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Published on: December 15, 2011
Infant feeding and anti-tissue transglutaminase antibody concentrations in the Generation R Study
Michelle A E Jansen1, Ilse I M Tromp1, Jessica C Kiefte-de Jong1
1From the Generation R Study Group (MAEJ, IIMT, and VWVJ) and the Departments of Pediatrics (MAEJ, IIMT, VWVJ, and HAM), Epidemiology (JCK-dJ, VWVJ, and AH), Pediatric Gastroenterology (JCE), and Immunology (HH), Erasmus MC, University Medical Center, Rotterdam, Netherlands.
Insights
Introducing gluten later than 6 months does not increase celiac disease autoimmunity risk. Extended breastfeeding for 6 months or more does not decrease this risk in children.
Area of Science:
- Pediatric gastroenterology
- Immunology
- Nutritional science
Background:
- Celiac disease (CD) is a prevalent, often undiagnosed condition.
- Infant nutrition's role in CD development is studied, but findings are inconsistent.
- Infant feeding practices may differentially affect potential CD forms.
Purpose of the Study:
- To investigate the association between gluten introduction timing and breastfeeding duration with celiac disease autoimmunity (CDA) at age 6.
- To analyze if early or delayed gluten introduction impacts CDA risk.
- To determine if breastfeeding duration influences CDA development.
Main Methods:
- Prospective cohort study (Generation R) of 1679 children positive for HLA-DQ2/DQ8.
- Questionnaire data collected on gluten introduction timing (<6 mo vs. ≥6 mo) and breastfeeding duration (<6 mo vs. ≥6 mo).
- Serum anti-tissue transglutaminase (anti-tTG) analyzed at age 6; logistic regression performed.
Main Results:
- 43 children (2.6%) had positive anti-tTG concentrations; 26 had concentrations ≥10 times the upper limit of normal (ULN).
- Gluten introduction at or after 6 months was not significantly associated with positive anti-tTG.
- Breastfeeding for ≥6 months was not significantly associated with positive anti-tTG.
- Neither gluten timing nor breastfeeding duration showed significant association with anti-tTG levels below or above 10x ULN.
Conclusions:
- Delayed gluten introduction beyond 6 months does not elevate the risk of developing celiac disease autoimmunity.
- Extended breastfeeding (≥6 months) does not reduce the risk of celiac disease autoimmunity in children by age 6.
- Current infant feeding guidelines regarding gluten and breastfeeding may need re-evaluation for CDA prevention.
Background:
Celiac disease (CD) has emerged as a common, but largely undiagnosed health problem. Numerous studies examined the influence of infant nutrition on the development of diagnosed CD. However, results are still inconsistent. In addition, the effect of infant feeding practices on the development of potential forms of CD might be different.
Objective:
The objective was to examine whether the timing of gluten introduction and breastfeeding duration are associated with CD autoimmunity (CDA) in children at the age of 6 y.
Design:
This study was embedded in the Generation R Study, a population-based prospective cohort study. Participants included 1679 Dutch children who were positive for human leukocyte antigen (HLA) DQ2/DQ8. Data on the timing of gluten introduction (<6 mo compared with ≥6 mo) and duration of breastfeeding (<6 mo compared with ≥6 mo) were obtained by questionnaire. Serum samples were analyzed for anti-tissue transglutaminase (anti-tTG) concentrations at age 6 y. Anti-tTG concentrations were categorized into negative (<7 U/mL) and positive (≥7 U/mL) values. Positive anti-tTG concentrations were further categorized based on ≥10 times the upper limit of normal (ULN) values of the test kit (≥7-70 and ≥70 U/mL). Multivariable logistic regression analyses were performed.
Results:
Positive anti-tTG concentrations were found in 43 children, 26 of whom had concentrations ≥10 times the ULN (≥70 IU/mL). The introduction of gluten from the age of 6 mo onward and breastfeeding for ≥6 mo were not significantly associated with positive anti-tTG concentrations. In addition, the timing of gluten introduction and duration of breastfeeding were not significantly associated with positive anti-tTG concentrations below or above 10 times the ULN.
Conclusions:
Delayed introduction of gluten beyond the age of 6 mo does not increase the risk of CDA. In addition, breastfeeding for ≥6 mo does not decrease the risk of CDA in children at 6 y of age.
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