Introducing gluten gradually to babies beginning at four months, preferably while still breastfeeding, may help to prevent celiac disease, according to a study involving two groups of Swedish infants born in different years.
The research study, published online yesterday in the journal Pediatrics, found a significantly reduced prevalence of celiac disease in a group of 12-year-olds born in 1997, a year when experts recommended introducing gluten-containing products when babies were four months old. Those children were compared to a group of 12-year-olds born in 1993, when experts were recommending beginning gluten foods at six months old.
The 12-year-olds born in 1997 also were raised when it was more common to breastfeed for longer periods of time, according to the study.
"We have shown a reduced prevalence of celiac disease in 12-year-olds born in 1997 compared with 1993, indicating that celiac disease can be avoided in some genetically predisposed children, at least up to 12 years of age," the researchers said. "Our findings suggest that the infant feeding recommendation (to gradually introduce gluten-containing foods in small amounts from four months of age, preferably during ongoing breastfeeding) is favorable."
This gluten-introduction strategy didn't prevent all cases of celiac disease -- there were still plenty of cases among the 1997 group. In total, 22 out of every 1,000 babies born in 1997 developed the condition by age 12, compared to 29 out of every 1,000 babies born in 1993.
However, the difference between the two groups indicate that the revised gluten introduction recommendations -- start at four months instead of at six months, go slowly, and continue breastfeeding -- likely had some effect, the study's authors said.
Sweden experienced what it calls an epidemic of celiac disease between 1984 and 1996 in children younger than two years old: according to Sweden's comprehensive national medical record database, there was a fourfold increase in celiac beginning in 1984, with a comparable decrease one decade later. That epidemic has been attributed to differences in the prevailing recommendations for infant feeding in those years.
This study adds weight to the body of research indicating early introduction of gluten, plus breastfeeding, can affect celiac disease diagnoses. Still, it's not clear whether it's possible to prevent celiac disease entirely by changing the age at which gluten is introduced, or whether susceptible children still will develop celiac, but at a later age.
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