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Timing of gluten introduction in infancy doesn’t matter

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Results change the celiac landscape

The findings of these two multicenter clinical trials will change the conceptual landscape of celiac disease.

From now on, it will be difficult for anyone to continue to recommend the introduction of gluten specifically at the age of 4-6 months, because this will not reduce the risk of developing celiac disease. And although breastfeeding is important to overall health, it doesn’t appear to protect against celiac disease.

Jonas F. Ludvigsson, M.D., Ph.D., is in the department of medical epidemiology and biostatistics at the Karolinska Institute, Stockholm, and the department of pediatrics at Orebro (Sweden) University Hospital. Peter H. R. Green, M.D., is at the Celiac Disease Center at Columbia University, New York. These remarks were taken from their editorial accompanying Dr. Lionetti’s and Dr. Vriezinga’s reports (N. Engl. J. Med. 2014 October 2 [doi:10.1056/NEJMe1408011]).


 

FROM THE NEW ENGLAND JOURNAL OF MEDICINE

References

These findings do not support guidelines that advocate early exposure to small amounts of gluten or maintenance of breastfeeding at the time of gluten introduction, “or any specific feeding recommendation with respect to the timing of gluten introduction for infants at risk for celiac disease,” Dr. Vriezinga and her associates said.

The PreventCD trial was supported by grants from the European Commission, the Azrieli Foundation, Deutsche Zöliakie Gesellschaft, Eurospital, Fondazione Celiachia, Fria Bröd, Instituto de Salud Carlos III, Spanish Society for Pediatric Gastroenterology, Hepatology, and Nutrition, Komitet Badan Naukowych, Fundacja Nutricia, Hungarian Scientific Research Funds, Stichting Coeliakie Onderzoek Nederland, Thermo Fisher Scientific, and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. The CELIPREV trial was supported by the Celiac Foundation of the Italian Celiac Society. A few coauthors from Dr. Lionetti’s study were scientific consultants or received grant support from diagnostics companies, but most had no relevant financial disclosures. A few coauthors from Dr. Vriezinga’s study received speaker’s fees or research support from pharmaceutical companies, but the majority had no relevant financial disclosures.

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