Coeliac disease (CD), also known as gluten sensitive enteropathy, is an intolerance to gluten found in cereal grains such as wheat, rye and barley and characterized by intestinal malabsorption. In industrialized countries the prevalence in children aged 7 years is about 1 per cent. Although the exact cause of CD is unknown, is it assumed that there may be an environmental trigger - perhaps early infant feeding - that makes the immune system of infants vulnerable to subsequent development of the disease.

In order to determine the effect of early infant feeding practices on the development of CD, i.e. the impact of breastfeeding versus no breastfeeding; the duration of breastfeeding; and the effect of breastfeeding while introducing gluten-containing foods, the authors of one study reviewed the literature available on breastfeeding and CD.

The study performed a review of articles and a meta-analysis. Fifteen relevant articles were identified, of which six met the inclusion criteria. All were case-controlled studies.

The researchers concluded that children with CD were breastfed for a significantly shorter period of time. The risk of developing CD decreased significantly by 63 per cent for children breastfed for two months or less. Children being breastfed at the time of gluten reduction had a 52 per cent reduction of risk of developing CD compared with children who were not breastfeeding at the time of introduction.

The authors pose two potential mechanisms for the protective effect. Firstly, that continued breastfeeding limits the actual amounts of gluten received. Secondly that breastfeeding protects against intestinal infections. Infections can increase the permeability of the infant’s gut and therefore allow the passage of gluten into the lamina propria.

Others have suggested that breastmilk IgA may reduce the immune response to ingested gluten or immune modulation may occur through specific T-cell suppressive effects. The authors suggest further research to determine if breastfeeding delays the onset of CD or if the protection provided by breastfeeding is permanent.

Akobeng A K et al. Effects of breast feeding on risk of coeliac disease: a systematic review and meta-analysis of observational studies. Arch Dis Child 91: 39-43, 2006