The Swedish Celiac Epidemic – Age at Gluten Introduction & Breastfeeding

BabyEatingPablum Data from the Swedish celiac disease epidemic continues to be collected and analyzed, obtaining useful information that may help people susceptible to celiac disease all over the world. In Sweden, the rate of CD diagnosed in children less than two years of age between 1984 and 1996 was four times that of what occurred in babies born before or after the epidemic period.

A recent study added more important information about this epidemic. Two large groups of 12-year-olds, one born in 1993 during the epidemic and one born after in 1997 after the epidemic were evaluated for the presence of celiac disease. There was still a statistically significant larger percentage of 12-year-olds with celiac disease who were born during the epidemic years as compared with those born afterwards. This indicates that the “epidemic” was not simply caused by earlier diagnosis of celiac disease during that period.

Data for this particular study was collected in 2009 and 2010, as all the children continue to be followed. The 12-year-olds in the two groups were comparable in terms of locations in Sweden and socioeconomic groups.

Among the two groups of study participants, infant feeding practices applicable to them were collected in two ways. One was by parental questionnaire. However, ten plus years later, not all parents remembered at what age they introduced gluten-containing foods or at what age the mother stopped breast feeding. A key factor was the overlap period, the time when babies first ate foods with gluten while still breastfeeding.

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The other way to determine feeding practices was more general. It is estimated that 99% of Swedish infants get standard well-baby care, and that 60% to 70% of parents follow the recommendations about how to feed their babies. These general numbers were used in the study.

In 1982, Swedish well-baby clinics suggested introducing gluten later than it had been in the past, at six rather than four months. Additionally, during this time frame, more gluten-containing ingredients were added into commercial baby cereals and other foods. There were no specific differences in suggestions regarding breast feeding. However, the “1993” group of babies was breast fed an average of seven months, as opposed to nine months in the later group.

As a result of the age of gluten introduction and discontinuation of breast feeding, there was a statistically significant difference between the two groups in terms of how many infants were still breast feeding when they first had gluten. During the non-epidemic years, breast feeding continued after gluten introduction in 78% of the infants, as opposed to 70% of those born during the epidemic years. This also was statistically significant.

It appears that during the epidemic years, more babies were introduced to higher amounts of gluten after they had stopped breast feeding. Researchers believe that each of these factors contributed to the epidemic. They now recommend introducing small amounts of gluten to younger babies who are still breast feeding. This is similar to what was recommended before the epidemic. The changes made to feeding advice in 1982 were reversed in 1996, the year before the epidemic ended.

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At the current time there is a study in Sweden comparing what happens when gluten is introduced to infants between 4 and 6 months of age as opposed to what happens when it is not introduced much later, at 12 months. The study is not finished, but after 36 months is seems that delaying gluten introduction does not prevent celiac disease, but does delay the time it is diagnosed.

There is another study looking at the amounts of gluten introduced to babies that may shed further light on this.

Researchers believe that breastfeeding may protect babies from a variety of autoimmune diseases include celiac disease, and that introducing gluten during breast feeding may help prevent the disease from developing.

However, celiac disease is very complicated. A person has to have the genetic predisposition to develop the disease, exposure to gluten, and a number of other factors, one of which appears to be early infectious illness. Whether or not modifying the timing of the first feedings of gluten along with breast feeding will be enough to actually change how many children develop celiac disease has not yet been determined.


Ivarsson A., Myléus A., Norström F., et al. Prevalence of Childhood Celiac Disease and Changes in Infant Feeding. Pediatrics 2013; 13: e687–e694.

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