Avoiding cow's milk does not reduce celiac disease in high-risk infants

Reference

Hyytinen M, Savilahti E, Virtanen SM, et al, for the Finnish TRIGR Pilot Study Group. Avoidance of cow's milk-based formula for at-risk infants does not reduce development of celiac disease: a randomized controlled trial. Gastroenterology 2017;153(4):961–970.

Synopsis

The researchers of this study conducted in Finland enrolled 230 infants with a first-degree relative with type 1 diabetes and a laboratory-verified predisposition to develop diabetes; both factors are associated with the development of celiac disease. The infants were randomly assigned, using concealed allocation, to receive either a cow's milk–based formula or a hydrolyzed casein–based formula (Nutramigen) to be used as desired to supplement breastfeeding for the first 6 months to 8 months of life. Breastfeeding rates were similar in both groups. Children were followed up until they were 10 years old with periodic testing for antibody development signaling celiac disease, with approximately 18% of the kids lost to drop-out. There was no difference in the development of either antibodies or symptomatic disease among the 2 groups. Using intention-to-treat analysis, 25 of the 189 participants (13.2%) developed antibodies. Ten of the children (4.3%; median age 16.7 years) were given a diagnosis of celiac disease: 6 in the control group and 4 in the cow's milk group. This was a small study with a small number of cases of celiac disease, so the study may not have had the power to identify a difference in the development of celiac disease among the 2 groups if one truly exists.