New guidelines for feeding infants at risk for celiac disease

By Amy Ratner, Medical and Science News Analyst

The amount of gluten fed to infants at risk for celiac disease may influence whether they actually get the disease, leading the University of Chicago Celiac Disease Center to recommend new guidelines for feeding these babies.

The guidelines say that at-risk infants should eat less than 5 grams of gluten-containing food on average per day beginning when food is introduced to a baby at 4-to-6 months and continuing until the age of 2. That equals less than an ounce of pasta or one slice of bread, Stefano Guandalini, M.D., wrote in the center’s March Impact newsletter.

Children are considered at risk for celiac disease if they have a first degree family member – a parent or a sibling, who has celiac disease. A newborn who has been tested and found to have the genes associated with celiac disease, HLADQ 2.5 or HLADQ8, would also be at risk, according to Guandalini.

More fruits and vegetables

In addition to limiting gluten-containing foods, the guidelines recommend that children in this “vulnerable population” should adopt a healthy, Mediterranean diet for the crucial first two years. Despite misconceptions based on its name, the Mediterranean diet is not built around consumption of pasta. Instead, it emphasizes primarily plant-based foods, such as fruits and vegetables, legumes and nuts. Healthy whole grains are also key.

The recommendations are based on six studies done from 2014 to 2018 regarding feeding infants who are at risk for celiac disease. The most recent study looked at dietary patterns of young children in the Netherlands and found that high consumption of vegetables and grains and low consumption of refined cereals and sweet beverages were associated with lower odds of celiac disease.

“Early-life dietary patterns might therefore be involved in the development of celiac disease during childhood,” the study, published in the journal Gastroenterology, concluded.

Evolving knowledge

Previously, it was thought that the precise timing of the introduction of gluten in the diet of at-risk infants and breast feeding had protective effects, but on-going research disproved both theories. “As sometimes happens in science, new studies disprove the old and our knowledge changes and evolves,” Guandalini wrote in the newsletter. “In this case, through a large number of prospective studies, we discovered that our old assumptions about infant feeding were largely inaccurate and that new feeding recommendations are needed.”

The Center for Celiac Research and Treatment at Mass General Hospital for Children advises parent to introduce gluten-containing food to at-risk infants at the same time as solid food, generally when a baby is about 4 months old. The amount is not specified.

In a 2016 position paper, the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) recommended that consumption of large amounts of gluten be discouraged during the first few months after gluten is introduced in an at-risk infant’s diet. The recommendation was conditional, the paper noted, because evidence regarding the association with reduced risk of celiac disease was limited and more study was needed.

In writing about the new feeding guidelines from the University of Chicago, Guandalini pointed out that the overall risk of a child developing celiac disease is small. One of eight female babies and one of 13 male babies with a parent who has celiac disease will develop celiac disease at some point in their lives. Following the new feeding guidelines could make the risk “smaller still,” he wrote.

You can find more about the most recent study regarding the association between diet and celiac disease in children here. And you can read the Impact newsletter here.