Timing of introduction of gluten into infant's diet associated with appearance of celiac disease

e (gluten-containing foods) in the first 3 months of life (3 [6 percent] CDA positive vs. 40 [3 percent] CDA negative) had a 5-fold increased risk of CDA compared with children exposed to gluten-containing foods at 4 to 6 months (12 [23 percent] CDA positive vs. 574 [38 percent] CDA negative). Children not exposed to gluten until the seventh month or later (36 [71 percent] CDA positive vs. 895 [59 percent] CDA negative) had a marginally increased risk of CDA compared with those exposed at 4 to 6 months.

Of the 25 children with biopsy-confirmed CDA-positive status, 3 (12 percent) were exposed to wheat, barley, or rye at 1 to 3 months, 3 (12 percent) at 4 to 6 months, and 19 (76 percent) at 7 months or later vs. 40 (3 percent), 583 (38 percent), and 912 (59 percent) of unaffected children, respectively. Initial exposure to wheat, barley, or rye in the first 3 months or in the seventh month or later significantly increased risk of biopsy-confirmed CDA compared with exposure at 4 to 6 months.

"Given that our study population was selected for specific genetic and family history characteristics, our findings are generalizable only to children at increased risk for celiac disease. We cannot exclude the possibility that earlier exposure to gluten simply leads to earlier appearance of CDA and that all exposed at-risk children will eventually develop CDA. Long-term follow-up of this cohort may be necessary to address this question. Given the small number of CDA-positive children and wide CIs [confidence intervals], we recommend that these results be confirmed in other prospective cohorts of children at risk for celiac disease before any interventions are implemented," the authors write.

(JAMA. 2005;293:2343-2351. Available post-embargo at JAMA.com)

Editor's Note: This research was supported by grants from the National Institutes of Health, Autoimmune Prevention Center, Diabetes Endocrine Research Center, Clinical In

Contact: Tonya Ewers
JAMA and Archives Journals

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