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Age at gluten introduction not linked to risk for celiac disease
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Results from a prospective, multinational study indicate that age at first introduction to gluten is not an independent risk factor for celiac disease.
“The incidence of celiac disease is increasing in the Western world. The optimal age at first introduction to gluten to avoid development of celiac disease has been rigorously debated,” study researcher Carin Andrén Aronsson, MSc, of Lund University in Malmö, Sweden, and colleagues wrote. “Several studies hypothesized that the age at first introduction to gluten could influence the onset of the disease. Others claim that breast-feeding and its interaction with gluten during weaning could reduce the risk for celiac disease.”
To investigate these hypotheses, researchers assessed 6,436 newborn infants from the ongoing TEDDY study, which has the primary objective of identifying environmental determinants of type 1 diabetes. Study participants are followed from birth to age 15 years or until they are diagnosed with type 1 diabetes. The study draws from research centers in Finland, Germany, Sweden, Colorado, Georgia, Florida and Washington. Starting at age 24 months, children were screened annually for tissue transglutaminase autoantibodies. Caregivers recorded early infant feeding practices, which were reviewed at ages 6, 9, 12, 15, 18, 21 and 24 months.
Risk factors for celiac disease autoimmunity and celiac disease included presence of genotype HLA DR3-DQ2, residing in Sweden, female gender and a family history of celiac disease. Maternal education level and age at delivery, season of birth and smoking during pregnancy were not significantly associated with development of celiac disease in newborns.
The median age of study participants at introduction to gluten-containing cereals was 26.1 weeks. Swedish children were introduced earliest (median age, 21.7 weeks) compared with children in Finland (26.1 weeks), Germany (30.4 weeks) and the US (30.4 weeks).
When adjusting for country, HLA, gender and family history of celiac disease, introduction to gluten before age 17 weeks or after age 26 weeks was not associated with increased risk for celiac disease.
Researchers assessed children who continued breast-feeding at least 1 month after gluten introduction to investigate associations between breast-feeding and celiac disease. After adjusting for country, HLA, gender, family history and age at gluten introduction, analysis indicated infants who were breast-fed for at least 1 month after gluten introduction had an increased risk for development of tissue transglutaminase autoantibodies (HR=1.23; 95% CI, 1.05-1.44) but not for celiac disease (HR=1.13; 95% CI, 0.88-1.46).
“In our study, timing of gluten introduction was not associated with risk for celiac disease autoimmunity and celiac disease,” Aronsson and colleagues wrote. “Our results do not support previous findings which suggest that avoiding either early (ie, before 4 months) or late (ie, after 6 months) gluten introduction reduces the risk for disease development.”
Disclosure: The researchers report no relevant financial disclosures.
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