DOI QR코드

DOI QR Code

Early Infant Feeding Practices May Influence the Onset of Symptomatic Celiac Disease

  • Vajpayee, Shailja (Department of Pediatric Medicine, Sir Padampat Mother and Child Health Institute, Swai Man Singh Medical College) ;
  • Sharma, Shiv Dayal (Department of Pediatric Medicine, Sir Padampat Mother and Child Health Institute, Swai Man Singh Medical College) ;
  • Gupta, Rajkumar (Department of Pediatric Medicine, Sir Padampat Mother and Child Health Institute, Swai Man Singh Medical College) ;
  • Goyal, Alok (Department of Pediatric Medicine, Sir Padampat Mother and Child Health Institute, Swai Man Singh Medical College) ;
  • Sharma, Aakash (Department of Pediatric Medicine, Sir Padampat Mother and Child Health Institute, Swai Man Singh Medical College)
  • Received : 2016.06.16
  • Accepted : 2016.10.01
  • Published : 2016.12.30

Abstract

Purpose: To study whether breastfeeding and breastfeeding status during gluten introduction influences the age at diagnosis of celiac disease (CD). In addition to study, whether the timing of gluten introduction influences the age at diagnosis of CD. Methods: It was a hospital based observational study. Total 198 patients diagnosed with CD as per modified European Society of Pediatric Gastroenterology, Hepatology and Nutrition (2012) criteria, aged between 6 months to 6 years were included. Detail history taken with special emphasis on breastfeeding and age of gluten introduction. Standard statistical methods used to analyze the data. Results: $Mean{\pm}standard$ deviation age of onset and diagnosis of CD in breastfed cases was $2.81{\pm}1.42$ years and $3.68{\pm}1.55$ years respectively as compared to $1.84{\pm}1.36$ years and $2.70{\pm}1.65$ years respectively in not breastfed cases (p<0.05). Those who had continued breastfeeding during gluten introduction and of longer duration had significantly delayed onset of disease. The age at onset of CD was under one year in 40.42% of the cases, who had started gluten before 6 months of age compared to only 12.58% of those who had started gluten later (p<0.001). The proposed statistical model showed that two variables, i.e., breast feeding status during gluten introduction and age at gluten introduction positively influencing the age at diagnosis of CD. Conclusion: Delayed gluten introduction to infant's diet along with continuing breastfeeding, delays symptomatic CD. However, it is not clear from our study that these infant feeding practices provide permanent protection against the disease or merely delays the symptoms.

