casein-hydrolysate and Celiac-Disease

Feeding during the first months of life might affect risk for celiac disease. Individuals with celiac disease or type 1 diabetes have been reported to have high titers of antibodies against cow's milk proteins. Avoidance of cow's milk-based formula for infants with genetic susceptibility for type 1 diabetes reduced the cumulative incidence of diabetes-associated autoantibodies. We performed a randomized controlled trial in the same population to study whether weaning to an extensively hydrolyzed formula reduced the risk of celiac disease autoimmunity or celiac disease.. We performed a double-blind controlled trial of 230 infants with HLA-defined predisposition to type 1 diabetes and at least 1 family member with type 1 diabetes. The infants were randomly assigned to groups fed a casein hydrolysate formula (n = 113) or a conventional formula (control, n = 117) whenever breast milk was not available during the first 6-8 months of life. Serum samples were collected over a median time period of 10 years and analyzed for antibodies to tissue transglutaminase (anti-TG2A) using a radiobinding assay, to endomysium using an immunofluorescence assay, and antibodies to a deamidated gliadine peptide using an immunofluorometry assay. Duodenal biopsies were collected if levels of anti-TG2A exceeded 20 relative units. Cow's milk antibodies were measured during the first 2 years of life.. Of the 189 participants analyzed for anti-TG2A, 25 (13.2%) tested positive. Of the 230 study participants observed, 10 (4.3%) were diagnosed with celiac disease. We did not find any significant differences at the cumulative incidence of anti-TG2A positivity (hazard ratio, 1.14; 95% confidence interval, 0.51-2.54) or celiac disease (hazard ratio, 4.13; 95% confidence interval, 0.81-21.02) between the casein hydrolysate and cow's milk groups. Children who developed celiac disease had increased titers of cow's milk antibodies before the appearance of anti-TG2A or celiac disease.. In a randomized controlled trial of 230 infants with genetic risk factors for celiac disease, we did not find evidence that weaning to a diet of extensively hydrolyzed formula compared with cow's milk-based formula would decrease the risk for celiac disease later in life. Increased titers of cow's milk antibody before anti-TG2A and celiac disease indicates that subjects with celiac disease might have increased intestinal permeability in early life. ClinicalTrials.gov Number: NCT00570102.

Topics: Autoantibodies; Autoimmunity; Biopsy; Caseins; Celiac Disease; Child; Child, Preschool; Diabetes Mellitus, Type 1; Double-Blind Method; Duodenum; Finland; Gliadin; GTP-Binding Proteins; Humans; Infant; Infant Formula; Milk Hypersensitivity; Milk Proteins; Protein Glutamine gamma Glutamyltransferase 2; Risk Assessment; Risk Factors; Serologic Tests; Time Factors; Transglutaminases; Treatment Outcome

Topics: Animals; Autoantibodies; Autoantigens; Breast Feeding; Caseins; Cattle; Celiac Disease; Contraindications; Diabetes Mellitus, Type 1; Environmental Exposure; Female; Genetic Markers; Genetic Predisposition to Disease; Genetic Testing; Genotype; HLA-D Antigens; Humans; Incidence; Infant Food; Infant Formula; Infant, Newborn; Islets of Langerhans; Italy; Male; Milk Proteins; Molecular Mimicry; Neonatal Screening; Patient Acceptance of Health Care; Vitamin D; Vitamin D Deficiency