Table 1

Effect of BF and duration of BF on the development of CD

ReferenceNumber of infants/children enrolledLength of observationEffect of BFEffect sizeGRADE scoreBias risk
Retrospective studies
 Auricchio et al17Biopsy-proven CD=216
controls=289
NABF >30 days protectiveOR 4.05 (95% CI 2.2 to 7.2)2High
 Greco et al18Biopsy-proven CD=201
controls=1949
NABF <90 days protectiveOR 4.97 (95% CI 3.5 to 6.9)2High
 Fälth-Magnusson et al19Biopsy-proven CD=72
controls=264
NABF >2.5 months protectivep<0.00022High
 Ascher et al2085 (8 found to have silent CD at biopsy)NANo effect of duration of BF on CD development6.5 months for cases vs 5.0 months for controls p ns2High
 Peters et al23Biopsy-proven CD=143
controls=137
NABF >2 months protectiveOR 0.37 (95% CI 0.21 to 0.64)1High
 Roberts et al25Biopsy-proven CD=90
controls=248 521
NANone22 vs 38; p=0.281High
 Decker et al24Biopsy-proven CD=157
controls=862
Up to a mean age of 13.9 yearsNoneOR 0.93 (95% CI 0.69 to 1.25)1High
Prospective studies
 Ivarsson et al21Biopsy-proven CD=627
controls=1254
NAProtective when CD diagnosis made in patients <2 years; none for CD diagnosis made in patients <2 yearsp<0.001
p NS
2High
 Ziegler et al141610 (27 developed CD autoimmunity*)From birth to 12 years of ageNone0–3 months OR 
0.88 (95% CI 0.2 to 2.7)
3.1–6 months OR 1.2 (95% CI 0.4 to 3.6)
>6 months OR 1.00 (reference)
3Medium
 Norris et al151560 (51 developed CD autoimmunity*)From birth to 10 years of ageNone1.02 (95% CI 0.99 to 1.05)3Medium
 Welander et al22Biopsy-proven CD=44
controls=936
At 10 years of ageNone0–2 months OR 0.7 (95% CI 0.2 to 3.1)
3–4 months OR 0.7 (95% CI 0.2 to 3.2)
5–6 months OR 0.3 (95% CI 0.0 to 2.1)
7–8 months OR 
1.4 (95% CI 0.7 to 3.1)
9–10 months OR 1.3 (95% CI 0.6 to 2.8)
11–12 OR 1.00 (reference)
3High
 Størdal et al26Biopsy-proven CD=324
controls=81 834
From birth to 12 years of ageBF >1 year predisposing<6 months reference
6–12 months OR 1.27 (95% CI 0.85 to 1.86)
>13 months OR 1.49 (95% CI 1.01 to 2.21)
3High
 Jansen, 2014271679 (43 developed CD autoimmunity*)At 6 years of ageNo difference in proportion of BF children in group who developed or do not have autoimmunityp ns3Medium
 Vriezinga et al13944 (105 developed CD autoimmunity*, out of them 77 biopsy-proven overt CD)From birth to 3 years of ageNoneOvert CD
0 months OR 0.90 (95% CI 0.22 to 3.6)
<3 months OR 1.3 (95% CI 0.41 to 4.1)
4–5 months OR 1.5 (95% CI 0.57 to 4.1)
>6 months OR 1.2 (95% CI 0.67 to 2.2)
4Low
 Lionetti et al12832 (117 developed CD autoimmunity,* out of them 86 biopsy-proven overt CD)From birth to 10 years of ageNoneCD autoimmunity
OR=1.0 (95% CI 0.9 to 1.0)
Overt CD
OR=1 (95% CI 0.9 to 1.1)
4Low
  • *Serological positivity of tTG antibodies.

  • BF, breast feeding; CD, celiac disease; NA, not available; NS, not significant; tTG, tissue transglutaminase.