Infants who consumed gluten for the first time before they were 17 weeks old or after 26 weeks were no more likely to develop the autoimmune disorder celiac disease and suffer damage to their small intestine than children who were introduced to the food in between those ages, according to a study published in the February issue of the journal Pediatrics.
The finding contradicts previous research that suggested early or late introduction to gluten could be associated with increased risk of celiac disease, but the researchers do not advocate changing the general recommendation for introducing gluten to children between four and six months while the infant is still breast feeding.
While the timing of the introduction may not be important, the amount could be. The researchers observed that children in Sweden had a two-fold higher risk of developing celiac disease than children in the U.S. They explained that while children in Sweden were, in general, introduced to gluten earlier than U.S. children, they believed it was the amount of gluten they ate that was more influential than when they first ate it.
“We speculate that the increased risk of CD among Swedish children compared with children from other countries could be caused by a higher intake of gluten-containing cereals at the time of weaning, although the assumption needs to be explored in future studies,” write the researchers, led by Carin Andren Aronsson from Lund University in Malmo, Sweden.
Also contradictory to previous research and global guidelines, the study found children who were breastfed when they first ate gluten were at a “significantly increased risk” of developing celiac disease autoimmunity, but not celiac disease. The researchers distinguished a child had CDA if he or she tested positive for the biomarker of the disease transglutaminase autoantibodies twice, in which case they were referred to a gastrointerologist to confirm the diagnosis of CD. Not all children with CDA were later diagnosed with CD. Children who breast fed for a month or more after trying gluten were 23% more likely to develop CDA, compared to an 8% increased risk among those who continued to breast feed for less than a month and no increased risk among those who were not breastfeeding when introduced to gluten.
“We are aware that our finding … is in contradiction to the recommendation of World Health Organization and that it is controversial. However, the risk was not seen for children who developed CD, suggesting that the associative risk of breastfeeding on CDA should be interpreted with caution,” they wrote.
Economic status matters
Children in higher economic households also were more likely to be diagnosed with celiac disease than those in poorer families, an unrelated study published in the British Medical Journal found.
This does not mean, however, they children from poorer families were less likely to develop the disease, note the researchers led by Fabiana Zingone of the University of Nottingham in the U.K.
They explain that children from the poorest areas in the U.K. in the study of 2,063,421 children were only half as likely to be diagnosed with celiac disease than those in “less deprived areas,” most likely because they had decreased access to testing.
“Awareness campaigns and the implementation of diagnostic guidelines may help to implement strategies for case-finding in all children and reduce this inequality,” they concluded.