Timing of gluten introduction into
infant diets tied to Celiac Disease
A new study by researchers at the Barbara Davis Center for Childhood Diabetes
and the Department of Preventive Medicine and Biometrics at the University of Colorado Denver has found that children
with gluten exposure from cereal grains at 4 to 6 months of age have a
lower risk of celiac disease than children with exposure before or after
this time period. The findings were published in the May 18 issue of the
Journal of the American Medical Association.
Celiac disease, also called gluten-sensitive enteropathy – a disease
of the intestinal tract – is characterized by chronic inflammation
in the small intestine, induced by gluten, a protein substance present in
wheat, rye or barley. Celiac disease develops when the body’s immune
system mistakenly targets and damages the small intestine. The classic form
of celiac disease typically presents itself in early childhood with abdominal
pain and diarrhea, malabsorption and nutrient deficiencies.
Most patients with celiac disease carry the gene for the disease. These gene
variations also confer increased risk for type 1 diabetes; thus, individuals
with type 1 diabetes – and their first-degree relatives – have
an increased risk of celiac disease. However, few genetically susceptible
individuals develop celiac disease, even though virtually all individuals
in wheat-consuming populations are exposed to gluten. This suggests that
additional factors play a role in disease risk.
Jill M. Norris, MPH, PhD, professor in the CU School of Medicine’s
Department of Preventive Medicine and Biometrics, and colleagues investigated
whether
there was an association between timing of exposure to cereals and subsequent
development of celiac disease autoimmunity (CDA) in children with a genetic
predisposition for celiac disease.
The study was conducted from 1994-2004 with 1,560 children at increased risk
for celiac disease or type 1 diabetes, as defined by possession of the susceptibility
gene variations, or having a first-degree relative with type 1 diabetes.
Children were tested for a specific antibody in the blood that marked the
destruction of the lining of the small intestine. The average follow-up was
4.8 years.
Fifty-one of the 1,560 children developed CDA. The researchers found that
findings adjusted for the celiac disease susceptibility gene indicated that
children exposed to foods containing wheat, barley, or rye in the first 3
months of life had a 5-fold increased risk of CDA compared with children
exposed to gluten-containing foods at 4 to 6 months.
Children not exposed
to gluten until after 6 months had a marginally increased risk of CDA compared
with those exposed at 4 to 6 months.
Twenty-five of the 51 CDA positive children were found already to have celiac
disease confirmed by biopsy. Initial exposure to wheat, barley, or rye in
the first 3 months or after the 6th month significantly increased risk of
biopsy-confirmed CDA compared with exposure at 4 to 6 months.
“Given that our study population was selected for specific genetic and
family history characteristics, our findings generally apply only to children
at
increased risk for celiac disease,” said Norris. “We cannot exclude
the possibility that earlier exposure to gluten leads to earlier appearance
of CDA and that all exposed at-risk children will eventually develop CDA.”
Norris and colleagues acknowledge that long-term follow-up and more detailed
studies on the effect of the amount of exposure are necessary to give a solid
determination of the relationship between gluten intake early in life and
celiac disease.
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