Celiac disease is a genetic autoimmune disease affecting the gut and other organs, developing in response to consumption of gluten. Those at risk were previously advised to avoid both early (less than 4 months) and late (7 months or later) introduction, based on observational studies suggesting that this approach reduced the risk for celiac disease.
Now two randomized controlled trials have shown that the age at gluten introduction does not affect overall rates of celiac disease during childhood. And observational evidence shows no difference in celiac disease risk when gluten is introduced while the infant is still breastfeeding, compared to after weaning, as previously thought. The results of these trials were published in Pediatrics, the official journal of the American Academy of Pediatrics.
"These findings suggest that primary prevention of celiac disease through nutritional interventions is not possible at the present time," said Professor Szajewska, lead author of the paper.
Updated recommendations now say gluten may be introduced anytime between four to 12 months of age, based on studies of infants with known risk genes for celiac disease.
Occurring only in persons carrying one or more susceptibility genes, celiac disease affects approximately 1 to 3 percent of the general population in most parts of the world. Celiac disease risk genes, however, are present in 30 to 40 percent of the general European population, as well as in 75 to 80 percent of children who have a close relative with celiac disease.
For now, there is not enough evidence to make specific recommendations for infants with a family history of celiac disease, and the authors say further studies are needed to determine the best approaches to introducing gluten into the diet.