Evidence-Based Research in Pediatric Nutrition

Editor(s): Szajewska H. (Warsaw) 
Shamir R. (Petach-Tikva) 
Table of Contents
Vol. 108, 2013
Section title: Issues in Nutrition of Children
Szajewska H, Shamir R (eds): Evidence-Based Research in Pediatric Nutrition. World Rev Nutr Diet. Basel, Karger, 2013, vol 108, pp 91-97

Celiac Disease - Prevention Strategies through Early Infant Nutrition

Chmielewska A. · Szajewska H. · Shamir R.
aThe Medical University of Warsaw, Warsaw, Poland, and bSchneider Children's Medical Center, Sackler Faculty of Medicine, Petach-Tikva, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Celiac disease (CD) is an immune-mediated disease of considerable incidence, which negatively influences the quality of life of affected individuals and their families. The only currently available treatment is a lifelong gluten-free diet. Possible prevention strategies for CD focus on early infant feeding practices, namely breastfeeding and the time and mode of gluten introduction into the infant's diet. A systematic review of available data suggested that the risk of developing CD may be decreased by breastfeeding and breastfeeding at the time of gluten introduction. It is not clear whether this strategy prevents the disease or only delays the onset of symptoms. Gluten introduction should not be done earlier than at 4 months of age and not later than 7 months of age since both early and late introduction of gluten have been shown to increase the risk of CD. A large randomized controlled trial is being conducted in 10 European countries to clarify whether breastfeeding and early gluten introduction are effective in preventing CD in genetically susceptible individuals.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Husby S, Koletzko S, Korponay-Szabo IR, et al: Guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr 2012;54:136-160.
  2. Mustalahti K, Catassi C, Reunanen A, et al: The prevalence of celiac disease in Europe: results of a centralized, international mass screening project. Ann Med 2010;42:587-595.
  3. Rubio-Tapia A, Kyle RA, Kaplan EL, et al: Increased prevalence and mortality in undiagnosed celiac disease. Gastroenterology 2009;137:88-93.
  4. Kurppa K, Collin P, Mäki M, Kaukinen K: Celiac disease and health-related quality of life. Expert Rev Gastroenterol Hepatol 2011;5:83-90.
  5. Troncone R, Ivarsson A, Szajewska H, Mearin ML, and the Members of European Multistakeholder Platform on CD (CDEUSSA): Review article: future research on coeliac disease - a position multistakeholder platform on celiac disease (CDEUSSA). Aliment Pharmacol Ther 2008;27:1030-1043.
  6. Hogen Esch CE, Rosen A, Auricchio R, et al: The Prevent CD Study design: towards new strategies for the prevention of coeliac disease. Eur J Gastroenterol Hepatol 2010;22:1424-1430.
  7. Szajewska H, Chmielewska A, Pieścik-Lech M, Ivarsson A, Kolacek S, Koletzko S, Mearin ML, Shamir R, Auricchio R, Troncone R, on behalf of the PREVENTCD Study Group: Systematic review: early infant feeding and coeliac disease prevention. Aliment Pharmacol Ther 2012;36:607-618.
  8. World Health Organization: The optimal duration of exclusive breastfeeding: report of an expert consultation. Geneva, WHO, 2001. Available at: (accessed September 4, 2012).
  9. ESPGHAN Committee on Nutrition: Agostoni C, Braegger C, Decsi T, Kolacek S, Koletzko B, Michaelsen KF, Mihatsch W, Moreno LA, Puntis J, Shamir R, Szajewska H, Turck D, van Goudoever J: Breast-feeding: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 2009;49:112-125.
  10. Solid LM: Breast milk against celiac disease. Gut 2002;51:767-768.
  11. Zanoni G, Navone R, Lunardi C, Tridente G, Bason C, Sivori S, Beri R, Dolcino M, Valletta E, Corrocher R, Puccetti A: In celiac disease, a subset of autoantibodies against transglutaminase binds toll-like receptor 4 and induces activation of monocytes. PLoS Med 2006;3:1637-1653.
  12. Troncone R, Auricchio S: Rotavirus and celiac disease: clues to the pathogenesis and perspectives on prevention. J Pediatr Gastroenterol Nutr 2007;44:527-528.
  13. Shulman RJ, Schanler RJ, Lau C, et al: Early feeding, antenatal glucocorticoids, and human milk decrease intestinal permeability in preterm infants. Pediatr Res 1998;44:519-523.
  14. Stene LC, Honeyman MC, Hoffenberg EJ, et al: Rotavirus infection frequency and risk of celiac disease autoimmunity in early childhood: a longitudinal study. Am J Gastroenterol 2006;101:2333-2340.
  15. Chirdo FG, Rumbo M, Anon MC, Fossati CA: Presence of high levels of non-degraded gliadin in breast milk from healthy mothers. Scand J Gastroenterol 1998;33:1186-1192.
  16. Verhasselt V: Neonatal tolerance under breastfeeding influence. Curr Opin Immunol 2010;22:623-630.
  17. Nova E, Pozo T, Sanz Y, Marcos A: Dietary strategies of immunomodulation in infants at risk for celiac disease. Proc Nutr Soc 2010;69:347-353.
  18. Nash S: Does exclusive breast-feeding reduce the risk of coeliac disease in children? Br J Community Nurs 2003;8:127-132.

