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 22 January 2018

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News

Timing of gluten infant diet and risk of celiac disease

This week's issue of JAMA reports that timing of introduction of gluten into the infant diet is associated with the appearance of celiac disease in children at increased risk for the disease.

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While gluten ingestion is responsible for the signs and symptoms of celiac disease, it is not known what factors are associated with initial appearance of the disease.

Dr Norris and colleagues examined whether the timing of gluten exposure in the infant diet was associated with the development of celiac disease autoimmunity.

The research team conducted a prospective observational study in Denver, Colorado, from 1994 to 2004 of 1560 children at increased risk for celiac disease or type 1 diabetes.

The researchers defined the disease risk of participants by possession of either HLA-DR3 or DR4 alleles, or having a first-degree relative with type 1 diabetes.

Children exposed to gluten-containing foods in the first 3 months of life had a 5-fold increased risk of celiac disease
Journal of the American Medical Association

The team undertook a mean follow-up of 5 years.

The investigative team defined the main outcome measure as risk of celiac disease defined as being positive for tissue transglutaminase autoantibody.

Patients had to have been transglutaminase autoantibody positive or transglutaminase autoantibody had to be present on 2 or more consecutive visits.

The team reported that patients also had to have a positive small bowel biopsy for celiac disease, by timing of introduction of gluten-containing foods into the diet.

The investigators reported that 51 children developed celiac disease.

Findings adjusted for HLA-DR3 allele status indicated that children exposed to gluten-containing foods of wheat, barley or rye in the first 3 months of life had a 5-fold increased risk of celiac disease compared with children exposed for 4 to 6 months.

The team found that children not exposed to gluten until 7 months or later had a marginally increased risk of celiac disease compared with those exposed at 4 to 6 months.

The researchers then restricted case groups to only the 25 celiac disease-positive children who had biopsy-diagnosed celiac disease.

Based on this restriction, the team observed that initial exposure to wheat, barley, or rye in the first 3 months or 7 months or later significantly increased risk compared with exposure at 4 to 6 months.

Dr Norris' team concluded, “Timing of introduction of gluten into the infant diet is associated with the appearance of celiac disease in children at increased risk for the disease.”

JAMA 2005: 293(19): 2343-2351
19 May 2005

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