Influence of specific dietary interventions on clinical manifestation of coeliac disease

Introduction: Breast-feeding duration and time of gluten introduction into infants’ diet are mentioned among the most important dietary factors that influence the development of coeliac disease (CD).
Aim: To evaluate the influence of time of gluten introduction into infants’ diet and/or breast-feeding duration on clinical manifestation of CD.
Material and methods: The retrospective analysis comprised 130 randomly chosen children, including 87 girls and 43 boys with CD diagnosed according to currently applied ESPGHAN criteria.
Results: Time of the first clinical symptoms and diagnosis of CD was statistically significantly later in case of gluten introduction into the infant’s diet after 6 months of life in comparison to children in whom gluten was introduced into the diet before 4 months of life. Time of gluten introduction had no influence on degree of damage of the small bowel mucosa. Significantly more often classic form of CD was diagnosed in children in whom gluten was introduced into the diet before 4 months of life, but atypical form of CD occurred more often in children in whom gluten was introduced into the diet after 6 months of life (p < 0.05). Statistical analysis revealed a statistically significant linear relation between breast-feeding duration and time of occurrence of the first clinical symptoms (p < 0.01) and diagnosis (p < 0.01) of CD. More advanced lesions in the small bowel mucosa were observed at the moment of diagnosis of CD in children who were fed artificially from birth in comparison with breast-fed children (p < 0.05). Classic form of CD was diagnosed significantly more often (p < 0.05) in children fed artificially from birth and in children who were breast-fed for less than 6 months than in children who were breast-fed longer than 6 months. The first clinical symptoms occurred significantly later in children in whom gluten was introduced into the diet during breast-feeding (p < 0.01), CD was diagnosed later (p < 0.01) and atypical form of the disease was diagnosed more often (p < 0.01). More advanced histopathological lesions in the small bowel mucosa were observed in children who were artificially fed during gluten introduction into the diet (p < 0.01).
Conclusions: Longer breast-feeding and later gluten introduction into the diet, particularly during breast-feeding, significantly delays the time when the first clinical symptoms of coeliac disease occur, delays the time of disease diagnosis and increases the probability of atypical coeliac disease being diagnosed. Artificial feeding from birth can increase the risk that more advanced histopathological lesions will occur in the small bowel mucosa.