title: Gluten Introduction, Breastfeeding, and Celiac Disease: Back to the Drawing Board.
abstract: 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.
authors.affiliation: Department of Medicine, Celiac Disease Center, Columbia University Medical Center, New York, New York, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Lebwohl
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Murray
authors.affiliation: Division of Gastroenterology, Department of Medicine, and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Elena F
authors.initials: EF
authors.lastname: Verdú
authors.affiliation: Division of Gastroenterology, University of California at San Diego, La Jolla, California, USA.
authors.forename: Sheila E
authors.initials: SE
authors.lastname: Crowe
authors.affiliation: Celiac Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Melinda
authors.initials: M
authors.lastname: Dennis
authors.affiliation: Division of Pediatric Gastroenterology and Nutrition, Center for Celiac Research, MassGeneral Hospital for Children, Boston, Massachusetts, USA.
authors.forename: Alessio
authors.initials: A
authors.lastname: Fasano
authors.affiliation: Department of Medicine, Celiac Disease Center, Columbia University Medical Center, New York, New York, USA.
authors.forename: Peter H R
authors.initials: PH
authors.lastname: Green
authors.affiliation: Pediatric Gastroenterology, Hepatology and Nutrition, Celiac Disease Center, University of Chicago, Chicago, Illinois, USA.
authors.forename: Stefano
authors.initials: S
authors.lastname: Guandalini
authors.affiliation: School of Engineering, Department of Chemistry, Stanford University, Stanford, California, USA.
authors.forename: Chaitan
authors.initials: C
authors.lastname: Khosla
mesh_terms: D001942:Breast Feeding; D002446:Celiac Disease / Q000139:chemically induced* / Q000517:prevention & control*; D005983:Glutens / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007223:Infant; D012307:Risk Factors
chemical_list: D005983:Glutens