Field Notes

New Recommendations on Gluten Introduction
to Prevent Celiac Disease

Based on new evidence, the age of introduction of gluten into the infant diet—or the practice of introducing gluten during breast-feeding—doesn’t reduce the risk of celiac disease in infants at risk, according to a position paper of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). The statement appears in the Journal of Pediatric Gastroenterology and Nutrition.

Contrary to previous advice, gluten may be introduced anytime between four to 12 completed months of age, the updated recommendations state. Although breast-feeding should be promoted for its other well-established health benefits, current evidence suggests that neither any breast-feeding nor breast-feeding during gluten introduction can reduce the risk of celiac disease.

Celiac disease is a unique genetic autoimmune disease affecting the gut and other organs, developing in response to consumption of a specific food ingredient—namely gluten. Occurring only in persons carrying one or more susceptibility genes, celiac disease affects approximately 1% to 3% of the general population in most parts of the world.

In 2008, ESPGHAN issued a recommendation to avoid both early (less than four months) and late (seven months or later) introduction of gluten, and to introduce gluten while the infant is still being breast-fed. Those recommendations were based on observational studies suggesting that this approach to gluten introduction reduced the risk of celiac disease.

But since then, two randomized controlled trials have shown that the age at gluten introduction doesn’t affect overall rates (incidence and prevalence) of celiac disease during childhood. Earlier gluten introduction causes the disease to present itself at an earlier age. “These findings suggest that primary prevention of celiac disease through nutritional interventions is not possible at the present time,” according to Hania Szajewska, MD, of The Medical University of Warsaw, the lead author of the new position paper.

Meanwhile, new observational evidence shows no difference in celiac disease risk when gluten is introduced while the infant is still breast-feeding, compared with after weaning. Because of its many other health benefits, breast-feeding is recommended for all infants, regardless of celiac disease risk.

The updated recommendations are based on studies of infants with known risk genes for celiac disease. However, because this information generally isn’t known at the time solid foods are introduced, the recommendations apply to all infants.

Celiac disease risk genes are present in 30% to 40% of the general European population, as well as in 75% to 80% of children who have a close relative (parent or sibling) with celiac disease. For now, there isn’t enough evidence to make specific recommendations for infants with a family history of celiac disease.

The authors highlight the need for recommendations on screening strategies for children with affected family members. They also call for further studies to determine the best approaches to introducing gluten into the diet. Currently, there’s no evidence on the effects of delaying gluten introduction for longer than one year.

— Source: Wolters Kluwer Health


Sedentary Lifestyle Linked to Increased Menopause Symptoms

Sedentary middle-aged Hispanic women in Latin America have significantly worse menopause symptoms than their active counterparts, according to a study of more than 6,000 women across Latin America, which was recently published online in Menopause, the journal of The North American Menopause Society (NAMS). The analysis also linked sedentary lifestyle with depression, anxiety, insomnia, and obesity.

The study analyzed data from the Collaborative Group for Research of the Climacteric in Latin America surveys and health records of 6,079 women, aged 40 to 59, who attended one of 20 urban health centers in 11 Latin American countries. The women completed standard questionnaires about depression, anxiety, insomnia, and menopause symptoms. Symptoms on the Menopause Rating Scale (MRS) questionnaire include somatic symptoms, such as hot flashes and joint pains, psychological symptoms such as depressed mood and anxiety, and urogenital symptoms such as sexual problems, vaginal dryness, and bladder problems. The women also answered other questions, such as what their activity level and menopause status were.

Women were considered to be sedentary if they reported fewer than three weekly sessions of physical activity, such as walking, jogging, or swimming, that lasted 30 minutes or longer, and menopause symptoms were considered severe if the MRS score was 16 or more.

A sedentary lifestyle was very common, reported by 64% of the women. And the following statistically significant contrasts between the sedentary women and active women stood out: Some 16% of the sedentary women had severe menopause symptoms compared with 11% of the active women. The sedentary women also had higher total menopause scores, and more of them had any of the individual symptoms than the active women did. The sedentary women also were more likely to be obese and have higher scores on the depression, anxiety, and insomnia scales.

Results of studies of the ability of exercise to reduce menopause symptoms have been conflicting, but this study adds some weight to the exercise side of the equation.

Less menopause misery is just one of the positive impacts of being active for women at midlife, according to NAMS Executive Director JoAnn V. Pinkerton, MD, NCMP.

“Regular physical activity reduces the risk of breast and colon cancer, dementia, heart attacks, stroke, depression, loss of lean muscle mass, and bone loss, and improves immune system function,” she says. “One study showed that just one hour of walking daily cut the risk of obesity by 24%. Fewer hot flashes, fewer health risks, increased well-being—who doesn’t want these benefits?”

— Source: North American Menopause Society