Debuten av gluten ? Har tidpunkt för glutenintroduktion någon betydelse för risken att utveckla celiaki hos högriskbarn?
AbstractTitle: The debut of gluten ? Does timing of gluten introduction affect the risk ofceliac disease in high-risk children?Author: Sandra Hagwall Frohm and Maria IngmarSupervisor: Frode SlindeExaminer: Mette AxelsenProgramme: Programme in dietetics, 180/240 ECTSType of paper: Bachelor?s thesis in clinical nutrition, 15 hpDate: May 26, 2015Background: Celiac disease is a chronic disease in which the intestinal mucosa is damaged bygluten exposure, and the only treatment is a lifelong gluten-free diet. The disease affects about1 % of the population worldwide, but the majority are undiagnosed. Ingestion of gluten and thegenotype HLA-DQ2/8 are required for disease development, although additional genetic andenvironmental factors are believed to be of importance. One hypothesis is that timing of glutenintroduction in infants affects the disease risk. Today, gradual introduction of gluten from 4 to 6months of age during continued breast-feeding is recommended.Objective: To evaluate the scientific evidence of whether timing of gluten introduction affects therisk of celiac disease in high-risk children.Search strategy: Searches were performed in the databases PubMed, Cochrane Library, andScopus, using the search terms celiac disease, gluten introduction, prevention and feeding.Selection criteria: RCTs published as original articles. The study population was to be infants withan increased risk of disease caused by genetic predisposition (HLA-DQ2/8) as well as at least onefirst-degree relative with celiac disease. The intervention should include gluten exposure atdifferent time points. Articles written in languages other than Swedish or English were excluded.Data collection and analysis: The search yielded three articles and the quality of the studies wasevaluated according to SBU?s grading templates. One study was excluded because of its low studyquality. For the remaining studies, a modified GRADE system was used in order to assess thequality of evidence for the selected outcome (celiac disease).Main results: None of the studies detected any significant differences with respect to disease riskof early compared to late gluten introduction, although early exposure to gluten was associatedwith an earlier onset of disease and an earlier immune response as evidenced by elevated levels ofdisease specific antibodies.Conclusions: There is moderate evidence (+++) that timing of gluten introduction does not affectthe risk of celiac disease during childhood in high-risk children. Thus, the result of this systematicliterature review does not support the current recommendation of gluten introduction for infantswith respect to reducing the risk of celiac disease. Further research on additional factors that mayaffect the disease risk is needed in order to determine whether the dietary recommendation shouldbe adjusted.