Evaluating the Timing of Gluten Introduction into Infant’s Diet and Other Influential Factors in Children with Celiac Disease

Document Type : original article

Authors

1 Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Department of Pediatric Gastroenterology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Department of Geriatric Nursing, Faculty of Nursing and Midwifery, North Khorasan University of Medical Sciences, Bojnourd, Iran.

Abstract

Background: Gluten is recognized as the main causative factor of celiac disease (CD), affecting many children worldwide.
Objective: This study aimed to assess the potential relationship between the timing of gluten introduction into infants’ diet and other influential factors in children diagnosed with CD.
Methods: This descriptive-analytical cross-sectional study was conducted from January 2016 to 2022 and included all patients, aged 1-18 years, who were referred to our hospital over this 6-year period. Patients had a confirmed diagnosis of CD. Patient hospital records were retrospectively reviewed, and the investigated variables included patients’ age, gender, mode of delivery, infant feeding mode, and timing of introducing gluten into their diet. A P-value <0.05 was considered statistically significant.
Results: A total of 155 children, comprising 101 (65.2%) girls and 54 (34.8%) boys, met the inclusion criteria. Patient age ranged from 1 to 17 years (mean: 9.68 ± 4.03 years). The average duration of breastfeeding was 23.14 ± 2.2 months. Most patients were born through vaginal delivery (57.4%) and were exclusively breastfed without any supplementary milk (67.7%). The majority of children (59.4%) had a timely introduction of gluten into their diet. There was no statistically significant correlation between the timing of gluten introduction and the other investigated variables (P > 0.05 for all).
Conclusion: Within this cohort of children with confirmed celiac disease, the timing of gluten introduction was not associated with the measured early-life factors. Prospective studies with non-celiac controls are needed to clarify potential causal relationships.

