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aklap

Joined: 02 Oct 2004
Posts: 10519
Location: WI, USA

Posted: Wed Sep 06, 2006 6:22 pm Post subject: Timing of Gluten Intro to Infants (2005)

Risk of celiac disease autoimmunity and timing of gluten introduction in the diet of infants at increased risk of disease. (2005)

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15900004&query_hl=1&itool=pubmed_docsum

Quote:

1: JAMA. 2005 May 18;293(19):2343-51. Links
Comment in:
JAMA. 2005 May 18;293(19):2410-2.

Norris JM,
Barriga K,
Hoffenberg EJ,
Taki I,
Miao D,
Haas JE,
Emery LM,
Sokol RJ,
Erlich HA,
Eisenbarth GS,
Rewers M.
Department of Preventive Medicine and Biometrics, University of Colorado at Denver and Health Sciences Center, Denver, CO 80262, USA. jill.norris@uchsc.edu

CONTEXT: While gluten ingestion is responsible for the signs and symptoms of celiac disease, it is not known what factors are associated with initial appearance of the disease.

OBJECTIVE: To examine whether the timing of gluten exposure in the infant diet was associated with the development of celiac disease autoimmunity (CDA).

DESIGN, SETTING, AND PATIENTS: Prospective observational study conducted in Denver, Colo, from 1994-2004 of 1560 children at increased risk for celiac disease or type 1 diabetes, as defined by possession of either HLA-DR3 or DR4 alleles, or having a first-degree relative with type 1 diabetes. The mean follow-up was 4.8 years.

MAIN OUTCOME MEASURE: Risk of CDA defined as being positive for tissue transglutaminase (tTG) autoantibody on 2 or more consecutive visits or being positive for tTG once and having a positive small bowel biopsy for celiac disease, by timing of introduction of gluten-containing foods into the diet.

RESULTS: Fifty-one children developed CDA. Findings adjusted for HLA-DR3 status indicated that children exposed to foods containing wheat, barley, or rye (gluten-containing foods) in the first 3 months of life (3 [6%] CDA positive vs 40 [3%] CDA negative) had a 5-fold increased risk of CDA compared with children exposed to gluten-containing foods at 4 to 6 months (12 [23%] CDA positive vs 574 [38%] CDA negative) (hazard ratio [HR], 5.17; 95% confidence interval [CI], 1.44-18.57). Children not exposed to gluten until the seventh month or later (36 [71%] CDA positive vs 895 [59%] CDA negative) had a marginally increased risk of CDA compared with those exposed at 4 to 6 months (HR, 1.87; 95% CI, 0.97-3.60). After restricting our case group to only the 25 CDA-positive children who had biopsy-diagnosed celiac disease, initial exposure to wheat, barley, or rye in the first 3 months (3 [12%] CDA positive vs 40 [3%] CDA negative) or in the seventh month or later (19 [76%] CDA positive vs 912 [59%] CDA negative) significantly increased risk of CDA compared with exposure at 4 to 6 months (3 [12%] CDA positive vs 583 [38%] CDA negative) (HR, 22.97; 95% CI, 4.55-115.93; P = .001; and HR, 3.98; 95% CI, 1.18-13.46; P = .04, respectively).

CONCLUSION: Timing of introduction of gluten into the infant diet is associated with the appearance of CDA in children at increased risk for the disease.

PMID: 15900004 [PubMed - indexed for MEDLINE]

Is the timing of infant cereal introduction a risk factor for celiac disease autoimmunity?

http://www.cmaj.ca/cgi/content/full/173/11/1324

Quote:

Jeanette E. Belanger* and Eric Wooltorton
*PGY2 Resident, Department of Family Medicine, University of Ottawa, Ottawa, Ont.; CMAJ

Norris JM, Barriga K, Hoffenberg EJ, et al. Risk of celiac disease autoimmunity and timing of gluten introduction in the diet of infants at increased risk of disease. JAMA 2005:293:2343-51.

Background: Celiac disease, or gluten-sensitive enteropathy, has an estimated prevalence of 1% in North America and Western Europe.1 A diet of wheat gluten, rye and barley appears to trigger chronic inflammation in the small intestine. Typically, affected patients present in early childhood with abdominal cramps, diarrhea, malabsorption and nutrient deficiencies. In the past, parents often fed their children infant cereal, which contains gluten, from birth. Now, parents are advised to wait until children are 4–6 months of age before introducing cereal into their diet. More recently, the Canadian Pediatric Society has advocated breastfeeding only (i.e., no infant cereal) until the infant is 6 months of age.2 The link between when gluten is introduced into an infant's diet and the risk of celiac disease autoimmunity is unknown.

