Babies' introduction to gluten not tied to celiac risk

Last Updated: 2015-11-10

By Kathryn Doyle

NEW YORK (Reuters Health) - It's still not clear that introducing gluten at a specific age in infancy will reduce a child's risk of celiac disease, say the authors of a new review of past studies.

The results, published online October 20 in the Journal of Pediatrics, "were surprising and somewhat disappointing as no clear guidelines on timing of introduction of gluten to infants' diets can be given and we need to await results from more studies to clarify this issue," study authors Drs. Maria Ines Pinto-Sanchez and Elena F. Verdu, of McMaster University in Hamilton, Ontario, Canada, said in a statement to Reuters Health.

Researchers reviewed the results of two randomized controlled trials and 13 other studies evaluating the timing of gluten introduction to the infant diet and later celiac disease risk.

Infants first consumed gluten in products such as cereal, for example, or specific preparations manufactured for research purposes.

In the two randomized trials there was no change in celiac disease risk for children introduced to gluten at five or six months of age compared to 12 months.

Five observational studies found that infants given gluten later than six months of age were 25% more likely to develop celiac disease than infants who started between four and six months.

"It is important to stress that the association we found was only modest and requires confirmation," Dr. Pinto-Sanchez said.

"It is thought that during the development of the immune system there may be a period during which there is an opportunity for tolerance to occur," study coauthor Dr. Joseph A. Murray of the Mayo Clinic in Rochester, Minnesota, told Reuters Health by email.

"Late introduction may miss some of that opportunity," Dr. Murray said.

Most of the studies in the review included children already at high risk for the disease, Dr. Pinto-Sanchez said.

The most favorable timing of first gluten seems to be before six months of age, which is consistent with American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and World Health Organization recommendations, she said.

There was no link between breastfeeding and celiac disease risk in the review, Dr. Pinto-Sanchez said.

"Early diagnosis and treatment of celiac disease with the gluten-free diet is very important, in order to prevent complications such as nutritional deficiencies, anemia, osteoporosis and even more serious complications involving ulcers in the intestine or cancer," she said.

"Parents should avoid radically altering diets, such as introducing a gluten-free diet, without a clear medical reason for doing so, as the diet may be deficient in fiber and also possibly in micronutrients that are routinely added to many cereals," she said.

"It also should be recognized that gluten-free foods are not in themselves any more healthy than gluten-containing foods," Dr. Murray said. "There is nothing inherently good from a general perspective about gluten-free foods."

Nestle funded this research. The authors reported no disclosures.

SOURCE: http://bit.ly/1NQrdNZ

J Pediatr 2015.