Chapter 14 - Early nutrition and its effect on the development of celiac disease

Abstract

Celiac disease is a systemic immune-mediated disorder caused by the ingestion of gluten in genetically susceptible persons. It is one of the most common lifelong disorders, affecting 1%–2% of the population worldwide. The prevalence of celiac disease has increased in some countries over recent decades, pointing to the role of one or more possible environmental triggers, other than gluten, that could be involved in its pathogenesis. It has been hypothesized that early nutrition may have a role in the switches of the tolerance–intolerance immune balance. However, both breastfeeding and age at gluten introduction were deemed less important or perhaps even irrelevant by two randomized clinical trials that failed to find an effect on the risk of celiac disease. Since then attention has shifted, and some evidence emerged on the possible role of the quantity of gluten on the risk of celiac disease. The idea that nutrition in the first years of life is not the only factor for the development of the disease is gaining ground in the recent years, but it may concur with other risk factors (in particular infections in the first years of life, and the composition of intestinal microbiota) to the development of celiac disease.