Design: This was a prospective observational study involving 1560 children born in Denver, Colorado, who were at risk of type 1 diabetes or celiac disease on the basis of genetic tests for specific human leukocyte antigens (HLA-DR3 or DR4) of their cord blood or a family history of a first-degree relative with type 1 diabetes. Histories of the infants' diets were collected when the children were 3, 6, 9, 12 and 15 months of age. At each interview mothers were asked to report their child's intake of all types of milk, formula and foods over the last 3 months. Breastfeeding start and termination dates were also recorded. The children had blood tests for tissue transglutaminase (tTG) autoantibodies at 9, 15 and 24 months and yearly thereafter. Children were deemed to have celiac disease autoimmunity if 2 tGT autoantibody test results were positive or 1 tTG test and a small bowel biopsy were positive. Follow-up lasted for a mean of 4.8 years.

Results: Of the 1560 children, 51 developed celiac disease autoimmunity. Infants exposed to gluten in the first 3 months of life had a 5-fold increased risk of autoimmunity compared with infants first exposed at 4–6 months (hazard ratio [HR] 5.17, 95% confidence interval [CI] 1.44–18.57). Infants introduced to gluten at 7 months or later also had an increased risk of celiac disease autoimmunity compared with those exposed between 4 and 6 months (HR 1.87, 95% CI 0.97–3.60). The risk of autoimmunity was independent of the age of first exposure to rice and oats. Breastfeeding duration was similar for children who developed autoimmunity and those who did not.

Commentary: The study's strengths are its prospective nature, its frequent and relatively detailed dietary histories, and the number of children studied. Its limitations include possible recall biases, problems with generalizing the risk estimates to other populations, and possible problems with reliability and validity of the results. For example, although 1560 children were studied, the primary outcome (celiac disease autoimmunity) was relatively rare. Only 51 children in total developed celiac disease autoimmunity, and only 3 of the children exposed before 3 months of age developed it. Further, the development of celiac disease autoantibodies is only a proxy for the more clinically relevant outcome of celiac disease (only 25 children went on to have biopsy-proven disease).

Practice implications: The World Health Organization (WHO) recommends exclusive breastfeeding until 6 months of age to protect children from gastrointestinal infections, to prolong lactational amenorrhea and to increase postpartum maternal weight loss. The results of this study did not show that breastfeeding protected against celiac disease autoimmunity. However, at least for children predisposed to celiac disease or type 1 diabetes, avoiding cereal with wheat, rye or barley until a child is 4–6 months of age appears to reduce the risk of autoimmunity. Starting cereal before 3 months or after 7 months appears to increase the risk. Thus, although current recommendations in Canada and from the WHO are to breastfeed exclusively until at least 6 months of age, the results of this study suggest that it may be wise to consider introducing cereals at around the sixth month.

REFERENCES

Farrell R. Infant gluten and celiac disease. Too early, too late, too much, too many questions. JAMA 2005;293:19.
Boland M. Exclusive breastfeeding should continue to six months. Pediatrics and Child Health 2005;10:148. Available: www.cps.ca/english/statements/N/BreastfeedingMar05.htm (accessed 2005 Oct 26).

_________________
Al

“We cannot all do great things, but we can do small things with great love.” Mother Teresa

aklap

Joined: 02 Oct 2004
Posts: 10519
Location: WI, USA

Posted: Thu May 22, 2008 2:19 pm Post subject:

bump _________________ Al “We cannot all do great things, but we can do small things with great love.” Mother Teresa

aklap

Joined: 02 Oct 2004
Posts: 10519
Location: WI, USA

Posted: Mon Feb 09, 2009 4:52 pm Post subject:

bump for Carissa _________________ Al “We cannot all do great things, but we can do small things with great love.” Mother Teresa

aklap

Joined: 02 Oct 2004
Posts: 10519
Location: WI, USA

Posted: Tue Mar 24, 2009 2:58 pm Post subject:

bump _________________ Al “We cannot all do great things, but we can do small things with great love.” Mother Teresa

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