Celiac disease (CD) occurs as a result of immunological responses in the intestinal mucosa to gluten found in many cereals. Various other factors including genetic, environmental and dietary content may contribute to the development of CD.
A recent study has suggested that breastfeeding may protect against celiac disease, by preventing or delaying the onset of the disease. According to this study, antigliadin antibodies (AGAs) are transferred in breast milk, which may modify the immune response in the gut of the infant to the ingested cereals. One hundred and five mothers who delivered at the obstetric clinic of Bursa, Turkey and who breastfed their children were included in this study. Mothers with any type of illness related to pregnancy or general disease were excluded. Women were divided into two groups according to their socioeconomic status. Group 1 (n = 55) consisted of women of low socioeconomic status. Women in group 2 (n = 50) were of high socioeconomic status.
The researchers determined IgA, albumin and AGA-IgA levels in serum and AGA-IgA levels in breast milk. They considered one loaf of bread as a reference point for determining daily bread consumption. Samples of colostrum were collected from 105 mothers within 3 days after birth. Subsequently, milk samples were obtained after 10 days, and after 30 – 45 days of lactation. Blood samples were obtained from all mothers, at the time of the first milk sampling, to measure serum albumin, total IgA and AGA-IgA levels. Antibody detection in colostrum and milk samples was done by enzyme-linked immune sorbent assay (ELISA). In group 1, daily bread consumption and parity were significantly higher as compared to group 2. Mothers in group 2 generally had higher education levels compared with group 1. No significant differences were observed between any of the AGA-IgA levels, serum albumin or serum IgA in the two groups. This means that despite the level of bread consumption, AGA-IgA levels were identical in both groups. Thus bread consumption did not change immunoglobulin levels.
AGA-IgA levels in breastmilk, however, decreased gradually over the first 30–45 days of breastfeeding in both groups. Concentrations of AGA-IgA in breastmilk on days 10 and days 30–45 were significantly lower than those in colostrum (P < 0.001). While the AGA-IgA concentrations in breast milk at day 10 were higher than those at days 30 – 45, the difference was not statistically significant (P > 0.05). Thus, levels of AGA-IgA colostrum were much higher.
It is known that AGA-IgA is a specific antibody to gliadin, which is found in high levels in breast milk and colostrum. In the present study, researchers found higher levels of AGA-IgA in both groups (281 ± 62AU; 269 ± 65 AU). In conclusion, AGA-IgA was present in high levels in both colostrum and breast milk compared with serum, but the levels did not vary with the socioeconomic status of mothers. Therefore, breastfeeding may be an effective means of transferring adequate amounts of AGA-IgA to infants and thus, may protect them from celiac disease.
Sonia Shoukat M.D.
Thomas W. Hale Ph.D.
1. T ÖZKAN, T ÖZEKE AND A MERAL. Gliadin-specific IgA Antibodies in Breast Milk. The Journal of International Medical Research 2000; 28: 234 – 240.