The gradual introduction of gluten-containing food in infants from 4 months of age, preferably during breast-feeding, is recommended to reduce the prevalence of celiac disease, according to new study findings.
Sweden experienced an epidemic of celiac disease from 1984 to 1996 in children aged younger than 2 years, researchers said.
The dual-phase, cross-sectional screening study was performed in which 13,279 Swedish children from two birth cohorts participated: children born during the epidemic (1993; n=7,567) and children born after the epidemic (1997; n=5,712). All of the previously diagnosed cases were reported and confirmed, according to Anneli Ivarsson, MD, PhD, and Anna Myléus, MD, PhD, of the department of public health and clinical medicine, epidemiology and global health, Umea University in Sweden, and colleagues.
The total prevalence of the disease was 29 in 1,000 (1993) and 22 in 1,000 (1997), researchers said. There was a significantly lower risk for celiac disease in children born after the celiac disease epidemic (1997) compared with during the epidemic (prevalence ratio=0.75; 95% CI, 0.60-0.93).
In the 1993 and 1997 cohorts, duration of breast-feeding was 7 and 9 months, respectively. The median age at gluten introduction was 5 months in both cohorts, but the proportion of infants with continued breast-feeding beyond the introduction was larger in the later cohort (70% vs. 78% in the 1993 and 1997 cohort, respectively, P<.001).
In 1982, infant feeding recommendations were changed by postponing the introduction of gluten from aged 4 months until 6 months, and in 1996 the recommendation was changed back to introduction at aged 4 months.
Researchers said introducing gluten during breast-feeding may increase the chance of developing oral tolerance through immune-modulating factors in breast milk and/or influence gut maturation and colonization.
Breast-feeding also has been associated with a reduced risk for gastrointestinal infections, an additional risk factor for celiac disease, according to researchers.
The researchers report no relevant financial disclosures.