ORIGINAL ARTICLE

Effect of breast feeding on risk of coeliac disease: a systematic review and meta-analysis of observational studies

A K Akobeng¹, A V Ramanan², I Buchan³, R F Heller³

¹ Department of Paediatric Gastroenterology, Booth Hall Children’s Hospital, Central Manchester and Manchester Children’s University Hospitals, Manchester, UK
² Department of Paediatrics, Booth Hall Children’s Hospital, Central Manchester and Manchester Children’s University Hospitals, Manchester, UK
³ Evidence for Population Health Unit, School of Epidemiology and Health Sciences, University of Manchester, Manchester, UK

Correspondence to:
Dr A K Akobeng
Department of Paediatric Gastroenterology, Central Manchester and Manchester Children’s University Hospitals, Booth Hall Children’s Hospital, Charlestown Road, Blackley, Manchester M9 7AA, UK; tony.akobeng{at}cmmc.nhs.uk

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.

Methods: 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 relation between breast feeding and CD.

Abbreviations: CD, coeliac disease; CI, confidence interval; OR, odds ratio; RR, relative risk

Keywords: breast feeding; coeliac disease; systematic review; meta-analysis

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