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New Recommendations from ESPGHAN: When is the Correct Time to Introduce Gluten in the Infants’ Diet?

Posted:  Monday, February 22, 2016

The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) has updated its recommendations regarding the timing of the introduction gluten into infants’ diets.

Coeliac disease (CD) is a unique disorder in which the consumption of gluten, in conjunction with genetic susceptibility, results in the development of an insidiously evolving autoimmune reaction affecting the gut and other organs. 

CD affects approximately 1% to 3% of the general population in most parts of the world, with the exception of South East Asia. Identifying preventive strategies that would reduce the prevalence of CD has been a major target of research in recent years; particularly with regards to the possible protective effect of breastfeeding and the most appropriate timing for the introduction of gluten to an infant’s diet. 

In 2008, the recommendation was 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. However new evidence prompted ESPGHAN to revise these recommendations. For an infant to develop CD during childhood, it needs to carry at least one of the CD risk alleles. But, since risk alleles are generally known in an infant at the time that solid food is introduced, the new recommendations should be applied to all infants. 

Key points form the new recommendations

Although breastfeeding should be promoted for its other well-established health benefits, neither 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. 

For further details of the latest ESPGHAN recommendations read the full report: 

Gluten Introduction And The Risk Of Coeliac Disease. A Position Paper By The European Society For Paediatric Gastroenterology, Hepatology & Nutrition