Early gluten exposure does not protect against celiac disease

October 6, 2014 in Allergies & Intolerances, Nutrition for Children and Teenagers, Nutrition Topics in the News

Early gluten exposure does not protect against celiac disease

Earlier research indicated that exposing a baby to small amounts of gluten around the age of four to six months may prevent the child from developing celiac disease, but two new studies suggest it makes no difference.

The tests, reported last week in the New England Journal of Medicine, also offer evidence that breast feeding doesn't guard against the autoimmune disease, which attacks the small intestine and affects as many as one in 133 Canadians.

Another study found that delaying exposure to gluten until the age of 12 months may delay the onset of celiac disease. However, it ultimately didn't prevent the condition.

In both studies, the researchers also did not find any evidence that breast-feeding, the duration of breast-feeding, or the introduction of gluten during breast-feeding influenced later development of celiac disease, findings the researchers didn't expect. There has been compelling circumstantial evidence that breast-feeding would protect against celiac disease.

The only difference was the genetic component; without the genes that increase the risk of celiac disease, children did not develop celiac disease.

Celiac disease runs in families and a particular genetic variant makes it much more likely a person will develop the condition. In the studies, the infants with that gene profile were considered to be at high risk for celiac.

The notion that limited gluten exposure might prevent the disease in high risk infants was based on studies that looked at historical data, but it had not been thoroughly tested. The idea was that delaying the introduction of gluten would allow the immune system to mature so there was less risk of celiac disease, which turned out not to be the case.

In that study, involving 832 newborns with an immediate family member with celiac disease, 12 percent introduced to gluten at six months developed overt celiac disease by age two compared to 5 percent of children exposed to dietary gluten at 12 months. But by age five, it didn't matter which group the child had been in. The rate of overt celiac disease was 16 percent in both.

In the second study, 944 children were given daily doses of 100 milligrams of gluten or placebo from age four months to six months. At the three-year mark, 5.9 percent in the gluten group and 4.5 percent in the placebo group had celiac disease - an insignificant difference.

"Of course, breast feeding is the best for all the babies, so pediatricians will have to advise that for babies," the researchers said. Yet when it comes to preventing celiac disease, it doesn't make any difference.

Yet some experts will still advise parents to introduce small amounts of gluten leaning toward the six-month mark and continuing to breastfeed, even if these studies haven't shown a significantly protective role.

Source: New England Journal of Medicine, online October 1, 2014.

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