primary prevention of coeliac disease - Associazione Italiana ...

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Age (years) 52 INFANT FEEDING PRACTICES AND COELIAC DISEASE children born during summer as compared to winter. It might be that seasonality reflects a varying exposure to infectious episodes throughout the year, but other possible explanations should be explored. Another associated factor is the increased risk for coeliac disease in Swedish children from the lower as compared to middle and upper socio-economic strata, suggesting that there are further component causes yet to be identified. Structural factors are any change on a societal level influencing the risk for coeliac disease. However, these must of course exhibit their effect through component causes close to the individual, as illustrated in the depicted model (Fig. 3). These could include dietary recommendations influencing how gluten is introduced into the infant diet, and changes in the gluten content in industrially produced infant foods. What can be learnt from the Swedish epidemic? What caused the epidemic? Changes in infant feeding practices have been suspected to contribute to the Swedish epidemic of coeliac disease in children. To clarify whether or not this was the case, we used an ecological approach comparing estimated yearly changes in infant feeding practices with the yearly incidence rate of coeliac disease in children below two 36 years of age . We collected national data for the years 1980 to 1997 on duration of breast-feeding 36 and intake of gluten-containing cereals in Swedish infants . The latter was estimated by changes in gluten intake by means of industrially produced follow-on formulas as an estimate of changes in total gluten intake. These follow-on formulas, combined with 59 porridge, provide about half of the total intake of gluten proteins , and of that half, follow-on formulas account for about 90%, according to the manufacturers. It should be noted that the incidence rate for a particular year in children below two years of age might also be influenced by the exposure pattern of the two preceding years. The reason for this, as illustrated by the Lexis diagram, is that the incidence rate in children below two years of age in 1997, for instance, is based on cases diagnosed that year, and these children were born during the period 1995 to 1997, which is thus the period during which they might have been exposed (Fig. 4). 2 Incidence rate in children 0-2 years of age in 1997 1 1995 1996 1997 1998 1999 Exposure period Fig. 4. A Lexis diagram illustrating the population and exposure periods on which the incidence rate by age is based.
INFANT FEEDING PRACTICES AND COELIAC DISEASE 53 36 Our results showed rapidly increasing incidence rates between 1985 and 1987 . The period of interest with regard to exposure was characterised by i) about half of the infants being breast-fed at six months of age, ii) doubling of the average daily consumption of flour through use of follow-on formula from 1981 to 1983 with regard to the total amount of wheat, rye and barley, while the amount of oats decreased, and iii) a national recommendation at the end of 1982 to postpone introduction of gluten from four to six months of age (Fig. 5).This latter change was in accordance with European 300 250 Incidence rate Breastfeeding index Wheat/Rye/Barley index 200 150 100 50 0 Changed national recommendations 1980 1985 1990 1995 Fig. 5. Annual incidence rate of coeliac disease per 100 000 person years for children 0-1.9 years of age from 1980 to 1997, in relation to breast-feeding habits, flour consumption and c h a n g e d n a t i o n a l re c o m m e n d a t i o n s . T h e a r ro w s i n d i c a t e c h a n g e d recommendation on introduction of gluten to infants. Breast-feeding index based on the proportion of all children breast-fed at six months of age (1980; index 100 = 37%). Wheat/Rye/Barley index based on the estimated average daily consumption of these cereals -1 -1 provided by follow-on formulas (1980; index 100 = 16 gram x child x day ). 36 From with permission. 78 recommendations . A rapid decline in the incidence rate began in 1995, and was still ongoing through 36 1997 . The period of interest with regard to exposure was characterised by i) a continuous increase (from 54% to 76%) in the proportion of infants still breast-fed at six months of age, ii) the average daily consumption of flour through the use of follow-on formula decreased by one third starting in 1995 with regard to the total amount of wheat, rye and barley, while the amount of oats increased, and iii) the national recommendation was changed in the autumn of 1996 to introduction of gluten into the diet in smaller amounts from four months of age, and preferably while the child is still breast-fed (Fig. 5). However, starting at the end of the 1980s, and particularly during a one-year period starting in the autumn of 1995, the media focused much attention on the increased incidence of coeliac disease in relation to the current dietary pattern. This most likely promoted a change in dietary patterns that was more extensive than revealed
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Perspectives on Coeliac Disease Vol
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The AIC Meeting was held in the Aul
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Italian Coeliac Society, Via Picott
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Preface Coeliac disease (CD) is a u
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Contents Current understanding of t
Page 16 and 17: 2 THE BASIS OF COELIAC DISEASE hapl
Page 18 and 19: 4 THE BASIS OF COELIAC DISEASE 1 pr
Page 20 and 21: 6 THE BASIS OF COELIAC DISEASE spre
Page 22 and 23: 8 THE BASIS OF COELIAC DISEASE Ackn
Page 24 and 25: 10 THE BASIS OF COELIAC DISEASE glu
Page 27 and 28: Catassi C, Fasano A, Corazza GR (ed
Page 29: T CELL RESPONSES TO GLUTEN PEPTIDES
Page 32 and 33: 18 A DOMINANT EPITOPE IN GLUTEN PEP
Page 42 and 43: 28 ROLE OF A-GLIADIN 31-49 PEPTIDE
Page 47 and 48: COELIAC DISEASE IN THE SAHARAWI 33
Page 55: COELIAC DISEASE IN THE SAHARAWI 41
Page 58 and 59: 44 INFANT FEEDING PRACTICES AND COE
Page 76 and 77: 62 MECHANISMS OF ORAL TOLERANCE the
Page 78 and 79: 64 MECHANISMS OF ORAL TOLERANCE pot
Page 80 and 81: 66 MECHANISMS OF ORAL TOLERANCE Epi
Page 82 and 83: 68 MECHANISMS OF ORAL TOLERANCE typ
Page 84 and 85: 70 MECHANISMS OF ORAL TOLERANCE 51
Page 86 and 87: 72 MECHANISMS OF ORAL TOLERANCE 23.
Page 91 and 92: GENETICALLY DETOXIFIED GRAINS 77 to
Page 93 and 94: • • GENETICALLY DETOXIFIED GRAI
Page 95 and 96: GENETICALLY DETOXIFIED GRAINS 81 3.
Page 99 and 100: IMMUNOTHERAPY OF COELIAC DISEASE 85
Page 101 and 102: IMMUNOTHERAPY OF COELIAC DISEASE 87
Page 105 and 106: RECENT ADVANCES ON GLUTEN TOXICITY
Page 107 and 108: Index A Antiendomysium antibodies (
Page 109: INDEX 95 W Wheat, 7, 23, 27, 31, 53
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