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 19 October 2017

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Avoiding cow's milk–based formula for at-risk infants does not reduce risk of celiac disease

Avoidance of cow's milk–based formula for at-risk infants does not reduce development of celiac disease, reports this month's issue of Gastroenterology.

News image

Feeding during the first months of life might affect risk for celiac disease.

Individuals with celiac disease or type 1 diabetes have been reported to have high titers of antibodies against cow’s milk proteins.

Avoidance of cow’s milk-based formula for infants with genetic susceptibility for type 1 diabetes reduced the cumulative incidence of diabetes-associated autoantibodies.

Dr Mila Hyytinen and colleagues performed a randomized controlled trial in the same population to study whether weaning to an extensively hydrolyzed formula reduced the risk of celiac disease autoimmunity or celiac disease.

The researchers performed a double-blind controlled trial of 230 infants with HLA-defined predisposition to type 1 diabetes and at least 1 family member with type 1 diabetes.

The infants were randomly assigned to groups fed a casein hydrolysate formula or a conventional formula whenever breast milk was not available during the first 6-8 months of life.

The team collected serum samples over a median time period of 10 years and analyzed for antibodies to tissue transglutaminase using a radiobinding assay, to endomysium using an immunofluorescence assay, and antibodies to a deamidated gliadine peptide using an immunofluorometry assay.

4% were diagnosed with celiac disease
Gastroenterology

Duodenal biopsies were collected if levels of anti-TG2A exceeded 20 relative units.

Cow’s milk antibodies were measured during the first 2 years of life.

Of the 189 participants analyzed for anti-TG2A, 13% tested positive.

Of the 230 study participants observed, the researchers found that 4% were diagnosed with celiac disease.

The researchers did not find any significant differences at the cumulative incidence of anti-TG2A positivity or celiac disease between the casein hydrolysate and cow’s milk groups.

The team noted that children who developed celiac disease had increased titers of cow’s milk antibodies before the appearance of anti-TG2A or celiac disease.

Dr Hyytinen's team concluded, "In a randomized controlled trial of 230 infants with genetic risk factors for celiac disease, we did not find evidence that weaning to a diet of extensively hydrolyzed formula compared with cow’s milk-based formula would decrease the risk for celiac disease later in life."

"Increased titers of cow's milk antibody before anti-TG2A and celiac disease indicates that subjects with celiac disease might have increased intestinal permeability in early life."

Gastroenterol 2017: 153(4): 961–970.e3
06 October 2017

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