TUESDAY, Sept. 29, 2020 — Childhood risk for developing the allergic/autoimmune disorder known as celiac disease might be eliminated if infants were exposed to gluten as early as 4 months of age, new British research suggests.
The observation is based on work with 1,300 infants. Half were exposed to solid foods — including wheat protein — at an age that conflicts with current breastfeeding guidelines. Among those who were, none developed celiac disease.
“It was a surprise,” said study author Dr. Gideon Lack. “But if this study is correct, it would indicate that in order to prevent the development of celiac disease, we would need to introduce significant quantities of wheat into a baby’s diet as of 4 months of life.”
But the finding is not the final word on the subject, cautioned Lack, a professor of pediatric allergy and immunology at King’s College London.
“This is one study with a relatively small number of patients,” he said. “And, therefore, it cannot be regarded as conclusive, and clearly demands further study and investigation.”
Celiac disease is an inflammatory condition where consuming gluten damages the small intestine. It can cause poor absorption of nutrients.
“In some ways it’s an allergic disease inasmuch as it is triggered by eating gluten, which is a major wheat constituent, although it’s also present in barley and rye,” Lack said. “And in other ways it is an autoimmune disease, in that the body launches an immune response, and that response becomes redirected against the lining of the small intestine.”
About 1% of the population is affected, he added. In children, celiac disease it can go undiagnosed for many years, leading to poor growth and malnutrition. In adults, it can cause bone-thinning, fatigue and in rare cases, colon cancer.
Celiac patients can manage by avoiding gluten altogether. But there is no known way to prevent the onset of celiac disease. Current guidelines stipulate that celiac risk is not affected by the age at which one is first exposed to gluten.
But Lack and his colleagues put that wisdom to the test during a broad investigation that examined food allergy risk as a whole, rather than celiac disease, specifically.
The team focused on 1,300 English and Welsh infants who were enrolled in a food study between 2009 and 2012.
All had been exclusively breastfed until 13 weeks of age. After that, half continued to be exclusively breastfed through their sixth month. The other half was also exposed to potentially allergy-provoking foods.
Those foods included cow’s milk, eggs, peanuts, sesame, cod fish and wheat. (The team aimed to include about 4 grams of wheat protein per week, which contains about 3 grams of gluten.)
By age 3, there were seven cases of celiac disease among the breastfeeding group, but zero among the group that was exposed to wheat early.
The American Academy of Pediatrics, the U.S. Centers for Disease Control and Prevention and the U.K. government all urge parents to breastfeed exclusively for six months, giving babies no additional foods or fluids unless medically recommended. The CDC says this “provides your child with ideal nutrition and supports growth and development.”
Lona Sandon is a program director in the Department of Clinical Nutrition at UT Southwestern Medical Center in Dallas, and reviewed the study. If the findings hold up, she said, big changes could ensue.
“This is one of those studies that makes you think that we — as in pediatricians, ob-gyns, dietitians and physician assistants — have been giving parents the wrong advice for years with the message of exclusive breastfeeding and limited introduction of regular foods before 6 months,” Sandon said.
Breastfeeding is an important means for conferring “immune enhancing factors,” she stressed. But infancy is also when children “form and learn to coexist with bacteria, viruses and other foreign substance like proteins found in foods,” including gluten in wheat.
“By not exposing infants to the common allergens in foods early on, it is theoretically possible the immune system is not being prepared to be robust enough to handle these foods,” Sandon said.
But she said it’s too soon to change practice. More research is needed, Sandon said, adding, “It’s always a bit risky to change advice based on one study.”
The findings were published online Sept. 28 in JAMA Pediatrics.
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