Author/Publication year - Crespo-Escobar et al. (2017) [9]
Objectives - The aim is to test whether consuming high doses of gluten during childhood increases the likelihood of developing celiac disease. The data used for this evaluation comes from the PreventCD trial study.
Design and methods - A study involving 715 children from 5 European countries with celiac-related genes examined their gluten intake from 11 to 36 months. Infants were given 100 mg gluten/day or a placebo from 4 to 6 months, gradually increasing until 10 months, then unrestricted. The aim was to assess the impact of post-10-month gluten consumption
Results - At 10 months, children from different countries showed significant variations in gluten consumption (P < 0.001). However, within the same country, there was no difference in gluten intake between those who developed celiac disease and those who didn't (P > 0.05). Factors like country, gender, intervention group, and gluten consumption pattern didn't influence celiac disease risk. Interaction between HLA risk group and gluten pattern was mostly insignificant, except for DQ2.2/DQ7 haplotype which had higher risk (HR: 5.81; 95% CI: 1.18, 28.74; P = 0.031).
Conclusion - Most children with genetic risk from various European countries do not develop Celiac Disease due to gluten consumption patterns and the amount of gluten consumed between 11-36 months of age, regardless of their HLA genotypes. |
Author/Publication year - Ivarsson et al., (2013) [10]
Objectives - To investigate and compare the total prevalence of celiac disease in two 12-year birth cohorts and relate the results to infant feeding observed in each cohort.
Design and methods - The ETICS screening study occurred in two phases with 13,279 children from distinct birth cohorts: 1993 epidemic-born and 1997-born. Previously reported and confirmed cases were taken into account. Blood samples were collected and tested for serological markers, with positive results leading to referrals for small bowel biopsies. Adolescent feeding practices were examined for both cohorts. Prevalence comparisons were presented as prevalence ratios.
Results - Out of every 1000 people, 29 in 1993 and 22 in 1997 had celiac disease. Those born in 1997 had a lower risk of having celiac disease than those born in 1993 (prevalence ratio: 0.75; 95% confidence interval: 0.60-0.93; P = 0.01). The cohorts had different infant feeding practices, particularly in the amount of dietary gluten introduced to infants during ongoing breastfeeding.
Conclusion - The decreased prevalence of celiac disease among 12-year-olds suggests a potential strategy for preventing the disease. Medical research supports the gradual introduction of gluten-containing foods starting at 4 months of age, ideally while continuing to breastfeed. |
Author/Publication year - Vriezinga et al., (2014) [11]
Objectives - To investigate the hypothesis that the introduction of gluten in the diet of children aged 4 to 6 months would reduce the risk of celiac disease.
Design and methods - A randomized, double-blind, placebo-controlled dietary intervention study involved 944 HLA-DQ2 or HLA-DQ8 positive children with a celiac-related first-degree relative. In the study, 475 participants received 100 mg of active gluten daily from 16 to 24 weeks of age, while 469 received a placebo. They measured anti-transglutaminase type 2 and antigliadin effects. The study's objective was to ascertain the occurrence of biopsy-confirmed celiac disease by age 3.
Results - The analysis focused on 80 children, median age 2.8 years, with 59% girls. Among them, 77 were biopsy-confirmed for celiac disease, and 3 were diagnosed based on 2012 diagnostic criteria to avoid underestimation. Celiac disease incidence at age 3 was 5.2%, similar in gluten and placebo groups. Rates of antibodies were alike in both groups. Celiac development wasn't notably affected by breastfeeding (exclusive or continued during gluten introduction) or the intervention's impact.
Conclusion - A study conducted on high-risk children showed that introducing gluten to them between 16 to 24 weeks of age did not increase the risk of developing Celiac Disease by the age of 3. |
Author/Publication year - Perkin et al., (2016) [12]
Objectives - To determine the feasibility of early introduction of multiallergenic foods for exclusively breastfed infants from 3 months of age and the effect on breastfeeding performance.
Design and methods - A randomized controlled trial was conducted on a population basis. The group that followed the early introduction guidelines (EIG) maintained breastfeeding while gradually introducing six allergenic foods: cow's milk, peanuts, boiled egg, egg yolk, sesame, white fish (cod), and wheat. The standard introduction group, on the other hand, adhered to British infant feeding recommendations by exclusively breastfeeding for approximately six months and not introducing any foods before the age of six months.
