper, the statements and recommendations have remained the same (refer to Table 1).…”

“…With the emergence of new evidence since the 2016/2017 recommendations, a systematic review was carried out in 2023 to assess how early infant feeding practices affect the risk of developing CDA and CD. 3 The primary objective of this review was to update the ESPGHAN position paper from 2016 based on this systematic review and the most recent publications regarding early feeding practices/diet and their impact on CDA and CD risk. This update adheres to the policy that mandates reviewing guidelines every 5 years, particularly when new data emerge.…”

Antibody Profile, Gene Expression and Serum Cytokines in At-Risk Infants before the Onset of Celiac Disease

“…The genetic profile [ 8 , 9 , 10 ] and a set of environmental factors contribute to the multiplicative risk of developing the disease [ 9 , 10 , 11 , 12 , 13 ]. In fact, prenatal events, early feeding patterns [ 11 , 12 , 13 , 14 ], viral infections [ 15 , 16 ] and other unknown factors may contribute to an increased risk of CeD.…”