Last Updated: 2008-10-01 17:28:46 -0400 (Reuters Health)
By Will Boggs, MD
NEW YORK (Reuters Health) - Differences in celiac disease risk between Swedish birth cohorts suggest that infant feeding patterns contribute to the disease, according to a new report by investigators in Sweden.
"The current study indicates both short- and long-term consequences of infant feeding on celiac disease risk, i.e., abrupt introduction of gluten without ongoing breastfeeding might contribute to increased celiac disease risk even later in childhood," Cecilia Olsson from Umea University told Reuters Health.
Olsson and colleagues analyzed celiac disease risk in birth cohorts before and after an epidemic of celiac disease in children under 2 years of age to explore the opportunity for primary prevention.
The start of the epidemic in 1984 coincided with implementation of national feeding recommendations for infants which postponed the introduction of gluten-containing foods from 4 to 6 months of age, the investigators explain in the September issue of Pediatrics.
The incidence of celiac disease more than tripled after adoption of the new feeding recommendations, the authors report. When the recommendations were changed again (suggesting introduction of gluten-containing foods in increasing amounts at 4 to 6 months of age, preferably while the infant was still breast-feeding), the incidence declined significantly but then increased again from 2000 to 2003, the last year of the study.
"Only longer follow-up monitoring will reveal whether the increase in incidence rates in children <2 years seen between 2000 and 2003 is an ongoing trend," the researchers note. "Only one half of the epidemic was explained by changes in infant feeding. Consequently, other, still unknown, environmental exposures contributed to the change in disease occurrence."
"Further studies are needed to explore the role of potentially contributing exposures operating during different parts of the life span," Olsson said. "The possible role of the increasing consumption of wheat-based food and processing of cereals and other foods should be given priority. If general dietary patterns can be identified as contributors to increased celiac disease risk, implementation of dietary guidelines and/or modification of food processing might have considerable public health effects."
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Pediatrics 2008;122:528-534.