Science You Can Use: Worried about celiac disease? New analysis says longer breastfeeding, especially at time of gluten introduction, reduces risk

For some time research has been drawing a link between breastfeeding and lowered risk of celiac disease, but a meta analysis published this month* is shedding more  light on this relationship.

Celiac disease is an auto-immune condition that damages the lining of the small intestine and prevents it from absorbing important nutrients.  It’s caused by a reaction to eating gluten.  Celiac disease runs in families, so infant feeding choices can take on particular importance for parents concerned about their kids’ risk.

The relationship between celiac disease and breastfeeding has been under investigation since the 1960’s, and the authors of a new meta analysis sought to update our understanding by examining literature from 2004 to 2011.  Three observational and one case control study were included in this analysis.

A prior analysis, published in 2006 established that:

  • Increasing duration of breast feeding is associated with a reduced risk of celiac disease
  • Breast feeding at the time of gluten introduction significantly reduces the risk of celiac disease
  • It is not clear from the primary studies whether breast feeding only delays the onset of symptoms or provides a permanent protection against the disease

The latest study, published this month, examined four newer studies, and found that two of three studies on duration of breastfeeding “reported significant associations between longer duration of breastfeeding and later onset of celiac disease.”

And as the prior analysis demonstrated, “breastfeeding during the introduction of gluten to the infant was reported to have a protective effect in two studies.”

The authors conclude:  “Our findings in combination with the previous findings from Akobeng et al‘s systematic review and the two recent published review articles make it safe to say that breastfeeding has an important role in delaying and/or preventing the development of celiac disease. ”

Duration of breastfeeding

The 2006 analysis found a widely varying degree of protection based on the duration of breastfeeding.  One study found that “children who were breast fed for less than 90 days were about five times more likely to develop celiac disease compared with children breast fed for more than 90 days.”  Another found that “the risk of developing celiac disease decreased significantly by 63% for children breast fed for more than 2 months compared with children breast fed for 2 months or less.”

The 2012 analysis confirms these findings.  While one study found no effect, one found that “longer duration of breastfeeding significantly reduced the risk to develop CD in the first year of life.”  Two studies found that exclusively breastfed children who did develop celiac disease exhibited symptoms and were diagnosed later, and one found that the symptoms of those diagnosed were less severe.

Breastfeeding at the time of gluten introduction

The 2006 analysis also found that “children being breast fed at the time of gluten introduction had a 52% reduction in risk of developing celiac disease compared with their peers who were not breast feeding at the time of gluten introduction.”

Similarly, the 2012 analysis reported on one study which found that “if gluten was introduced while the child was still breastfeeding the risk of developing celiac disease was reduced by 58–62%.”  Another found that of the children who did develop celiac disease, those who were breastfeeding at the time of gluten introduction exhibited symptoms significantly later.

Further questions

There remain a number of questions about the relationship between breastfeeding and celiac disease.  The authors of the 2006 analysis point out that 1) the case controls used in these studies were healthy children, but that celiac disease can be asymptomatic, and 2) since the studies didn’t follow the children into adulthood it’s possible that breastfeeding delayed but didn’t prevent celiac disease.

And the protective mechanism at work?  That’s not at all clear.  Could it be that children get a lower “dose” of gluten at the time of introduction because of a higher intake of breastmilk?  Could it be the breastfeeding-related reduction in gastrointestinal infections which might trigger celiac disease in predisposed children?  Is it something in the milk itself?

Whatever the reason, this study gives parents concerned about their children’s risk of celiac disease more reason to think carefully about their infant feeding choices.

Does celiac disease run in your family?  What do you make of this study’s findings?

*A previously published version of this post incorrectly linked to and described the 2006 analysis.  The post has been updated to clarify the findings of the 2006 the 2012 analyses.

 



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5 Comments | Last revised on 08/10/2012


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