Keywords

References

  1. Husby S, Koletzko S, Korponay-Szabo IR, Mearin ML, Phillips A, Shamir R, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr 2012;54:136-60. https://doi.org/10.1097/MPG.0b013e31821a23d0
  2. Stankovic B, Radlovic N, Lekovic Z, Ristic D, Radlovic V, Nikčevic G, et al. HLA genotyping in pediatric celiac disease patients. Bosn J Basic Med Sci 2014;14:171-6. https://doi.org/10.17305/bjbms.2014.3.28
  3. Radlovic NP, Mladenovic MM, Lekovic ZM, Stojsic ZM, Radlovic VN. Influence of early feeding practices on celiac disease in infants. Croat Med J 2010;51:417-22. https://doi.org/10.3325/cmj.2010.51.417
  4. Akobeng AK, Ramanan AV, Buchan I, Heller RF. Effect of breast feeding on risk of coeliac disease: a systematic review and meta-analysis of observational studies. Arch Dis Child 2006;91:39-43.
  5. Silano M, Agostoni C, Guandalini S. Effect of the timing of gluten introduction on the development of celiac disease. World J Gastroenterol 2010;16:1939-42. https://doi.org/10.3748/wjg.v16.i16.1939
  6. Norris JM, Barriga K, Hoffenberg EJ, Taki I, Miao D, Haas JE, 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. https://doi.org/10.1001/jama.293.19.2343
  7. Tadele N, Habta F, Akmel D, Deges E. Knowledge, attitude and practice towards exclusive breastfeeding among lactating mothers in Mizan Aman town, Southwestern Ethiopia: descriptive cross-sectional study. Int Breastfeeding J 2016;11:3. https://doi.org/10.1186/s13006-016-0062-0
  8. Hernell O, Ivarsson A, Persson LA. Celiac disease: effect of early feeding on the incidence of the disease. Early Hum Dev 2001;65 Suppl:S153-60. https://doi.org/10.1016/S0378-3782(01)00217-1
  9. Laass MW, Schmitz R, Uhlig HH, Zimmer KP, Thamm M, Koletzko S. The prevalence of celiac disease in children and adolescents in Germany. Dtsch Arztebl Int 2015;112:553-60.
  10. Catassi C, Anderson RP, Hill ID, Koletzko S, Lionetti E, Mouane N, et al. World perspective on celiac disease. J Pediatr Gastroenterol Nutr 2012;55:494-9. https://doi.org/10.1097/MPG.0b013e318272adf4
  11. Gupta R, Reddy DN, Makharia GK, Sood A, Ramakrishna BS, Yachha SK, et al. Indian task force for celiac disease: current status. World J Gastroenterol 2009; 15:6028-33. https://doi.org/10.3748/wjg.15.6028
  12. Sood A, Midha V, Sood N, Kaushal V, Puri H. Increasing incidence of celiac disease in India. Am J Gastroenterol 2001;96:2804-5. https://doi.org/10.1111/j.1572-0241.2001.04150.x
  13. Greco L, Auricchio S, Mayer M, Grimaldi M. Case control study on nutritional risk factors in celiac disease. J Pediatr Gastroenterol Nutr 1988;7:395-9. https://doi.org/10.1097/00005176-198805000-00013
  14. Peters U, Schneeweiss S, Trautwein EA, Erbersdobler HF. A case-control study of the effect of infant feeding on celiac disease. Ann Nutr Metab 2001;45:135-42. https://doi.org/10.1159/000046720
  15. Falth-Magnusson K, Franzen L, Jansson G, Laurin P, Stenhammar L. Infant feeding history shows distinct differences between Swedish celiac and reference children. Pediatr Allergy Immunol 1996;7:1-5. https://doi.org/10.1111/j.1399-3038.1996.tb00098.x
  16. Hanson LA, Korotkova M, Håversen L, Mattsby-Baltzer I, Hahn-Zoric M, Silfverdal SA, et al. Breastfeeding, a complex support system for the offspring. Pediatr Int 2002;44:347-52. https://doi.org/10.1046/j.1442-200X.2002.01592.x
  17. Sollid LM. Breast milk against coeliac disease. Gut 2002;51:767-8. https://doi.org/10.1136/gut.51.6.767
  18. Mincheva-Nilsson L, Hammarstrom ML, Juto P, Hammarstrom S. Human milk contains proteins that stimulate and suppress T lymphocyte proliferation. Clin Exp Immunol 1990;79:463-9.
  19. Rautava S, Walker WA. Academy of breastfeeding medicine founder's lecture 2008: breastfeeding--an extrauterine link between mother and child. Breastfeed Med 2009;4:3-10. https://doi.org/10.1089/bfm.2009.0004
  20. Newburg DS. Innate immunity and human milk. J Nutr 2005;135:1308-12. https://doi.org/10.1093/jn/135.5.1308
  21. Szajewska H, Shamir R, Mearin L, Ribes-Koninckx C, Catassi C, Domellof M, et al. Gluten introduction and the risk of coeliac disease: a position paper by the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr 2016; 62:507-13. https://doi.org/10.1097/MPG.0000000000001105
  22. Szajewska H, Shamir R, Chmielewska A, Pieścik-Lech M, Auricchio R, Ivarsson A, et al. Systematic review with meta-analysis: early infant feeding and celiac disease--update 2015. Aliment Pharmacol Ther 2015;41:1038-54. https://doi.org/10.1111/apt.13163
  23. World Health Organization. Infant and young child feeding. Fact sheet. Updated January 2016. Available from: www.who.int/mediacentre/factsheets/fs342/en/.

Cited by

  1. Eosinophilic Esophagitis: Leaky Gullet or Leaky Gut? vol.112, pp.7, 2016, https://doi.org/10.1038/ajg.2017.136
  2. Diagnostic challenges of celiac disease in a young child : A case report and a review of the literature vol.97, pp.22, 2016, https://doi.org/10.1097/md.0000000000010893