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

Pinto-Sánchez MI, Verdu EF, Liu E, Bercik P, Green PH, Murray JA, Guandalini S, Moayyedi P.

J Pediatr. 2016 Jan;168:132-143.e3.

PMID:26500108

Abstract

OBJECTIVE:
To assess the evidence regarding the effect of time of gluten introduction and breastfeeding on the risk of developing celiac disease (CD).

STUDY DESIGN:
We included randomized controlled trials and observational studies evaluating the proper timing for introducing gluten to the infant diet, the appropriate quantity of gluten consumption at weaning, and the effect of breastfeeding on CD risk. Studies were located through the electronic databases Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), EMBASE (Ovid), and System for Information on Grey Literature in Europe (SIGLE). Two independent authors collected the data.

RESULTS:
A total of 1982 studies were identified, 15 of which were eligible for data extraction. A meta-analysis was performed on 2 randomized controlled trials, 10 cohort studies, and 1 case-control study. There was a 25% increase in CD risk with late (>6 months) vs recommended (4-6 months) gluten introduction (risk ratio [RR], 1.25; 95% CI, 1.08-1.45). There was no significant effect of breastfeeding vs no breastfeeding on CD risk (OR, 0.55; 95% CI, 0.28-1.10), with substantial heterogeneity (I(2) = 92%) among studies.

CONCLUSION:
There is currently no evidence to support that early introduction of gluten to the infant diet increases the risk of CD; however, late introduction of gluten may be associated with increased risk of CD. More studies are needed that control for potential confounders and that evaluate environmental factors in low-risk families.

There is currently no evidence to support that early introduction of gluten to infant diet increases the risk of CD. However, late introduction of gluten may be associated with increased risk of CD. There was no significant effect of breast-feeding versus no breast-feeding on CD risk

Environmental factors, such as time of gluten introduction to infant diet and breastfeeding may influence CD risk. However, the evidence remains controversial. We conducted a meta-analysis to assess the evidence on time of gluten introduction and breastfeeding on the risk of developing CD. We included randomized controlled trials (RCTs) and observational studies (OS) evaluating: the right timing for gluten introduction to infant’ diet; appropriate quantities of gluten consumption at weaning; and the effect of breast-feeding on CD risk. We found a 25% increase on CD risk with late (>6 months) versus recommended (4-6 months) gluten introduction There was no significant effect of breast-feeding versus no breast-feeding on CD risk.

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