Results - A total of 1303 infants were included in the study. The early introduction group (EIG) consumed each of the 6 foods 2 to 3 times per week at 5 months of age, while the standard introduction group did not consume any of them (P < 0.001 for all comparisons). By 6 months of age, less than 5% of EIG infants had not been introduced to allergenic foods. However, achieving the strict intake target established by the protocol was challenging for 42% of EIG participants. Both groups had higher breastfeeding rates than what is typically seen among matched mothers in the UK government data (P < 0.001 at 6 and 9 months of age).
Conclusion - Introducing certain types of allergenic foods before a baby is 6 months old appears to be possible without impacting breastfeeding. This has significant implications for developing strategies to prevent food allergies. |
Author/Publication year - Lionetti et al., (2014) [13]
Objectives - To investigate the relationship between the risk of developing celiac disease, the age at which gluten is introduced into a child's diet, and the child's early eating pattern.
Design and methods - The study involved 832 newborns with a first-degree relative having celiac disease. Randomly divided into two groups, Group A introduced gluten at 6 months, while Group B did so at 12 months. HLA genotype was determined at 15 months, and celiac disease was screened at various intervals up to 10 years, including intestinal biopsies for positive cases. The study's goal was to establish celiac autoimmunity and overt celiac disease prevalence among 5-year-old children.
Results - Among the 707 participants remaining in the study for 36 months, 553 with standard or high-risk HLA genotypes completed it. At age 2, a higher percentage of children in group A had celiac autoimmunity and overt celiac disease compared to group B, with significant differences (16% vs. 7%, P=0.002) for autoimmunity and (12% vs. 5%, P=0.01) for overt disease. However, by age 5, the differences between the groups became insignificant for both autoimmunity (21% in group A and 20% in group B, P=0.59) and overt disease (16% and 16%, P=0.78). At age 10, children with high-risk HLA faced a notably higher risk of celiac autoimmunity (38% vs. 19%, P=0.001) and overt celiac disease (26% vs. 16%, P=0.05) compared to standard-risk HLA. Other factors like breastfeeding didn't show associations with celiac disease development.
Conclusion - Delaying the introduction of gluten and breastfeeding did not affect the likelihood of developing celiac disease in at-risk individuals, but it was linked to a later onset of the disease. The presence of a high-risk HLA genotype was a significant indicator of the disease. |
Author/Publication year - Kemppainen et al., (2017) [14]
Objectives - To investigate temporal associations between caregiving and the development of celiac disease autoimmunity, and to examine the effects of HLA alleles, rotavirus vaccination status, and infant feeding.
Design and methods - A study monitored 6,327 at-risk children aged 1 to 4 in the US and Europe for HLA celiac disease. They were tested for tissue transglutaminase until March 31, 2015. Parents reported on their child's health every three months since birth. The study analyzed factors like complications, rotavirus vaccination, gluten introduction timing, breastfeeding, and celiac disease autoimmunity risk using proportional hazards models.
Results - During the study, 13,881 gastrointestinal infections (GIE) and 79,816 respiratory infections were identified. Among 6,327 children, 11.6% (732) developed celiac disease autoimmunity. GIE increased the celiac disease autoimmunity risk by 33% over 3 months (hazard ratio [RR], 1.33; 95% confidence interval [CI], 1.11-1.59). Winter-born children introduced to gluten before 6 months faced a 2-fold risk (RR, 2.08; 95% CI, 1.46-2.98), while those without HLA-DQ2 alleles breastfed less than 4 months had a 10-fold risk (RR, 9.76; 95% CI, 3.87-24.8). However, rotavirus-vaccinated children introduced to gluten before 6 months showed a reduced risk (RR, 0.57; 95% CI, 0.36-0.88).
Conclusion - Children genetically prone to celiac disease face elevated celiac autoimmunity risk with gastrointestinal infections. Multiple factors like HLA genotype, childhood gluten intake, breastfeeding, and rotavirus vaccination influence this risk. This underscores the intricate interplay of infections, genetics, diet, and celiac disease causes in childhood |
Food Introduction and Its Implications on the Development of Celiac Disease in Childhood
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