Updated Guidelines from European Society for Paediatric Gastroenterology, Hepatology, and Nutrition: Gluten Introduction and the Risk of Coeliac Disease
Coeliac disease (CD) is an autoimmune disorder in which consumption of gluten, in conjunction with genetic susceptibility, results in the development of an insidiously evolving autoimmune reaction affecting the gut and other organs. In 2008, the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) had recommended to avoid both early (less than 4 months) and late (more than 7 months) introduction of gluten and to introduce gluten while the infant was still being breast-fed. However, based on recent evidence, the ESPGHAN revised its recommendations on gluten introduction in infants and the risk of coeliac disease during childhood.
The risk of developing CD following the consumption of gluten exclusively applies to individuals carrying at least one of the CD risk alleles. Since genetic risk alleles are generally not known in an infant at the time of solid food introduction, these recommendations apply to all infants.
Breastfeeding recommendations should not be modified to prevent CD in infants. Introduction of gluten cannot be recommended while the infant is being breast-fed, to reduce the risk of developing CD. Between the ages of 4 and 12 completed months, gluten can be introduced into the infant’s diet. Introducing gluten to infants in this age range does not appear to impact the absolute risk of developing coeliac disease autoimmunity during childhood. There are no recommendations on the type of gluten to be used at introduction. The effects of different wheat preparations and the optimal amounts of gluten to be introduced at weaning have not been established.
In spite of the limited evidence on the exact quantity of gluten to be introduced and in the absence of randomised controlled trials to support the same, ESPGHAN suggests avoiding large amounts of gluten during the first months after gluten introduction and during infancy. There are no recommendations on gluten introduction in children with first-degree relatives with CD.
News source – Szajewska H, Shamir R, Mearin L, et al. Gluten Introduction and the Risk of Coeliac Disease: A Position Paper by the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2016; 62(3):507–13.