Cereal for Infants: A Link to Celiac Disease?

Infants who are introduced to cereals between the ages of 4 months and 6 months may have a lower risk of developing celiac disease than those who start eating cereal earlier or later, according to new research.

Celiac disease is a condition in which the small intestine becomes inflamed and damaged after eating foods containing gluten, a type of protein found in grains such as wheat, barley, and rye. The disease, which causes malabsorption of nutrients, usually develops in early childhood, and treatment requires following a strict gluten-free diet.

In the study, researchers found that infants at risk for the disease who were introduced to gluten-containing cereals in the first three months of life were five times more likely to develop celiac disease as children compared with those who started cereals between the ages of 4 months and 6 months.

The results appear in the May 18 issue of The Journal of the American Medical Association.

Determining Celiac Disease Risk

Although the exact cause of celiac disease is unknown, children who have a close relative with the condition or certain genetic markers recognized by the immune system and associated with the disease have a higher risk of developing the disease. These genetic markers are also associated with a higher risk of developing type 1 diabetes, which means people with type 1 diabetes and their relatives are also at increased risk.

Even so, researchers say few people with these genetic variations actually develop celiac disease and other factors must also play a role in determining a person's risk.

Is Timing the Key?

In the study, researchers looked at whether the timing of when a high-risk infant was first exposed to gluten, such as cereal, affected their risk of developing celiac disease.

Researchers followed more than 1,500 children at risk for celiac disease for an average of about five years. They tested the children for celiac disease antibodies as a marker of their future risk of the disease. Antibodies are proteins created by the immune system that help fight infection and are involved in inflammation.

During this time, 51 of the children developed celiac disease antibodies.

The results showed that children who were fed foods containing wheat, barley, or rye, which have gluten, in the first three months of life were five times more likely to have celiac-disease antibodies compared with children who were first exposed to these foods between the ages of 4 months and 6 months.

Children who were exposed to gluten-containing foods after their seventh month also had a slightly higher risk of developing celiac disease antibodies compared with those who were exposed between the ages of 4 months and 6 months.

Too Early or Too Late for Gluten?

In an editorial that accompanies the study, Richard J. Farrell, MD, of Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, says long-term follow-up of this group of children is needed to explain the association between timing of cereal introduction and celiac disease risk.

Researchers agree and note that they only looked at a blood marker of celiac disease risk rather than the actual development of the disease, and it's possible that children with these antibodies may not develop the actual disease.

Previous studies have reported that children with celiac disease were less likely to have been breastfed or were breastfed for a shorter period of time than children without celiac disease. Studies have suggested that the infants' diet may be important in the development of celiac disease, but the studies lack consistency, write the authors.

The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of an infant's life and gradual introduction of foods containing gluten, such as cereal, after age 6 months. However, the Academy notes that some children may need introduction of these foods earlier, at age 4 months.

By Jennifer Warner, reviewed by Brunilda Nazario, MD

SOURCE: Norris, J. The Journal of the American Medical Association, May 18, 2005; vol 293: pp 2343-2451.