Breast milk is the natural nutrition for infants, but in the second half of the first year of life, complementary feeding is needed. Many complementary foods contain gluten, but gluten exposure is associated with the risk of developing celiac disease (CD). CD is a disease with considerable morbidity and mortality. Although CD is associated with certain genetic features, carrying the human leukocyte antigen haplotypes DQ2 or DQ8 (a prerequisite for CD development) cannot fully explain who will or who will not develop CD. Potential risk factors for CD include perinatal events and infant feeding practice. With the exception that children who are breastfed at and beyond gluten introduction into the diet probably may be at a lower risk of developing CD, and that heavy gluten load early in life may increase the risk of future CD, data on the impact of infant feeding are inconsistent.

1.
Fasano A, Berti I, Gerarduzzi T, et al: Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med 2003;163:286–292.
2.
Maki M, Mustalahti K, Kokkonen J, et al: Prevalence of celiac disease among children in Finland. N Engl J Med 2003;348:2517–2524.
3.
Walker MM, Murray JA, Ronkainen J, et al: Detection of celiac disease and lymphocytic enteropathy by parallel serology and histopathology in a population-based study. Gastroenterology 2010;139:112–119.
4.
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;102:330–354.
5.
Oberhuber G, Granditsch G, Vogelsang H: The histopathology of coeliac disease: time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol 1999;11:1185–1194.
6.
Corazza GR, Villanacci V: Coeliac disease. J Clin Pathol 2005;58:573–574.
7.
Sollid LM, Thorsby E: HLA susceptibility genes in celiac disease: genetic mapping and role in pathogenesis. Gastroenterology 1993;105:910–922.
8.
Ludvigsson JF, Montgomery SM, Ekbom A, et al: Small-intestinal histopathology and mortality risk in celiac disease. JAMA 2009;302:1171–1178.
9.
West J, Logan RF, Smith CJ, et al: Malignancy and mortality in people with coeliac disease: population based cohort study. BMJ 2004;329:716–719.
10.
Elfström P, Granath F, Ekström Smedby K, et al: Risk of lymphoproliferative malignancy in relation to small intestinal histopathology among patients with celiac disease. J Natl Cancer Inst 2011;103:436–444.
11.
Gandolfi L, Pratesi R, Cordoba JC, et al: Prevalence of celiac disease among blood donors in Brazil. Am J Gastroenterol 2000;95:689–692.
12.
Gomez JC, Selvaggio GS, Viola M, et al: Prevalence of celiac disease in Argentina: screening of an adult population in the La Plata area. Am J Gastroenterol 2001;96:2700–2704.
13.
Abu-Zekry M, Kryszak D, Diab M, et al: Prevalence of celiac disease in Egyptian children disputes the east-west agriculture-dependent spread of the disease. J Pediatr Gastroenterol Nutr 2008;47:136–140.
14.
Remes-Troche JM, Ramirez-Iglesias MT, Rubio-Tapia A, et al: Celiac disease could be a frequent disease in Mexico: prevalence of tissue transglutaminase antibody in healthy blood donors. J Clin Gastroenterol 2006;40:697–700.
15.
Sood A, Midha V, Sood N, et al: Prevalence of celiac disease among school children in Punjab, North India. J Gastroenterol Hepatol 2006;21:1622–1625.
16.
Akbari MR, Mohammadkhani A, Fakheri H, et al: Screening of the adult population in Iran for coeliac disease: comparison of the tissue-transglutaminase antibody and anti-endomysial antibody tests. Eur J Gastroenterol Hepatol 2006;18:1181–1186.
17.
Ivarsson A, Persson LA, Nystrom L, et al: Epidemic of coeliac disease in Swedish children. Acta Paediatr 2000;89:165–171, comments pp 140–141, 749–750.
18.
Ivarsson A, Hernell O, Stenlund H, et al: Breast-feeding protects against celiac disease. Am J Clin Nutr 2002;75:914–921.
19.
