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Am J Gastroenterol. 2016 Jan;111(1):12-4. doi: 10.1038/ajg.2015.219. Epub 2015 Aug 11.

Gluten Introduction, Breastfeeding, and Celiac Disease: Back to the Drawing Board.

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Department of Medicine, Celiac Disease Center, Columbia University Medical Center, New York, New York, USA.
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Division of Gastroenterology, Department of Medicine, and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Division of Gastroenterology, University of California at San Diego, La Jolla, California, USA.
Celiac Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Division of Pediatric Gastroenterology and Nutrition, Center for Celiac Research, MassGeneral Hospital for Children, Boston, Massachusetts, USA.
Pediatric Gastroenterology, Hepatology and Nutrition, Celiac Disease Center, University of Chicago, Chicago, Illinois, USA.
School of Engineering, Department of Chemistry, Stanford University, Stanford, California, USA.


This commentary by the leadership of the North American Society for the Study of Celiac Disease (NASSCD) concerns recent research findings regarding infant feeding practices. Celiac disease has increased markedly in recent decades, and seroprevalence studies indicate that this is a true rise, rather than one due to increased awareness and testing. Prior studies have suggested that infant feeding practices and timing of initial gluten exposure are central to the development of celiac disease. Two recent multicenter randomized trials tested strategies of early or delayed gluten introduction in infants, and neither strategy appeared to influence celiac disease risk. These studies also found that breastfeeding did not protect against the development of celiac disease. While disappointing, these results should spur the study of wider environmental risk factors beyond infant feeding, such as intrauterine and perinatal exposures as well as environmental influences later in life, including drug exposure, microbial infections, and the microbiome. Given that celiac disease can develop at any age, it is imperative to study these proposed triggers so as to elucidate the loss of tolerance to gluten and to develop future intervention strategies.

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