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Early infant feeding and risk of developing type 1 diabetes-associated autoantibodies.

Abstract

CONTEXT

Dietary factors modifying type 1 diabetes mellitus (DM) risk have been proposed, but little is known if they trigger the islet autoimmunity that precedes clinical disease.

OBJECTIVE

To determine whether breastfeeding duration, food supplementation, or age at introduction of gluten-containing foods influences the risk of developing islet autoantibodies.

DESIGN AND SETTING

Prospective natural history cohort study conducted from 1989 to 2003 in inpatient/outpatient clinics in Germany.

PARTICIPANTS

The BABYDIAB study follows newborn children of parents with type 1 DM. Eligibility requirements were met in 1610 children. Blood samples were obtained at birth, age 9 months, 2, 5, and 8 years. Dropout rate was 14.4% by age 5 years. Breastfeeding data were obtained by prospective questionnaires (91% complete), and food supplementation data were obtained by family interview (72% for food supplementation and 80% for age of gluten introduction).

MAIN OUTCOME MEASURE

Development of islet autoantibodies (insulin, glutamic acid decarboxylase, or IA-2 antibodies) in 2 consecutive blood samples.

RESULTS

Life-table islet autoantibody frequency was 5.8% (SE, 0.6%) by age 5 years. Reduced total or exclusive breastfeeding duration did not significantly increase the risk of developing islet autoantibodies. Food supplementation with gluten-containing foods before age 3 months, however, was associated with significantly increased islet autoantibody risk (adjusted hazard ratio, 4.0; 95% confidence interval, 1.4-11.5; P =.01 vs children who received only breast milk until age 3 months). Four of 17 children who received gluten foods before age 3 months developed islet autoantibodies (life-table 5-year risk, 24%; SE, 10%). All 4 children had the high-risk DRB1*03/04,DQB1*0302 genotype. Early exposure to gluten did not significantly increase the risk of developing celiac disease-associated autoantibodies. Children who first received gluten foods after age 6 months did not have increased risks for islet or celiac disease autoantibodies.

CONCLUSION

Ensuring compliance to infant feeding guidelines is a possible way to reduce the risk of development of type 1 DM autoantibodies.

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  • Authors+Show Affiliations

    ,

    Diabetes Research Institute and Hospital München-Schwabing, Munich, Germany. anziegler@lrz.uni-muenchen.de

    , , ,

    Source

    JAMA 290:13 2003 Oct 01 pg 1721-8

    MeSH

    Autoantibodies
    Child
    Child, Preschool
    Cohort Studies
    Diabetes Mellitus, Type 1
    GTP-Binding Proteins
    Genotype
    Glutamate Decarboxylase
    Glutens
    HLA Antigens
    Humans
    Infant
    Infant Food
    Infant Nutritional Physiological Phenomena
    Infant, Newborn
    Insulin Antibodies
    Islets of Langerhans
    Milk, Human
    Proportional Hazards Models
    Risk Factors
    Transglutaminases

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    14519706

    Citation

    Ziegler, Anette-G, et al. "Early Infant Feeding and Risk of Developing Type 1 Diabetes-associated Autoantibodies." JAMA, vol. 290, no. 13, 2003, pp. 1721-8.
    Ziegler AG, Schmid S, Huber D, et al. Early infant feeding and risk of developing type 1 diabetes-associated autoantibodies. JAMA. 2003;290(13):1721-8.
    Ziegler, A. G., Schmid, S., Huber, D., Hummel, M., & Bonifacio, E. (2003). Early infant feeding and risk of developing type 1 diabetes-associated autoantibodies. JAMA, 290(13), pp. 1721-8.
    Ziegler AG, et al. Early Infant Feeding and Risk of Developing Type 1 Diabetes-associated Autoantibodies. JAMA. 2003 Oct 1;290(13):1721-8. PubMed PMID: 14519706.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Early infant feeding and risk of developing type 1 diabetes-associated autoantibodies. AU - Ziegler,Anette-G, AU - Schmid,Sandra, AU - Huber,Doris, AU - Hummel,Michael, AU - Bonifacio,Ezio, PY - 2003/10/2/pubmed PY - 2003/10/8/medline PY - 2003/10/2/entrez SP - 1721 EP - 8 JF - JAMA JO - JAMA VL - 290 IS - 13 N2 - CONTEXT: Dietary factors modifying type 1 diabetes mellitus (DM) risk have been proposed, but little is known if they trigger the islet autoimmunity that precedes clinical disease. OBJECTIVE: To determine whether breastfeeding duration, food supplementation, or age at introduction of gluten-containing foods influences the risk of developing islet autoantibodies. DESIGN AND SETTING: Prospective natural history cohort study conducted from 1989 to 2003 in inpatient/outpatient clinics in Germany. PARTICIPANTS: The BABYDIAB study follows newborn children of parents with type 1 DM. Eligibility requirements were met in 1610 children. Blood samples were obtained at birth, age 9 months, 2, 5, and 8 years. Dropout rate was 14.4% by age 5 years. Breastfeeding data were obtained by prospective questionnaires (91% complete), and food supplementation data were obtained by family interview (72% for food supplementation and 80% for age of gluten introduction). MAIN OUTCOME MEASURE: Development of islet autoantibodies (insulin, glutamic acid decarboxylase, or IA-2 antibodies) in 2 consecutive blood samples. RESULTS: Life-table islet autoantibody frequency was 5.8% (SE, 0.6%) by age 5 years. Reduced total or exclusive breastfeeding duration did not significantly increase the risk of developing islet autoantibodies. Food supplementation with gluten-containing foods before age 3 months, however, was associated with significantly increased islet autoantibody risk (adjusted hazard ratio, 4.0; 95% confidence interval, 1.4-11.5; P =.01 vs children who received only breast milk until age 3 months). Four of 17 children who received gluten foods before age 3 months developed islet autoantibodies (life-table 5-year risk, 24%; SE, 10%). All 4 children had the high-risk DRB1*03/04,DQB1*0302 genotype. Early exposure to gluten did not significantly increase the risk of developing celiac disease-associated autoantibodies. Children who first received gluten foods after age 6 months did not have increased risks for islet or celiac disease autoantibodies. CONCLUSION: Ensuring compliance to infant feeding guidelines is a possible way to reduce the risk of development of type 1 DM autoantibodies. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/14519706/Early_infant_feeding_and_risk_of_developing_type_1_diabetes_associated_autoantibodies_ L2 - https://jamanetwork.com/journals/jama/fullarticle/vol/290/pg/1721 DB - PRIME DP - Unbound Medicine ER -