Ten years of follow-up of the Spanish cohort of the European PreventCD study: the lessons learned

Escobar, Paula Crespo; Castillejo, Gemma; Martínez-Ojinaga, Eva; Donat, Ester; Polanco, Isabel; Ribes-Koninckx, Carmen

doi:10.17235/reed.2018.5324/2017

Cited by 6 publications

(5 citation statements)

References 37 publications

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“…However, infant gluten interventions beyond this tight time window with longer intervals have not been fully evaluated. However, recent publications with longer follow-up in the PREVENT-CD cohort show contradictory results (37)(38)(39). A study based on the Italian study population found that children who developed celiac disease by the age of 6 years had significantly higher gluten consumption after 24 months of age compared with children who did not develop celiac disease (39).…”

Section: Discussionmentioning

confidence: 99%

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

Aronsson

Agardh

2023

Front. Immunol.

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A higher intake of gluten during childhood is associated with increased risk of celiac disease, and the incidence of celiac disease peaks shortly after the time point when associations with higher gluten intake during the second and third year of life occur. Additional environmental factors are most likely necessary for celiac disease to develop. It is hypothesized that gastrointestinal infections increase gut permeability and exposure to gluten. Alternatively, infections may lead to gut dysbiosis and chronic inflammation, with leakage of self-antigens that mimic gluten peptides that leads to an autoimmune-like response. Different gluten interventions to prevent celiac disease have been proposed. Early clinical studies suggested an optimal time point introducing gluten between 4 and 6 months of age while the infant is being breastfed. However, later clinical trials on reduced gluten intake given to infants have shown no protection from celiac disease if gluten introduction was delayed or if gluten was introduced in small amounts during the child’s first year of life. Still, more randomized clinical trials (RCTs) are warranted to answer the question if a reduced amount of gluten, not only at the time of introduction during infancy but also in a longer time frame, will prevent children at genetic risk from having lifelong celiac disease. It needs to be clarified whether dietary interventions are effective strategies to be proposed as future prevention of celiac disease in the general population. The present mini-review provides an overview of ongoing or completed RCTs that have focused on interventions during early childhood with the aim of preventing celiac disease.

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Section: Discussionmentioning

confidence: 99%

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

Aronsson

Agardh

2023

Front. Immunol.

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“…Several observational studies have noted an association between higher gluten intake and CDA/CD—both at first introduction 13 and cumulatively throughout childhood, 14–16 consistent with patterns during the Swedish CD epidemic. However, when the entire PreventCD cohort was considered, this association held for only the DQ2.2/DQ7 17 heterozygotes, and extended follow‐up of the Spanish cohort showed no effect of the amount of gluten consumption in the first 3 years on the development of CD through age 6 18 . More rigorous randomised controlled trials (RCTs) failed to show an effect of timing of gluten introduction 19 or breastfeeding, 20 nor have meta‐analyses including various study designs identified an effect 21 …”

Section: Risk Factors and Preventionmentioning

confidence: 94%

Review article: Becoming and being coeliac—special considerations for childhood, adolescence and beyond

Chang

O'Shea

Therrien

et al. 2022

Aliment Pharmacol Ther

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Classically considered a disease of early childhood characterised by malabsorption and failure to thrive, coeliac disease is now recognised to arise in genetically susceptible individuals at any age. Although permissive HLA genotypes are the strongest predictor of coeliac disease, they are not sufficient. Several prospective cohort studies enrolling genetically at-risk infants have investigated the role of potential triggers of coeliac disease autoimmunity, such as timing of gluten introduction, viral infections and dietary patterns. Much less is known about triggers of coeliac disease in adulthood. Better understanding of factors leading to coeliac disease may be helpful in the management of those with potential coeliac disease (elevated serum celiac antibodies without villous atrophy in the small intestine), many of whom initiate a gluten-free diet without demonstration of villous atrophy. There are a range of clinical presentations of celiac disease in childhood and patterns of coeliac serology, including fluctuation and spontaneous reversion on a gluten-containing diet, vary.There is a current debate over best strategies to manage adults and children with potential coeliac disease to avoid over-treatment and under-treatment. Childhood and adolescence carry unique issues pertaining to the diagnosis and management of coeliac disease, and include nutrition and growth, rescreening, repeat biopsy, dietary adherence concerns and transition to adult care. In conclusion, while coeliac disease has similar pathogenesis and general clinical manifestations in paediatric and adult populations, diagnostic and management approaches need to adapt to the developmental stages.

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“…However, in this multicenter study, which included several European countries, they did find differences for the HLA-DQ2.2/-DQ7 risk group, observing that a gradual increase in the amount of gluten between 11 and 18 months can act as a modulating factor for this specific group. Later, the data from this cohort in Spain were analyzed [91], concluding that the consumption of gluten during the first 3 years of life does not influence the risk of developing CD before 6 years of age.…”

Section: Early Gluten Consumption and Development Of Celiac Diseasementioning

confidence: 99%

The Role of Early Programming and Early Nutrition on the Development and Progression of Celiac Disease: A Review

et al. 2020

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Experimental and epidemiological evidence has shown that modifications of the intrauterine environment can have deleterious consequences for individuals, expressed as an increased risk of suffering non-communicable pathologies in adult life, which is known as the hypothesis of the early origin of diseases or fetal programming. On the other hand, changes in gene expression patterns through epigenetic modifications can be the basis for long-term maintenance of the effects of fetal programming. In this sense, epigenetics comprises the study of intrauterine disturbances, which develop diseases in the adult, including celiac disease (CD). In addition, early feeding practices could influence the risk of CD development, such as breastfeeding timing and duration and age of gluten introduction in the diet. Gluten acts as a trigger for CD in genetically predisposed subjects, although approximately 30% of the world population has HLA DQ2 or DQ8, the prevalence of the disease is only 1–3%. It is not known what factors act to modify the risk of disease in genetically at-risk subjects. Taking into account all these considerations, the aim of the current review is to elucidate the role of early programming and the effect of early nutrition on the development and progression of CD. It is logical that attention has been paid to gluten as a key element in preventing the disease. However, there is no strong evidence in favor of the protective factor of breastfeeding, timing of introduction of gluten during lactation, and the development of CD. Diet, genetic risk, microbiota, and environmental interaction are possible triggers of the change in tolerance to an immune response to gluten, but large-scale cohort studies are needed. Emerging scientific concepts, such as epigenetics, may help us establish the role of these factors.

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Ten years of follow-up of the Spanish cohort of the European PreventCD study: the lessons learned

Cited by 6 publications

References 37 publications

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

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

Review article: Becoming and being coeliac—special considerations for childhood, adolescence and beyond

The Role of Early Programming and Early Nutrition on the Development and Progression of Celiac Disease: A Review

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