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Gluten Introduction and The Risk of Coeliac Disease

Background: The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) recommended in 2008, based on observational data, to avoid both early (less than 4 months) and late (7 or more months) introduction of gluten and to introduce gluten while the infant is still being breastfed. New evidence prompted ESPGHAN to revise these recommendations.

Objective: To provide updated recommendations regarding gluten introduction in infants and the risk of developing coeliac disease (CD) during childhood.

SUMMARY: The risk of inducing CD through a gluten-containing diet exclusively applies to persons carrying at least one of the CD risk alleles. Since genetic risk alleles are generally not known in an infant at the time of solid food introduction, the following recommendations apply to all infants, although they are derived from studying families with first-degree relatives with CD. Although breastfeeding should be promoted for its other well-established health benefits, neither any breastfeeding nor breastfeeding during gluten introduction has been shown to reduce the risk of CD. Gluten may be introduced into the infant's diet anytime between 4-12 completed months of age. In children at high risk for CD, earlier introduction of gluten (4 vs. 6 mo or 6 vs. 12 mo) is associated with earlier development of CD autoimmunity (defined as positive serology) and CD, but the cumulative incidence of each in later childhood is similar. Based on observational data pointing to the association between the amount of gluten intake and risk of CD, consumption of large quantities of gluten should be avoided during the first weeks after gluten introduction and during infancy. However, the optimal amounts of gluten to be introduced at weaning have not been established.

(C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

 

Read the referenced Article on Journal of Pediatric Gastroenterology & Nutrition
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