It has been proposed that risk for developing the autoimmune condition coeliac disease (CD) may be linked to the time that the infant is weaned to consume gluten containing foods. However, the timing of gluten introduction into an infant’s diet does not appear to influence a child’s subsequent risk of developing CD investigators report in an article published online January 19 in Pediatrics. The new finding, from a multinational prospective birth cohort study, challenges some current ideas on how best to prevent the onset of the autoimmune disorder.
Purpose of the Study.
Patients with HLA-DR3 or DR4 alleles are at increased risk for the development of coeliac disease. However, not all genetically susceptible individuals develop celiac disease. The objective of this study was to investigate whether there was an association between the timing of exposure to gluten and subsequent development of coeliac disease autoimmunity (CDA) in children with a genetic predisposition for coeliac disease.
Fifty-one children in this study of just over 1500 children developed CDA. Children exposed to foods containing wheat, barley, or rye in the first 3 months of life had a 5 times increased odds ratio (P = .02) of CDA as compared with children first exposed to gluten at 4 to 6 months of age.
Twenty-five of the CDA-positive children had biopsy-proven coeliac disease. In these children, exposure to gluten in the first 3 months of life had a 23 times increased risk (P = .001) of CDA. In the biopsy-proven cohort, children not exposed to gluten until >7 months of age also had a significantly increased risk of CDA (odds ratio: 4; P = .04). There was no association between the development of CDA and the timing of introduction of oats or rice. No protective effect of breastfeeding was found with the development of CDA. Although all children in the cohort were exposed to gluten by 12 months of age, the first positive tTG autoantibody test did not occur until 2 years of age, with a mean age of positive conversion of 4.7 years.
In children at increased risk of developing coeliac disease, timing of gluten exposure in the diet is associated with the appearance of CDA. Exposure to gluten in the first 3 months of life is thought to be associated with increased risk because of immature or incomplete intestinal barrier function. The authors speculate that late gluten exposure may have been associated with CDA because of greater amounts introduced in the older infants.