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

Anthony K Akobeng ^1*, Athimalaipet V Ramanan ¹, Iain Buchan ² and Richard F Heller ²

¹ Booth Hall Children's Hospital, United Kingdom
² University of Manchester, United Kingdom

^* To whom correspondence should be addressed. E-mail: tony.akobeng{at}cmmc.nhs.uk.

Accepted 11 October 2005

Abstract

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.

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

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