Primary Prevention of Celiac Disease: Environmental Factors with a Focus on Early Nutrition
Celiac disease (CD) is a common autoimmune disordercaused by ingestion of gluten. When diagnosed, it should betreated with a lifelong, strict gluten-free diet. Early infantfeeding practices have been suggested as a means of preventingCD. In the last few decades, observational data havesuggested that breastfeeding, especially at the time of introducinggluten into the infant’s diet, as well as the time and mode of gluten first being given to a child could prevent ordelay the occurrence of CD. As a result, recommendationsadvised that it is prudent to avoid both early (<4 months) andlate (>7 months) introduction of gluten, and to introducegluten gradually while the infant is still being breastfed, asthis may reduce the risk of celiac disease, type 1 diabetesmellitus, and wheat allergy. Recently, the results of two largerandomized trials have shown that breastfeeding in general,breastfeeding during gluten introduction, and early or delayedgluten introduction do not influence the total risk ofCD in genetically predisposed individuals. Introducing glutenat 4 versus 6 months in very small amounts, or at 6 versus12 months, resulted in similar rates of CD in these children.Thus, early feeding practices seem to have no impact on therisk of developing CD during childhood. In children withoutthe genetic predisposition, the age and mode of gluten introductiondo not influence the risk anyway.