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http://www.medpagetoday.com/Pediatrics/DietNutrition/tb/2178

Breastfeeding May Protect Against Celiac Disease
By Katrina Woznicki, MedPage Today Staff Writer
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of
Pennsylvania School of Medicine.  </reviewer.cfm?reviewerid=30> 
November 18, 2005

Review
MANCHESTER, England, Nov. 17 - Infants who are still being breastfed at
the time of cereal introduction have only half the risk of celiac
disease, a systematic review has found. 
What's more, the protection improves the longer the child is nursed,
according to a meta-analysis of case-control studies that was reported
in the online edition of Archives of Disease in Childhood by Anthony K.
Akobeng, M.D., of Central Manchester Children's University Hospital and
colleagues. 
It showed that babies breastfed at the time of cereal introduction
showed a 52% reduction in the risk of developing gluten sensitivity,
compared with infants not breastfed during this period (pooled odds
ratio 0.48, with a 95% confidence interval 0.40 to 0.59). 
The authors said the finding affirms earlier epidemiological data
suggesting that early infant-feeding practices could affect the risk
factor for celiac disease. They acknowledged, however, that they cannot
yet determine whether breastfeeding directly and permanently protects
against celiac disease, or merely postpones its onset. 
"Celiac disease can be notoriously asymptomatic and the absence of
symptoms does not necessarily mean absence of the disease," Dr. Akobeng
and colleagues noted. 
The researchers analyzed six case-controlled observational studies,
collectively involving more than 4,600 participants, published from 1966
to 2004. 
Regarding the variability of breastfeeding duration, the researchers
decided not to pool the study findings and instead offered a brief
summary of each. Five of the six studies found strong associations
between breastfeeding and protection against celiac disease, and many
showed a dose-relationship response. 
For example, a study from Italy that compared 1,949 healthy controls to
201 cases found children who were breastfed for less than 90 days were
five times more likely to develop celiac disease than those breastfed
more than 90 days (OR 4.97, 95% 3.5-6.9). 
Meanwhile, a German study comparing 137 controls to 143 cases found the
risk of celiac disease dropped by 63% for children breastfed more than
two months (OR, 0.37, 95% CI 0.21-0.64). 
Even one month of breastfeeding appeared to make a difference. Another
study from Italy comparing 216 cases with 289 controls showed infants
breastfed less than 30 days were about four times more likely to develop
celiac disease compared with infants breastfed more than 30 days (OR
4.05, 95% 2.20 to 7.27). 
Breast milk is known to boost immunity so it is possible the protection
from celiac disease stems from properties in the milk itself, said the
authors. "Human milk IgA antibodies may diminish immune response to
ingested gluten by mechanisms such as agglutination of the antigen to
immune complexes on the mucosal surface so that uptake is prevented,"
they wrote. 
The American Academy of Pediatrics recommends exclusive breastfeeding
for the first six months of life. Mothers typically introduce solid
foods to infants between four and six months of age. Cereals, which
contain the gluten protein, are usually the first foods introduced. 
Dr. Akobeng and colleagues cautioned these were case-controlled studies,
so the potential for recall bias exists. They also pointed out that
"case-control studies are also susceptible to bias because other risk
factors of celiac disease [such as socioeconomic class] could be
unbalanced across children who were breast fed and those who were not." 
But they stressed that the findings are provocative and warrant further
research. "Long-term prospective cohort studies are required to
investigate further the relation between breast feeding and celiac
disease," they wrote. 
Primary source: Archives of Disease in Childhood
Source reference: 
Akobeng, "Effect of breast feeding on risk of celiac disease: a
systematic review and meta-analysis of observational studies," Archives
of Disease in Childhood, published in online edition Nov. 15, 2005 

* Please remember some posters may be WHEAT-FREE, but not GLUTEN-FREE *