Breastfeeding May Not Protect Again Gluten Sensitive Celiac Disease Interview with:
Maria Ines Pinto Sanchez, MD MSc​
Post-doctoral Clinical ​ Research Fellow and
Dr Elena Verdu, MD, PhD
Farncombe Family Digestive Health Research Institute
McMaster University
Health Sciences Centre Hamilton, ON

Medical Research: What is the background for this study? What are the main findings?

Response: Celiac disease is a condition caused by ingestion of gluten in people with genetic predisposition, in which the finger like projections of the intestinal lining are damaged by inflammation. The “celiac” genes are necessary, but not sufficient, to develop celiac disease. For this reason, it is believed that additional factors could influence the risk of a predisposed child to develop celiac disease. Some studies have indeed suggested that the ideal time for the introduction of gluten to the diet would fall between the 4th and 6th month of life, when gluten should be introduced in “small quantities” and progressively, while maintaining breastfeeding whenever possible. The Nutrition Committee of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition recommended avoiding the introduction of gluten before 4 months and after 7 months of age in an attempt to prevent celiac disease. However, not all clinical studies reached this conclusion and we therefore conducted an updated analysis of the literature published on this subject to evaluate the relationship between time and amount of gluten introduction, breastfeeding and the risk of developing celiac disease. Our systematic analysis revealed that based on the studies published to date there is no strong support that early gluten introduction to an infant’s diet increases the chances to develop celiac disease or that breastfeeding specifically protects from it.

Medical Research: What should clinicians and patients take away from your report?

Response: Our detailed systematic review of the current studies does not support that early (< 4 months) introduction of gluten to infant diet increases the risk of a child to develop celiac disease. However, our analysis revealed a mild increase in risk when late (>7 months) introduction of gluten was performed compared to recommended age of gluten introduction (4-6 months). Surprisingly the absence of breastfeeding did not impact the risk of developing celiac disease.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: In the future, studies that provide information on the optimal amounts of gluten that can be given to babies and that take into account other factors that could also influence the risk of developing celiac disease, such as infections and gut microbiota alterations, are needed. It will also be important to determine whether the results of these studies apply to the general population or only to children with high risk to develop celiac disease.


Gluten Introduction to Infant Feeding and Risk of Celiac Disease: Systematic Review and Meta-Analysis

Pinto-Sánchez, María Inés et al.

The Journal of Pediatrics Published Online:October 20, 2015

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Maria Ines Pinto Sanchez, MD MSc​; Dr Elena Verdu, MD, PhD (2015). Breastfeeding May Not Protect Again Gluten Sensitive Celiac Disease 

Last Updated on October 26, 2015 by Marie Benz MD FAAD