Celiac Disease: When Should Gluten Be Introduced to Infants?

Ketil Stordal Researcher/consultant paediatrician National Institute of Public Health NorwayMedicalResearch.com Interview with:
Ketil Stordal
Researcher/consultant paediatrician
National Institute of Public Health

What are the main findings of the study?

Answer: The study identified 324 children with celiac disease from a cohort of 82 000. Start of gluten in the diet later than 6 months was associated with a 27% increased risk of celiac disease compared to those starting during the 5th or 6th month of life. Breastfeeding was not protective; the duration of breastfeeding was slightly longer among children with celiac disease (10.4 vs 9.9 months) and breastfeeding at the time of gluten introduction was not associated with the later risk of celiac disease. The participating mothers had submitted detailed data since pregnancy including infant feeding practices, and these were collected before onset of the disease.

MedicalResearch.com: Were any of the findings unexpected?

Answer: An unexpected finding was that breastfeeding was not protective. Early introduction of gluten before 5 months age was not associated with increased risk, but this practice was unusual in the population and is likely explained by lack of power in the study.

MedicalResearch.com: What should clinicians and patients take away from your report?

Answer: The study supports that there could be a time window in which the infants should be introduced to gluten, as this may induce tolerance to the protein. The lack of protection from breastfeeding does not change the importance of breastfeeding for other disease outcomes.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Answer: The findings of the study should be replicated in other similar cohorts. Randomized trials comparing introduction of gluten from four months compared to six months should be carried out to build the knowledge for infant feeding recommendations.


Early Feeding and Risk of Celiac Disease in a Prospective Birth Cohort
Ketil Størdal, Richard A. White, and Merete Eggesbø
Pediatrics peds.2013-1752; published ahead of print October 7, 2013, doi:10.1542/peds.2013-1752


Last Updated on October 8, 2013 by Marie Benz MD FAAD