Pediatrics 2013 Oct 07;[EPub Ahead of Print], K Størdal, RA White, M Eggesbø

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When should gluten be introduced to minimize the risk of celiac disease in children?
A Norwegian birth cohort of > 100,000 children was analyzed in which gluten introduction was reported monthly from 0 to 6 months of age and breastfeeding from 0 to 18 months.
Children who were introduced to gluten after age 6 months and children breastfed after age 12 months were at a higher risk for celiac disease.
ABSTRACT

Objectives: Timing of gluten introduction has been associated with the risk of celiac disease (CD) in children, but the optimal time window is unknown. We aimed to study the effect of age of gluten introduction on the risk of CD, adjusting for continued breastfeeding.

Methods: In The Norwegian Mother and Child Cohort Study, a prospective birth cohort including 107 000 children, CD was identified by questionnaires and by linkage to the Norwegian Patient Register. Gluten introduction was reported monthly from 0 to 6 months of age, and breastfeeding from 0 to 18 months.

Results: After exclusion of cases with insufficient information, 324 children with CD in a cohort of 82 167 were used in the analyses. Gluten was introduced before or at 4 months in 8.0%, 5 to 6 months in 45.3%, and after 6 months in 46.6%, whereas continued breastfeeding was stable at ∼78% at 6 months age. CD was diagnosed in 3.68/1000 of the infants with gluten introduction at 5 to 6 months compared with 4.15/1000 with late and 4.24/1000 with early gluten introduction. After adjustment for the child’s age and gender, breastfeeding, and maternal CD, delayed gluten introduction was associated with an increased risk of CD (adjusted odds ratio, 1.27 [95% confidence interval, 1.01–1.65], P = .045). Breastfeeding >12 months was also associated with increased risk (adjusted odds ratio, 1.49 [95% confidence interval, 1.01–2.21], P = .046).

Conclusions: We found an increased risk of CD in children introduced to gluten after 6 months and a higher risk in children breastfed after 12 months age.

Journal Abstract:  http://pediatrics.aappublications.org/content/early/2013/10/02/peds.2013-1752