BREAST-FEEDING EFFECT RELATIVE TO THE ONS ET AGE OF CELIAC-DISEASE

Background. - Age at onset and clinical presentation of celiac disease have often been related to the age of gluten introduction into the di et. It has also been shown that breastfeeding delays the onset of the disease. Patients and methods. - This retrospective study attempts to evaluate the respective contributions of these two parameters in the d etermination of the age at onset of the symptoms in celiac Tunisian ch ildren. Results. - One-hundred-sixty-nine children were studied. Mean duration of breast feeding in our population was 9.6 +/- 8.9 months an d mean age of gluten introduction was 5.6 +/- 3.2 months. The mean age at onset of the disease was 15 +/- 8.7 months and mean latency time b etween gluten introduction and onset of the disease was 9.5 +/- 7.8 mo nths. Both variables, duration of breast feeding and age at gluten int roduction were strongly correlated to the age at onset of the disease (r = 0.47 and 0.40, respectively). Only breastfeeding was correlated t o the variable latency time (r = 0.33). Stepwise multiple regression a nalysis showed that the two variables independently influenced the age at onset with coefficients of regression of 0.90 +/- 0.20 and 0.26 +/ - 0.07, respectively. Only breast feeding influenced the latency time with a coefficient of regression equal to 0.26 +/- 0.07. Discussion. - Our study confirms the independent effect of breast feeding in the de termination of the age at onset of the disease. Breast feeding has two effects: an indirect effect, by delaying the introduction of gluten, and a direct effect, by increasing de latency time between gluten intr oduction and onset of the disease. Conclusion. - Prolonged breast feed ing, at least until the 6th month, and gluten introduction started at least at the 5th month of life, significantly delay the onset of the t he disease. Gluten introduction should be done progressively and under breast feeding protection. Introduction of gluten 2 months before wea ning has a protective effect. (C) 1998, Elsevier, Paris.