Karell K, Louka AS, Moodie SJ, et al: HLA types in celiac disease patients not carrying the DQA1*05-DQB1*02 (DQ2) heterodimer: results from the European Genetics Cluster on Celiac Disease. Hum Immunol 2003;64:469–477.
20.
Qiao SW, Bergseng E, Molberg O, et al: Refining the rules of gliadin T cell epitope binding to the disease-associated DQ2 molecule in celiac disease: importance of proline spacing and glutamine deamidation. J Immunol 2005;175:254–261.
21.
Greco L, Romino R, Coto I, et al: The first large population based twin study of coeliac disease. Gut 2002;50:624–628.
22.
Trynka G, Wijmenga C, van Heel DA: A genetic perspective on coeliac disease. Trends Mol Med 2010;16:537–550.
23.
Louka AS, Lie BA, Talseth B, et al: Coeliac disease patients carry conserved HLA-DR3-DQ2 haplotypes revealed by association of TNF alleles. Immunogenetics 2003;55:339–343.
24.
Greco L, Corazza G, Babron MC, et al: Genome search in celiac disease. Am J Hum Genet 1998;62:669–675.
25.
Van Belzen MJ, Meijer JW, Sandkuijl LA, et al: A major non-HLA locus in celiac disease maps to chromosome 19. Gastroenterology 2003;125:1032–1041.
26.
Monsuur AJ, Bakker PI, Alizadeh BZ, et al: Myosin IXB variant increases the risk of celiac disease and points toward a primary intestinal barrier defect. Nat Genet 2005;37:1341–1344.
27.
Sandberg-Bennich S, Dahlquist G, Kallen B: Coeliac disease is associated with intrauterine growth and neonatal infections. Acta Paediatr 2002;91:30–33.
28.
Roberts SE, Williams JG, Meddings D, et al: Perinatal risk factors and coeliac disease in children and young adults: a record linkage study. Aliment Pharmacol Ther 2009;29:222–231.
29.
Ludvigsson JF, Ludvigsson J: Parental smoking and risk of coeliac disease in offspring. Scand J Gastroenterol 2005;40:336–342.
30.
Decker E, Engelmann G, Findeisen A, et al: Cesarean delivery is associated with celiac disease but not inflammatory bowel disease in children. Pediatrics 2010;125:e1433–e1440.
31.
Kagnoff MF, Paterson YJ, Kumar PJ, et al: Evidence for the role of a human intestinal adenovirus in the pathogenesis of coeliac disease. Gut 1987;28:995–1001.
32.
Yoon JW, Austin M, Onodera T, et al: Isolation of a virus from the pancreas of a child with diabetic ketoacidosis. N Engl J Med 1979;300:1173–1179.
33.
Oldstone MB, Nerenberg M, Southern P, et al: Virus infection triggers insulin-dependent diabetes mellitus in a transgenic model: role of anti-self (virus) immune response. Cell 1991;65:319–331.
34.
Hyoty H, Hiltunen M, Knip M, et al: A prospective study of the role of coxsackie B and other enterovirus infections in the pathogenesis of IDDM. Childhood Diabetes in Finland (DiMe) Study Group. Diabetes 1995;44:652–657.
35.
Kokkonen J, Simila S, Vuolukka P: The incidence of coeliac disease and pyloric stenosis in children in Northern Finland. Ann Clin Res 1982;14:123–128.
36.
Ivarsson A, Hernell O, Nystrom L, et al: Children born in the summer have increased risk for coeliac disease. J Epidemiol Community Health 2003;57:36–39.
37.
Tanpowpong P, Vassallo M, Katz AK, et al: Season of birth and celiac disease in Massachusetts children (abstract Su1254). Gastroenterology 2011;140(suppl 1):S442.
38.
Stene LC, Honeyman MC, Hoffenberg EJ, et al: Rotavirus infection frequency and risk of celiac disease autoimmunity in early childhood: a longitudinal study. Am J Gastroenterol 2006;101:2333–2340.
39.
Welander A, Honeyman MC, Hoffenberg EJ, et al: Infectious disease and risk of later celiac disease in childhood. Pediatrics 2010;125:e530–e536.
