An association was investigated between changing infant feeding practices and a declining incidence of childhood coeliac disease and transient gluten intolerance (TGI) in West Somerset, England during 1971-92. Dietary histories of 18 patients with coeliac disease were compared with 23 controls during 1971-80 and eight patients with coeliac disease and 39 controls during 1981-92. Our findings showed that the declining incidence of coeliac disease and TGI were associated with changing infant feeding practices, characterised by the later introduction of dietary gluten, an increased use of baby rice and gluten free foods for weaning, and an increased incidence of initial breast feeding. (Arch Dis Child 1997;77:206-209) Keywords: coeliac disease; declining incidence; infant feedingThe incidence of coeliac disease in childhood has declined in England, 1-4 Scotland, 5 and Ireland 6 over the past two decades. However, in Italy, the incidence has been unchanged, 7 and probably in Finland, 8 where patients increasingly present with mild or atypical symptoms and signs of coeliac disease, at school age or during adolescence. In Sweden, the incidence of coeliac disease has increased since 1982.
10The reasons for these conflicting trends are unclear, with genetic and environmental factors being implicated, including the age of introducing dietary gluten in infancy.11 In this study we have investigated the influence of changing infant feeding practices on the incidence of childhood coeliac disease and transient gluten intolerance (TGI) in West Somerset, during 1971-92.
Patients and methodsWest Somerset had a mean annual population of 263 000 (51 600 <14 years) during 1971-92 and a mean number of live births of 2700 per annum.During this period, 39 children with a history of coeliac disease (22 boys, 17 girls; median age = 16 months, range = 3 months-13 years 8 months) were admitted to the children's unit, Taunton and Somerset Hospital for further investigation. Peroral small intestinal biopsy specimens showed villous flattening by light microscopy, and they responded clinically to treatment with a gluten free diet. An initial diagnosis of coeliac disease was made and later confirmed on 16 patients (six boys, 10 girls), according to criteria of the European Society for Paediatric Gastroenterology and Nutrition (ESPGAN).12 A further 10 patients (five boys, five girls) were diagnosed with coeliac disease according to revised ESPGAN criteria. 13 The age of presentation of coeliac disease in all patients was the time of their initial biopsy and the cumulative incidence of coeliac disease was the number of patients per 1000 live births, calculated for each birth cohort.Dietary histories during infancy were obtained on patients and controls by a paediatric dietitian. The numbers of infants initially breast or bottle fed, the age of introduction of dietary gluten, and the types of solids used for weaning were determined. Controls were children admitted to hospital in whom coeliac disease was excluded and 23 were studied bet...
