Baby's Early Diet Not Linked to Celiac Risk

October 2, 2014
News Review From Harvard Medical School -- Timing of 1st Gluten Not Linked to Celiac Risk
Children have the same risk of developing celiac disease regardless of when they start eating foods containing gluten, 2 new studies suggest. People with celiac disease have pain, diarrhea, gas and other symptoms if they eat grains and other foods containing gluten. Children may have growth problems. Babies in the new studies had high-risk genes or a family history of celiac disease. In one study, 900 babies were randomly divided into 2 groups. One group had small amounts of gluten added to their diets at age 16 weeks. The other group received a placebo. At age 24 weeks, parents were advised to gradually add gluten for both groups. By age 3, about 5.2% of the early-gluten group and 5.9% of the placebo group had been diagnosed with celiac disease. The other study included about 700 babies. One group started eating gluten at age 6 months and the other at 12 months. By age 5, about 16% of each group had celiac disease. But those who started gluten at 12 months tended to develop it later. Breastfeeding also did not appear to offer protection in either study. The New England Journal of Medicine published the studies. HealthDay News wrote about them October 2.
By Robert H. Shmerling, M.D.What Is the Doctor's Reaction? Harvard Medical SchoolReported new cases of celiac disease have increased dramatically in recent years. Recent estimates suggest that it affects up to 1 in 130 people in the United States. But it is not clear whether the disease is becoming more common or is just recognized more often.
Celiac disease develops because of an abnormal immune reaction in the intestine to gluten. This is a protein found in many grains. Symptoms include:
Stomach pain or bloating Diarrhea or excess gas Delayed growth (in children) or weight loss Fatigue Bone or joint pain An itchy or painful rash Depression or irritability Neurological problems, such as poor balance or seizures
The cause of celiac disease is unknown. At least part of the cause is genetic. However, not everyone with a family history or certain high-risk genes develops the disease.
Past research has suggested that feeding gluten to babies for the first time between ages 4 and 6 months might reduce their risk of celiac disease. Two studies published today examine the effect on risk when gluten is introduced at different times.
The first study enrolled more than 900 children. They were at high risk for developing celiac disease based on genetic testing and family history. At 4 to 6 months of age, half were randomly assigned to receive gluten in their daily diet. The others received a placebo. After 6 months of age, gluten was gradually added to the diets of both groups.
Here's what the study found:
About 5% of the high-risk children developed celiac disease by age 3. The rates were similar in those consuming gluten (5.9%) or not consuming gluten (4.5%) at 4 to 6 months of age. The development of antibodies linked with celiac disease was similar in the gluten group (7%) and the gluten-free group (5.7%). Results were similar whether or not the babies were breastfed.
The second study examined different timing for introducing gluten to high-risk babies. However, the results were similar. Gluten was added to babies' diets at age 6 months or 12 months. This timing made no difference in whether they developed celiac disease by age 5. The children did tend to develop it later if they had been introduced to gluten later (at 12 months).
These results are disappointing. But they are unlikely to end speculation about whether there is a way to introduce gluten to infants that will reduce the risk of celiac disease. The number of children developing celiac disease in these studies was rather small. A larger study might have come to a different conclusion. It's also possible that introducing gluten earlier than 4 months or later than 12 months might be helpful.
What Changes Can I Make Now?Still, the findings provide little support for the idea that there is an ideal timeframe for when infants should begin eating foods that contain gluten.
Unfortunately, there is no well-established way to prevent celiac disease. As a result, all you can do is to see your doctor if you have symptoms of celiac disease and follow a celiac diet if you have the disease.
If you have been diagnosed with celiac disease, it's important -- and challenging -- to remove gluten from your diet. Some foods you should avoid include:
Foods containing wheat, rye, barley or oats, including many cereals, breads, cookies, baked goods and pastas Canned soups Dairy products (such as ice cream or yogurt) that have fillers or additives Prepared or processed meats Beer, whiskey or gin
Foods that can be part of a gluten-free diet include:
Rice Corn Potatoes Nuts Fresh fish, poultry or meat Vegetables without sauces or additives Wine Plain yogurt and cheeses that are free of additives or fillers
Be sure to read food labels carefully. At restaurants, ask your server about gluten-free menu items.
What Can I Expect Looking to the Future?Maintaining a gluten-free diet is not easy. But it has become easier than in the past. Awareness is increasing and food labels are clearer. You also can find more gluten-free options now than ever before.
Interest in celiac disease is high. Researchers are hard at work trying to identify the trigger or triggers that cause the immune system to react badly to gluten. You can expect to hear about the results of that research in the years to come.
Given the dramatic increase in new cases of the disease, the search is on for the reasons. From this latest research, it appears that introducing gluten to babies at a particular time isn't one of them.
Last updated October 02, 2014