40.
Akobeng AK, Ramanan AV, Buchan I, et al: Effect of breast feeding on risk of coeliac disease: a systematic review and meta-analysis of observational studies. Arch Dis Child 2006;91:39–43.
41.
Norris JM, Barriga K, Hoffenberg EJ, et al: Risk of celiac disease autoimmunity and timing of gluten introduction in the diet of infants at increased risk of disease. JAMA 2005;293:2343–2351.
42.
Auricchio S, Follo D, de Ritis G, et al: Does breast feeding protect against the development of clinical symptoms of celiac disease in children? J Pediatr Gastroenterol Nutr 1983;2:428–433.
43.
Greco L, Auricchio S, Mayer M, et al: Case control study on nutritional risk factors in celiac disease. J Pediatr Gastroenterol Nutr 1988;7:395–399.
44.
Falth-Magnusson K, Franzen L, Jansson G, et al: Infant feeding history shows distinct differences between Swedish celiac and reference children. Pediatr Allergy Immunol 1996;7:1–5.
45.
Ascher H, Krantz I, Rydberg L, et al: Influence of infant feeding and gluten intake on coeliac disease. Arch Dis Child 1997;76:113–117.
46.
Peters U, Schneeweiss S, Trautwein EA, et al: A case-control study of the effect of infant feeding on celiac disease. Ann Nutr Metab 2001;45:135–142.
47.
Rinne M, Kalliomaki M, Arvilommi H, et al: Effects of probiotics and breastfeeding on the bifidobacterium and lactobacillus/enterococcus microbiota and humoral immune responses. J Pediatr 2005;147:186–191.
48.
Greco L, Mayer M, Grimaldi M, et al: The effect of early feeding on the onset of symptoms in celiac disease. J Pediatr Gastroenterol Nutr 1985;4:52–55.
49.
Hopman EG, Kiefte-de Jong JC, le Cessie S, et al: Food questionnaire for assessment of infant gluten consumption. Clin Nutr 2007;26:264–271.
50.
Michaelsen KF, Weile B, Larsen P, et al: Does the low intake of wheat in Danish infants cause the low incidence rate of coeliac disease? Acta Paediatr 1993;82:605–606.
51.
Weile B, Cavell B, Nivenius K, et al: Striking differences in the incidence of childhood celiac disease between Denmark and Sweden: a plausible explanation. J Pediatr Gastroenterol Nutr 1995;21:64–68.
52.
Mitt K, Uibo O: Low cereal intake in Estonian infants: the possible explanation for the low frequency of coeliac disease in Estonia. Eur J Clin Nutr 1998;52:85–88.
53.
Doherty M, Barry RE: Gluten-induced mucosal changes in subjects without overt small-bowel disease. Lancet 1981;1:517–520.
54.
Catassi C, Rossini M, Ratsch IM, et al: Dose dependent effects of protracted ingestion of small amounts of gliadin in coeliac disease children: a clinical and jejunal morphometric study. Gut 1993;34:1515–1519.
55.
Catassi C, Fabiani E, Iacono G, et al: A prospective, double-blind, placebo-controlled trial to establish a safe gluten threshold for patients with celiac disease. Am J Clin Nutr 2007;85:160–166.
56.
Hogen Esch CE, Rosen A, Auricchio R, et al: The PreventCD Study design: towards new strategies for the prevention of coeliac disease. Eur J Gastroenterol Hepatol 2010;22:1424–1430.
57.
De Palma G, Capilla A, Nadal I, et al: Interplay between human leukocyte antigen genes and the microbial colonization process of the newborn intestine. Curr Issues Mol Biol 2010;12:1–10.
58.
Mignard S, Flandrois JP: 16S rRNA sequencing in routine bacterial identification: a 30-month experiment. J Microbiol Methods 2006;67:574–581.
59.
Palmer C, Bik EM, DiGiulio DB, et al: Development of the human infant intestinal microbiota. PLoS Biol 2007;5:e177.
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