[Is it time for mass screening for celiac disease?]. / Is het tijd voor bevolkingsonderzoek naar coeliakie?

Celiac disease is a common condition with a variable presentation, and is frequently not recognized by the physician. Although a gluten-free diet has a positive effect on the health of the celiac patient, prevention would be even more beneficial. In this article we outline the different possibilities for primary and secondary prevention of celiac disease. Results of recent prospective studies show that at this moment primary prevention is not possible, but secondary preventive strategies can be applied to decrease the morbidity associated with this disease; mass screening is one option. Results of recent studies concerning this topic will be discussed.

[Gluten tolerance as a result of earlier exposure?]. / Tolerantie voor gluten door vroegere blootstelling?

In a recently published article in Pediatrics on the Swedish coeliac disease 'epidemic', it is suggested that the gradual introduction of gluten-containing foods from 4 months of age, preferably while breastfeeding is still ongoing, is favourable for the prevention of coeliac disease. This stirred up the discussion about the timing of introduction of gluten to the diet of infants in the Netherlands, where gluten-containing foods are mostly introduced from 6 months of age onwards. The retrospective character of data collection, however, has to be taken into account when interpreting the Swedish study. Future results of prospective studies on gluten introduction and coeliac disease, such as the PreventCD family study (www.preventcd.com), should provide the information necessary for deciding on a change in the Dutch guidelines for the introduction of gluten to the diet of young children.