Hi, I'm Ritu Verma. I'm one of the pediatric gastroenterologists at the Children's Hospital in Philadelphia, and I'm the director of the Celiac Center.
Today, I would like to provide some updates about celiac disease. As you know, celiac disease is an autoimmune condition, and it's the result of certain genetic factors and eating gluten. However, we do know that there are some people who have these specific genes, eat gluten-containing foods, and do not get the disease. There has been a lot of discussion about what these other factors are that actually cause the disease to be manifested.
One of the big concerns and questions in the past has been about actual nutritional input for these babies, in terms of when do we introduce gluten. Does it really make a difference in onset of the disease or the severity of the disease?
In the past, studies have found that introducing gluten between 4 and 6 months of age—not too early in life, and not too late in life—and breastfeeding at the same time seems to have been protective. We've recommended in the past that children who are genetically susceptible to celiac disease be fed cereal between those 4 to 6 months of age.
Recently, however, there were two large studies[1,2] from Europe that followed genetically susceptible babies and their eating patterns over time. It seemed that it did not make a difference whether these babies were given cereal early or late in the first year of life. It did not seem to make a difference whether they were being breastfed or not. This is definitely contrary to what we've been discussing so far with our patients.
What was also found as part of the studies was that the genetic types seem to be the more important factor. Babies who were HLA DQ2 homozygous-positive had earlier onset of the disease. Once again, it did not seem to make a difference when the cereal or gluten were introduced.
Currently, what we are recommending is to have babies and moms and dads follow the guidelines[3] by the American Academy of Pediatrics (AAP) in terms of when to introduce cereals and foods. We totally agree that breastfeeding is important for the babies. This has been confusing. However, this is what we have currently.
These questions are just like, for example, those raised by the Learning Early About Peanut Allergy (LEAP) study,[4] whose results were published earlier this year. Initially, we were always taught that peanuts should be introduced later in life to cut down on peanut allergies. The recent study indicates that introducing peanuts early in the diet seems to cut down on peanut allergies in life.
A lot of confusion; however, this is the update, currently, for celiac disease. As we have more research and more long-term studies being done, we will bring those back to you as well. Thank you.
References
- Aronsson CA, Lee HS, Liu E, et al; TEDDY Study Group. Age at gluten introduction and risk of celiac disease. Pediatrics. 2015;135:239-245. http://pediatrics.aappublications.org/content/early/2015/01/13/peds.2014-1787.full.pdf+html Accessed April 1, 2015.
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