Data from: Infant feeding and risk of developing celiac disease: a systematic review

Objective: To review the evidence for the association of breast feeding, breastfeeding duration or the timing of gluten introduction and the later development of celiac disease (CD). Design: Systematic review. Methods: We searched MEDLINE, via PubMed, EMBASE and Web of Science, for studies published up to 31 August 2015 investigating the association of breastfeeding duration, breast feeding at the moment of gluten introduction or the timing of gluten introduction and the later development of CD. Prospective studies had to enrol infants/children at high risk of CD. For retrospective studies, participants had to be children or adults with CD. The paper quality was assessed by means of a GRADE score and the bias risk was assessed by the Newcastle-Ottawa Scale (for observational cohort studies) and Cochrane Collaboration's tool (for randomised trials). Results: Out of 149 retrieved papers, 48 were considered in depth and 16 were included in this review (9 were prospective and 2 were interventional). We found that neither duration of breastfeeding nor breastfeeding at time of gluten introduction nor the delayed introduction of gluten during weaning were effective in preventing later development of CD. Conclusions: Currently, there is no evidence on the optimal breastfeeding duration or the effects of avoiding early (<4 months of age) or late (≥6 or even at 12 months) gluten introduction in children at risk of CD. Accordingly, no specific general recommendations about gluten introduction or optimal breastfeeding duration can be presently provided on evidence-based criteria in order to prevent CD.

研究目标：本研究旨在系统梳理母乳喂养、母乳喂养时长或麸质引入时机与乳糜泻（celiac disease, CD）后续发病之间关联的相关证据。
研究设计：系统综述。
研究方法：通过PubMed检索MEDLINE数据库、EMBASE及Web of Science，检索时限截至2015年8月31日，纳入探讨母乳喂养时长、麸质引入时的母乳喂养情况或麸质引入时机与乳糜泻后续发病关联的研究。前瞻性研究需纳入乳糜泻高风险婴儿/儿童；回顾性研究的研究对象需为乳糜泻患儿或成人。采用GRADE评分对论文质量进行评估，针对观察性队列研究使用纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale）评估偏倚风险，针对随机对照试验使用考克兰协作组（Cochrane Collaboration）工具评估偏倚风险。
研究结果：共检索到149篇文献，经深度筛选后纳入48篇，最终16篇纳入本综述（其中9篇为前瞻性研究，2篇为干预性研究）。研究发现，母乳喂养时长、麸质引入时的母乳喂养情况，以及断奶期间延迟引入麸质，均无法有效预防乳糜泻的后续发病。
研究结论：目前尚无证据表明最优母乳喂养时长，或规避儿童早期（<4月龄）或晚期（≥6月龄甚至12月龄）引入麸质，可降低乳糜泻高风险儿童的发病风险。因此，当前尚无基于循证医学标准的通用推荐意见，可指导调整麸质引入时机或优化母乳喂养时长以预防乳糜泻。