Effect of Breast-Feeding on Risk of Coeliac Disease: A Systematic Review and Meta-Analysis of Observational Studies

By Joel Fuhrman, M.D.

Anthony K Akobeng 1*, Athimalaipet V Ramanan 1, Iain Buchan 2 and Richard F Heller 2 Arch Dis Child. Published Online First: 15 November 2005.

Background: Coeliac disease (CD) is a disorder that may depend on genetic, immunological, and environmental factors. Recent observational studies suggest that breast-feeding may prevent the development of CD.

Aim: To evaluate articles that compared effects of breast-feeding on risk of CD.

Design: Systematic review and meta-analysis of observational studies published between 1966 and June 2004 that examined the association between breast- feeding and the development of CD.

Results: Six case-control studies met the inclusion criteria. With the exception of one small study, all the included studies found an association between increasing duration of breast-feeding and decreased risk of developing CD. Meta-analysis showed that the risk of CD was significantly reduced in infants who were breast-feeding at the time of gluten introduction (pooled odds ratio 0.48, 95% CI 0.40 to 0.59) compared with infants who were not breast-feeding during this period.

Conclusions: Breast-feeding may offer protection against the development of CD. Breast-feeding during the introduction of dietary gluten, and increasing duration of breast-feeding were associated with reduced risk of developing CD. It is, however, not clear from the primary studies whether breast-feeding delays the onset of symptoms or provides a permanent protection against the disease. Long- term prospective cohort studies are required to investigate further the relationship between breast-feeding and CD.