    External Resources

  19. Auricchio S, Follo D, de Ritis G, et al: Does breastfeeding protect against the development of clinical symptoms of celiac disease in children? J Pediatr Gastroenterol Nutr 1983;2:428-433.
  20. Greco L, Auricchio S, Mayer M, et al: Case-control study on nutritional risk factors in celiac disease. J Pediatr Gastroenterol Nutr 1988;7:395-399.
  21. Peters U, Schneeweiss S, Trautwein EA, et al: A case-control study of the effect of infant feeding on celiac disease. Ann Nutr Metab 2001;45:135-142.
  22. Decker E, Engelmann G, Findeisen A, et al: Cesarean delivery is associated with celiac disease but not inflammatory bowel disease in children. Pediatrics 2010;125:e1433-e1440.
  23. Akobeng AK, Ramanan AV, Buchan I, et al: Effect of breast feeding on risk of coeliac disease: a systematic review and meta-analysis of observational studies. Arch Dis Child 2006;91:39-43.
  24. Ascher H, Krantz I, Rydberg L, et al: Influence of infant feeding and gluten intake on coeliac disease. Arch Dis Child 1997;76:113-117.
  25. Falth-Magnusson K, Franzen L, Jansson G, et al: Infant feeding history shows distinct differences between Swedish celiac and reference children. Pediatr Allergy Immunol 1996;7:1-5.
  26. Ivarsson A, Hernell O, Stenlund H, et al: Breast-feeding protects against celiac disease. Am J Clin Nutr 2002;75:914-921.

    External Resources

  27. Norris JM, Barriga K, Hoffenberg EJ, et al: Risk of celiac disease autoimmunity and timing of gluten introduction in the diet of infants at increased risk of disease. JAMA 2005;293:2343-2351.
  28. Roberts SE, Williams JG, Meddings D, et al: Perinatal risk factors and coeliac disease in children and young adults: a record linkage study. Aliment Pharmacol Ther 2009;29:222-231.
  29. Welander A, Tjernberg AR, Montgomery SM, et al: Infectious disease and risk of later celiac disease in childhood. Pediatrics 2010;125:e530-e536.
  30. Ziegler AG, Schmid S, Huber D, et al: Early infant feeding and risk of developing type 1 diabetes-associated autoantibodies. JAMA 2003;290:1721-1728.
  31. Sausenthaler S, Heinrich J, Koletzko S; GINIplus and LISAplus Study Groups: Early diet and the risk of allergy: what can we learn from the prospective birth cohort studies GINIplus and LISAplus? Am J Clin Nutr 2011;94(suppl):2012S-2017S.
  32. ESPGHAN Committee on Nutrition: Agostoni C, Decsi T, Fewtrell M, Goulet O, Kolacek S, Koletzko B, Michaelsen KF, Moreno L, Puntis J, Rigo J, Shamir R, Szajewska H, Turck D, van Goudoever J: Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 2008;46:99-110.
  33. Sellitto M, Bai G, Serena G, et al: Proof of concept of microbiome-metabolome analysis and delayed gluten exposure on celiac disease autoimmunity in genetically at-risk infants. PLoS One 2012;7:e33387.
  34. Ivarsson A, Persson LA, Nystrom L, et al: Epidemic of coeliac disease in Swedish children. Acta Paediatr 2000;89:165-171.
  35. Vader W, Stepniak D, Kooy Y, et al: The HLA-DQ2 gene dose effect in celiac disease is directly related to the magnitude and breadth of gluten-specific T-cell responses. Proc Natl Acad Sci USA 2003;14:100.
  36. Kooy-Winkelaar Y, van Lummel M, Moustakas AK, et al: Gluten-specific T cells cross-react between HLA-DQ8 and the HLA-DQ2a/DQ8b transdimer. J Immunol 2011;187:5123-5129.
  37. Johnston M, Landers S, Noble L, Szucs K, Viehmann L: Section on breastfeeding: breastfeeding and the use of human milk. Pediatrics 2012;129:e827-e841.

Pay-per-View Options
Direct payment This item at the regular price: USD 33.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 23.00