Introduction of Gluten to Infants at High Risk of Celiac Disease: Current Evidence

Updated: May 1

As a diagnosed celiac and mom of two young boys, I have been eagerly following the research on how feeding practices influence the development of celiac disease among infants at high risk of the disease.




Over the past 20 years, researchers have been examining the effects of breastfeeding, timing of gluten introduction and quantity of gluten introduced, on the risk of developing celiac disease among high risk infants (i.e., those with a first degree relative diagnosed with celiac disease). While findings from several studies suggest that breastfeeding may offer some protective effects for infants at high risk of celiac disease, results of a systematic review indicate that breastfeeding does not offer any protective effects against the development of celiac disease (1). Results of other studies suggest that timing of gluten introduction (i.e., before or after 4-6 months of age) may affect the development of celiac disease, however, authors of a systematic review concluded that there were no differences in development of celiac disease between early and late gluten introduction (1).*


Researchers have also been exploring how the amount of gluten in an infant’s diet may impact development of celiac disease. In 2019, results from a prospective, large-scale study (i.e., 6605 genetically at-risk children) revealed that a higher level of gluten consumption over the first 5 years of life was an independent risk factor for celiac disease (2). Genetically at-risk children who consumed a smaller amount of gluten (2 grams per day or less**) over the first 5 years of life had the lowest rates of celiac disease autoimmunity and celiac disease.


Translation – what could parents feed high risk infants and children? What does this look like in everyday life?


Through discussions with our pediatrician, we decided to introduce a small amount of gluten at 5-6 months of age. When we offer gluten, we do our best to ensure that we offer whole grain gluten containing foods or fermented gluten products (i.e., sourdough), along with an anti-inflammatory diet (think whole foods based diet rich in vegetables, fruit, protein, healthy fats, iron and low in processed foods and sugar). Overall, we aim to offer a small amount of gluten to my young boys at 2-3 meals per week, which on average equals out to about 2 grams or less per day.


Most importantly – do not put your child on a gluten-free diet before testing for celiac disease or consulting with your pediatrician as this can result in false negative test results. Please speak with your health care provider about the best approach for your family.


My primary area of research is coping with celiac disease – so please don’t let gluten introduction be a cause of stress! I do not get caught up in measuring food and if we are out and my sons have something with a larger amount of gluten or processed foods, I take a deep breath, and make a mental note to offer less gluten over the following 1-2 weeks. We are all doing the best that we can do. Aiming to offer a whole foods-based diet in your home will allow you to be more relaxed when dining out and you have less control over the food your child consumes.


*Silano and colleagues note that although timing of introduction of gluten does not appear to influence the development of celiac disease in most cases, DQ2 homozygous girls may be at higher risk of developing celiac disease with early gluten introduction.


**Equivalent to ½ a cup of whole wheat pasta, ½ an English muffin, ½ a cup of wheat-based cereal. The serving will vary based on the grams of flour but typically 1 serving of a wheat-based food is equivalent to ~2-4g gluten. (Thanks to Andrea Hardy, RD of Ignite Nutrition for these reference amounts).


References

1. Silano, M., Agostoni, C., Sanz, Y., & Guandalini, S. (2016). Infant feeding and risk of developing celiac disease: A systematic review. BMJ Open, 6(e009163). doi: 10.1136/bmjopen-2015-009163

2. Aronsson, C. A., Lee, H. S., Segerstad, E. M. H. et al. (2019). Association of gluten intake during the first 5 years of life with incidence of celiac disease autoimmunity and celiac disease among children at increased risk. Journal of the American Medical Association, 322(6), 514-523. DOI: 10.1001/jama.2019.10329


Suggested Reading

Gallegos, C., Merkel, R. (2019). Current evidence in the diagnosis and treatment of children with celiac disease. Gastroenterology Nursing, 42(1), 41-48. DOI: 1- /1097/sga.0000000000000365


Reprinted with permission from the Canadian Celiac Association.

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©2020 BY JUSTINE DOWD, PHD.