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Part 2 - Bacteria, Breast-feeding, and CD
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Br J Community Nurs. 2003 Mar;8(3):127-32
Does exclusive breast-feeding reduce the risk of coeliac disease in
children?
Nash S.
Westminster Primary Care Trust, London, UK. Samantha.Nash@westminster-
pct.nhs.uk
The aim of this review was to identify if exclusive breast-feeding reduced
the risk of coeliac disease (CD) in children. Medline, Embase and CINAHL
databases were searched for cohort studies and case control studies that
compared exclusive breast-feeding rates with formula or mixed (breast and
formula) of the same duration. Three case control studies met the review
criteria and were included in the review. The results from these studies
show that there is a reduced risk in the onset of CD in those children who
were exclusively breast-fed compared to those who were not. However, the
design of these studies did not allow a causal relationship to be
established. The evidence from these studies suggests a delay in the onset
of CD in breast-fed children, however it cannot be ruled out that breast-
feeding continues to have a protective factor in adolescence and adulthood.
The exact role of breast-feeding in CD prevention needs to be clarified: is
it a protective factor against CD, or does it delay the appearance of
clinical symptoms? Parents should continue to be encouraged and supported
with breast-feeding, as it is the best form of infant nutrition and
protective against short and long-term health outcomes.
Publication Types:
Review
Review, Academic
PMID: 12682607 [PubMed - indexed for MEDLINE]
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Gut. 2002 Dec;51(6):767-8
http://www.dddjournal.com/main/jou_con_detlast.asp?art=64
Breast milk against coeliac disease.
Sollid LM.
Institute of Immunology, University of Oslo, Rikshospitalet, N-0027 Oslo,
Norway. [log in to unmask]
PMID: 12427772 [PubMed]
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J Pediatr Gastroenterol Nutr. 2003 Jan;36(1):96-104
Experimentally induced gluten enteropathy and protective effect of
epidermal growth factor in artificially fed neonatal rats.
Stepankova R, Kofronova O, Tuckova L, Kozakova H, Cebra JJ, Tlaskalova-
Hogenova H.
Laboratory of Electron Microscopy, Institute of Microbiology, Academy of
Sciences of the Czech Republic, Prague. [log in to unmask]
BACKGROUND: A protective effect of breast-feeding against the development
of celiac disease has been described, but the nature and effects of the
actual milk components have not been established. Epidermal growth factor
(EGF), a milk cytokine affecting the proliferation and differentiation of
mucosal epithelial cells, was studied as to its potential protective effect
on the damage of intestinal mucosa by gliadin in a model system. METHODS:
Enteropathy was induced by gliadin in inbred AVN strain rat pups delivered
by cesarean section, breast-fed, or hand-fed a milk formula. All
experimental groups were treated with interferon-gamma (1,000 U per animal,
administered intraperitoneally) after birth. Gliadin (0.5 and 3 mg) was
intragastrically administered to the pups on days 0 and 3, and a 30-mg
challenge dose was given on day 20 (24 hours before the termination of the
experiment). One group of artificially fed pups received EGF (100 ng/ml)
continuously in the diet. RESULTS: Gliadin- and interferon-gamma-treated
formula-fed rat pups showed villus atrophy, increase of inflammatory cells,
including CD4+ T lymphocytes in the lamina propria, and damage to
epithelial tight junctions and the enterocyte brush border.
Morphometrically, the villus height was significantly less than in other
groups. Recombinant EGF was markedly increased in the epithelial cells of
injured jejunum. The intestinal mucosa of gliadin- and interferon-gamma-
treated pups kept on a EGF-supplemented artificial diet resembled that of
breast-fed pups. CONCLUSION: Pathologic changes in jejunal mucosa (villus
atrophy and inflammation) resembling gliadin-induced atrophy appeared on
administration of interferon-gamma and gliadin to rat pups fed an
artificial milk diet immediately after birth. Addition of EGF to the diet
protected the rats against pathologic mucosal changes.
PMID: 12500003 [PubMed - indexed for MEDLINE]
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Am J Clin Nutr. 2002 May;75(5):914-21
Full text HTML
http://www.ajcn.org/cgi/content/full/75/5/914
Full text PDF
http://www.ajcn.org/cgi/reprint/75/5/914
Breast-feeding protects against celiac disease.
Ivarsson A, Hernell O, Stenlund H, Persson LA.
Department of Clinical Sciences, Pediatrics, Umea University, Umea, Sweden.
[log in to unmask]
BACKGROUND: Celiac disease, or permanent gluten-sensitive enteropathy, is
an immunologic disease strictly dependent on exposure to wheat gluten or
related proteins in rye and barley. OBJECTIVE: The aim of this study was to
explore whether breast-feeding and the mode of introducing dietary gluten
influence the risk of celiac disease in childhood. DESIGN: A population-
based incident case-referent study of Swedish children, 627 cases with
celiac disease and 1254 referents, was conducted; 78% of the matched sets
were included in the final analyses. A questionnaire was used to assess
patterns of food introduction to infants. Models were built, based on
current epidemiologic and immunologic knowledge of celiac disease, to study
the potential influence of dietary patterns on disease risk and were
evaluated by conditional logistic regression in multivariate analyses.
RESULTS: The risk of celiac disease was reduced in children aged <2 y if
they were still being breast-fed when dietary gluten was introduced
[adjusted odds ratio (OR): 0.59; 95% CI: 0.42, 0.83]. This effect was even
more pronounced in infants who continued to be breast-fed after dietary
gluten was introduced (OR: 0.36; 95% CI: 0.26, 0.51). The risk was greater
when gluten was introduced in the diet in large amounts (OR: 1.5; 95% CI:
1.1, 2.1) than when introduced in small or medium amounts. In older
children, these risk factors were of no or only minor importance.
CONCLUSIONS: The gradual introduction of gluten-containing foods into the
diet of infants while they are still being breast-fed reduces the risk of
celiac disease in early childhood and probably also during the subsequent
childhood period.
PMID: 11976167 [PubMed - indexed for MEDLINE]
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Ann Nutr Metab. 2001;45(4):135-42
A case-control study of the effect of infant feeding on celiac disease.
Peters U, Schneeweiss S, Trautwein EA, Erbersdobler HF.
Institute of Human Nutrition and Food Science, University of Kiel, Germany.
AIMS: The aim of this study was to investigate the association between the
duration of breast-feeding and the age at the first gluten introduction
into the infant diet and the incidence and age at onset of celiac disease.
METHODS: In a case-control study, 143 children with celiac disease and 137
randomly recruited gender- and age-matched control children were
administered a standardized questionnaire. Multivariate-adjusted odds
ratios (OR) as estimates of the relative risk and corresponding 95%
confidence intervals (95% CI) were calculated. RESULTS: The risk of
developing celiac disease decreased significantly by 63% for children
breast-fed for more than 2 months (OR 0.37, 95% CI 0.21-0.64) as compared
with children breast-fed for 2 months or less. The age at first gluten
introduction had no significant influence on the incidence of celiac
disease (OR 0.72, 95% CI 0.29-1.79 comparing first gluten introduction into
infant diet >3 months vs. < or =3 months). CONCLUSIONS: A significant
protective effect on the incidence of celiac disease was suggested by the
duration of breast-feeding (partial breast-feeding as well as exclusive
breast-feeding). The data did not support an influence of the age at first
dietary gluten exposure on the incidence of celiac disease. However, the
age at first gluten exposure appeared to affect the age at onset of
symptoms. Copyright 2001 S. Karger AG, Basel
PMID: 11463995 [PubMed - indexed for MEDLINE]
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