Infections occurring early in life, a high-gluten diet and discontinuation of breastfeeding before gluten introduction can increase the risk for celiac disease among infants, according to recent results.
In a population-based, incident case-control study, researchers evaluated data from 373 children aged younger than 2 years with celiac disease (CD), along with 581 matched controls randomly selected from the national population register in Sweden. Patients’ parents responded to a questionnaire regarding the child’s first years of life, with topics including incidence of early infections — defined as fever or common childhood infections occurring before age 6 months —demographic information and feeding habits at infancy.
Factors associated with risk for CD included lower socioeconomic status (adjusted OR=1.3, 1.0-1.8) and continuation of breastfeeding during the same month as gluten introduction (OR=0.55, 0.39-0.78) and beyond (OR=0.32, 0.23-0.45). A large daily consumption of flour (16 g or more) 2 weeks after initial gluten offering also was linked to elevated disease risk (OR=1.9, 1.4-2.6 compared with those receiving smaller amounts of gluten) (95% CI for all).
The incidence of three or more infectious episodes within the first 6 months occurred in 132 cases and 159 controls, and was significantly associated with increased risk for CD after adjustment for socioeconomic status and feeding habits (OR=1.5; 95% CI,1.1-2.0). This risk was further elevated among infants who had stopped breastfeeding before gluten introduction, and was highest among those who received large amounts of gluten 2 weeks after introduction (OR=5.6; 95% CI, 3.1-10).
“This study suggests that having repeated infectious episodes early in life increases the risk for later celiac disease,” the researchers wrote. “In addition, we found a synergistic effect between early infections and daily amount of gluten intake, more pronounced among infants when breastfeeding had been discontinued prior to gluten introduction. This synergistic effect substantiates the importance of breastfeeding with respect to celiac disease risk, especially in a setting with high infectious load.”