Keywords

References

  1. Sollid LM, Jabri B. Triggers and drivers of autoimmunity: lessons from coeliac disease. Nature Reviews Immunology. 2013 Apr;13(4):294-302.
  2. Ludvigsson JF, Leffler DA, Bai JC, Biagi F, Fasano A, Green PH, et al. The Oslo definitions for coeliac disease and related terms. Gut. 2013 Jan 1;62(1):43-52.
  3. Husby S, Koletzko S, Korponay‐Szabó IR, Mearin ML, Phillips A, Shamir R, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. Journal of pediatric gastroenterology and nutrition. 2012 Jan;54(1):136-60.
  4. Rodrigo L. Celiac disease. World journal of gastroenterology: WJG. 2006 Nov 7;12(41):6577.
  5. Ghergherehchi R, Rafeey M, Hazhir N. Frequency of Celiac disease in short stature children in north-west of Iran. Medical Journal of Tabriz University of Medical Sciences. 2013 Dec 25;35(5):60-5.
  6. Houshiyar A, Fouladi N, Ghorbani F, Mohammadi R, AlimohammadiAsl H. Prevalence of Human Leukocyte Antigen (HLA DQ2 and DQ8) in celiac disease in patients with irritable bowel syndrome. Journal of Ardabil University of Medical Sciences. 2015 Oct 10;15(3):277-82.
  7. Shadman M, Abedian Kenari S, Alizadeh A, Kaveh M, Hosseini V. Anti-endomysial and anti-tissue transglutaminase serological test compared with small bowel biopsy in the diagnosis of celiac disease. Medical Laboratory Journal. 2013 Oct 10;7(3):46-53.
  8. Green PH. Cell ier C. Celiac d is eas e. N En gl J Med. 2007;357:1731-43.
  9. James MW, Scott BB. Coeliac disease: the cause of the various associated disorders?. European journal of gastroenterology & hepatology. 2001 Sep 1;13(9):1119-21.
  10. Narayan KV, Boyle JP, Thompson TJ, Sorensen SW, Williamson DF. Lifetime risk for diabetes mellitus in the United States. Jama. 2003 Oct 8;290(14):1884-90.
  11. Caio G, Volta U, Sapone A, Leffler DA, De Giorgio R, Catassi C, Fasano A. Celiac disease: a comprehensive current review. BMC medicine. 2019 Jul 23;17(1):142.
  12. Phillips D. Online Clinical Guide for Pediatric Celiac Disease Released by NASPGHAN, Celiac Disease Foundation. Medscape; 2017.
  13. Durham J, Temples HS. Celiac disease in the pediatric population. Journal of Pediatric Health Care. 2018 Nov 1;32(6):627-31.
  14. Hujoel IA, Van Dyke CT, Brantner T, Larson J, King KS, Sharma A, et al. Natural history and clinical detection of undiagnosed coeliac disease in a North American community. Alimentary pharmacology & therapeutics. 2018 May;47(10):1358-66.
  15. Murray JA, Van Dyke C, Plevak MF, Dierkhising RA, Zinsmeister AR, Melton III LJ. Trends in the identification and clinical features of celiac disease in a North American community, 1950–2001. Clinical Gastroenterology and Hepatology. 2003 Jan 1;1(1):19-27.
  16. Lebwohl B, Rubio-Tapia A, Assiri A, Newland C, Guandalini S. Diagnosis of celiac disease. Gastrointestinal endoscopy clinics of North America. 2012 Oct 1;22(4):661-77.
  17. Baudon JJ, Johanet C, Absalon YB, Morgant G, Cabrol S, Mougenot JF. Diagnosing celiac disease: a comparison of human tissue transglutaminase antibodies with antigliadin and antiendomysium antibodies. Archives of pediatrics & adolescent medicine. 2004 Jun 1;158(6):584-8.
  18. Mokhtari M, Saneian H, Tavakoli R. Evaluation and specification of intraepithelial lymphocyte cut-off point with hematoxiline-eosine (H&E) and immunohistochemistry (CD3 marker) in duodenal biopsy of children with celiac disease. Journal of Isfahan Medical School. 2018 Mar 21;36(467):83-9.
  19. Kaukinen K, Halme L, Collin P, Färkkilä M, Mäki M, Vehmanen P, et al. Celiac disease in patients with severe liver disease: gluten-free diet may reverse hepatic failure. Gastroenterology. 2002 Apr 1;122(4):881-8.
  20. Newton KP, Singer SA. Celiac disease in children and adolescents: special considerations. InSeminars in Immunopathology 2012 Jul (Vol. 34, No. 4, pp. 479-496). Berlin/Heidelberg: Springer-Verlag.
  21. Rubio-Tapia A, Hill ID, Kelly CP, Calderwood AH, Murray JA. ACG clinical guidelines: diagnosis and management of celiac disease. Official journal of the American College of Gastroenterology| ACG. 2013 May 1;108(5):656-76.
  22. Oyarzún A, Nakash T, Ayala J, Lucero Y, Araya M. Following gluten free diet: less available, higher cost and poor nutritional profile of gluten-free school snacks. Int J Celiac Dis. 2015 Jun;3(3):102-7.
  23. Miranda J, Lasa A, Bustamante MA, Churruca I, Simon E. Nutritional differences between a gluten-free diet and a diet containing equivalent products with gluten. Plant foods for human nutrition. 2014 Jun;69(2):182-7.
  24. Marsh MN. Gluten, major histocompatibility complex, and the small intestine: a molecular and immunobiologic approach to the spectrum of gluten sensitivity (‘celiac sprue’). Gastroenterology. 1992 Jan 1;102(1):330-54.
  25. Lionetti E, Castellaneta S, Francavilla R, Pulvirenti A, Catassi C, of Weaning SW, et al. Mode of delivery and risk of celiac disease: risk of celiac disease and age at gluten introduction cohort study. The Journal of pediatrics. 2017 May 1;184:81-6.
  26. Koletzko S, Lee HS, Beyerlein A, Aronsson CA, Hummel M, Liu E, et al. Cesarean section on the risk of celiac disease in the offspring: the teddy study. Journal of pediatric gastroenterology and nutrition. 2018 Mar;66(3):417-24.
  27. Dydensborg Sander S, Hansen AV, Størdal K, Andersen AM, Murray JA, Husby S. Mode of delivery is not associated with celiac disease. Clinical Epidemiology. 2018 Mar 19:323-32.
  28. Shahraki T, FARAHMAND F, Shahraki M, KARAMI H. Clinical and laboratory findings of celiac disease in patients referred to children medical center (tehran; Iran).2009.
  29. Radlović NP, Mladenović MM, Leković ZM, Stojšić ZM, Radlović VN. Influence of early feeding practices on celiac disease in infants. Croatian medical journal. 2010 Oct 15;51(5):417-22.
  30. Akobeng AK, Ramanan AV, Buchan I, Heller RF. Effect of breast feeding on risk of coeliac disease: a systematic review and meta-analysis of observational studies. Archives of disease in childhood. 2006 Jan 1;91(1):39-43.
  31. Ivarsson A, Hernell O, Stenlund H, Persson LÅ. Breast-feeding protects against celiac disease. The American journal of clinical nutrition. 2002 May 1;75(5):914-21.
  32. Auricchio S, Follo D, de Ritis G, Giunta A, Marzorati D, Prampolini L, et al. Does breast feeding protect against the development of clinical symptoms of celiac disease in children?. Journal of pediatric gastroenterology and nutrition. 1983 Aug;2(3):428-33.
Journal of Pediatric Perspectives
Volume 14, Issue 1
January 2026
Pages 19861-19868

Files

Share

How to cite

Statistics