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Timing of initial cereal exposure in infancy and risk of islet autoimmunity.
JAMA 2003; 290(13):1713-20JAMA

Abstract

CONTEXT

Dietary exposures in infancy have been implicated, albeit inconsistently, in the etiology of type 1 diabetes mellitus (DM).

OBJECTIVE

To examine the association between cereal exposures in the infant diet and appearance of islet autoimmunity (IA).

DESIGN

Birth cohort study conducted from 1994 to 2002 with a mean follow-up of 4 years.

SETTING

Newborn screening for HLA was done at St Joseph's Hospital in Denver, Colo. First-degree relatives of type 1 DM individuals were recruited from the Denver metropolitan area.

PARTICIPANTS

We enrolled 1183 children at increased type 1 DM risk, defined as either HLA genotype or having a first-degree relative with type 1 DM, at birth and followed them prospectively. We obtained exposure and outcome measures for 76% of enrolled children. Participants had variable lengths of follow-up (9 months to 9 years).

MAIN OUTCOME MEASURES

Blood draws for the detection of insulin autoantibody, glutamic acid decarboxylase autoantibody, or IA-2 autoantibody were performed at 9, 15, and 24 months and annually thereafter. Children with IA (n = 34) were defined as those testing positive for at least 1 of the autoantibodies on 2 or more consecutive visits and who tested positive or had diabetes on their most recent visit.

RESULTS

Children initially exposed to cereals between ages 0 and 3 months (hazard ratio [HR], 4.32; 95% confidence interval [CI], 2.0-9.35) and those who were exposed at 7 months or older (HR, 5.36; 95% CI, 2.08-13.8) had increased hazard of IA compared with those who were exposed during the fourth through sixth month, after adjustment for HLA genotype, family history of type 1 DM, ethnicity, and maternal age. In children who were positive for the HLA-DRB1*03/04,DQB8 genotype, adjusted HRs were 5.55 (95% CI, 1.92-16.03) and 12.53 (95% CI, 3.19-49.23) for initial cereal exposure between ages 0 to 3 months and at 7 months or older, respectively.

CONCLUSION

There may be a window of exposure to cereals in infancy outside which initial exposure increases IA risk in susceptible children.

Authors+Show Affiliations

Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver 80262, USA. jill.norris@uchsc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

14519705

Citation

Norris, Jill M., et al. "Timing of Initial Cereal Exposure in Infancy and Risk of Islet Autoimmunity." JAMA, vol. 290, no. 13, 2003, pp. 1713-20.
Norris JM, Barriga K, Klingensmith G, et al. Timing of initial cereal exposure in infancy and risk of islet autoimmunity. JAMA. 2003;290(13):1713-20.
Norris, J. M., Barriga, K., Klingensmith, G., Hoffman, M., Eisenbarth, G. S., Erlich, H. A., & Rewers, M. (2003). Timing of initial cereal exposure in infancy and risk of islet autoimmunity. JAMA, 290(13), pp. 1713-20.
Norris JM, et al. Timing of Initial Cereal Exposure in Infancy and Risk of Islet Autoimmunity. JAMA. 2003 Oct 1;290(13):1713-20. PubMed PMID: 14519705.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Timing of initial cereal exposure in infancy and risk of islet autoimmunity. AU - Norris,Jill M, AU - Barriga,Katherine, AU - Klingensmith,Georgeanna, AU - Hoffman,Michelle, AU - Eisenbarth,George S, AU - Erlich,Henry A, AU - Rewers,Marian, PY - 2003/10/2/pubmed PY - 2003/10/8/medline PY - 2003/10/2/entrez SP - 1713 EP - 20 JF - JAMA JO - JAMA VL - 290 IS - 13 N2 - CONTEXT: Dietary exposures in infancy have been implicated, albeit inconsistently, in the etiology of type 1 diabetes mellitus (DM). OBJECTIVE: To examine the association between cereal exposures in the infant diet and appearance of islet autoimmunity (IA). DESIGN: Birth cohort study conducted from 1994 to 2002 with a mean follow-up of 4 years. SETTING: Newborn screening for HLA was done at St Joseph's Hospital in Denver, Colo. First-degree relatives of type 1 DM individuals were recruited from the Denver metropolitan area. PARTICIPANTS: We enrolled 1183 children at increased type 1 DM risk, defined as either HLA genotype or having a first-degree relative with type 1 DM, at birth and followed them prospectively. We obtained exposure and outcome measures for 76% of enrolled children. Participants had variable lengths of follow-up (9 months to 9 years). MAIN OUTCOME MEASURES: Blood draws for the detection of insulin autoantibody, glutamic acid decarboxylase autoantibody, or IA-2 autoantibody were performed at 9, 15, and 24 months and annually thereafter. Children with IA (n = 34) were defined as those testing positive for at least 1 of the autoantibodies on 2 or more consecutive visits and who tested positive or had diabetes on their most recent visit. RESULTS: Children initially exposed to cereals between ages 0 and 3 months (hazard ratio [HR], 4.32; 95% confidence interval [CI], 2.0-9.35) and those who were exposed at 7 months or older (HR, 5.36; 95% CI, 2.08-13.8) had increased hazard of IA compared with those who were exposed during the fourth through sixth month, after adjustment for HLA genotype, family history of type 1 DM, ethnicity, and maternal age. In children who were positive for the HLA-DRB1*03/04,DQB8 genotype, adjusted HRs were 5.55 (95% CI, 1.92-16.03) and 12.53 (95% CI, 3.19-49.23) for initial cereal exposure between ages 0 to 3 months and at 7 months or older, respectively. CONCLUSION: There may be a window of exposure to cereals in infancy outside which initial exposure increases IA risk in susceptible children. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/14519705/full_citation L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.290.13.1713 DB - PRIME DP - Unbound Medicine ER -