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Dietary manipulation of beta cell autoimmunity in infants at increased risk of type 1 diabetes: a pilot study.

Abstract

AIMS/HYPOTHESIS

We aimed to assess the feasibility of a dietary intervention trial with weaning to hydrolysed formula in infants at increased risk of type 1 diabetes and to study the effect of the intervention on the emergence of diabetes-associated autoantibodies in early childhood.

METHODS

We studied 242 newborn infants who had a first-degree relative with type 1 diabetes and carried risk-associated HLA-DQB1 alleles. After exclusive breastfeeding, the infants underwent a double-blind, randomised pilot trial of either casein hydrolysate (Nutramigen; Mead Johnson) or conventional cow's milk-based formula until the age of 6-8 months. During a mean observation period of 4.7 years, autoantibodies to insulin, anti-glutamic acid decarboxylase and insulinoma-associated antigen-2 were measured by radiobinding assays, and islet cell antibodies (ICA) by immunofluorescence.

RESULTS

The feasibility of screening and identifying a cohort of first-degree relatives with HLA-conferred disease susceptibility, enrolling them in a dietary intervention trial and following them for seroconversion to autoantibody positivity is established. The cumulative incidence of autoantibodies was somewhat smaller in the casein hydrolysate vs control formula group, suggesting the need for a larger well-powered study. After adjustment for duration of study formula feeding, life-table analysis showed a significant protection by the intervention from positivity for ICA (p=0.02) and at least one autoantibody (p=0.03).

CONCLUSIONS/INTERPRETATION

The present study provides the first evidence ever in man, despite its limited power, that it may be possible to manipulate spontaneous beta cell autoimmunity by dietary intervention in infancy.

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  • Authors+Show Affiliations

    ,

    Hospital for Children and Adolescents, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, PO Box 700, 00029 Helsinki, Finland. hans.akerblom@helsinki.fi

    , , , , , , , , , , , , , ,

    Source

    Diabetologia 48:5 2005 May pg 829-37

    MeSH

    Autoantibodies
    Autoimmunity
    Body Height
    Body Weight
    Breast Feeding
    Child
    Child, Preschool
    Diabetes Mellitus, Type 1
    Diet, Diabetic
    Double-Blind Method
    Female
    Follow-Up Studies
    HLA-DQ Antigens
    HLA-DQ beta-Chains
    Humans
    Infant
    Infant Food
    Islets of Langerhans
    Male
    Pilot Projects
    Risk Factors
    Time Factors

    Pub Type(s)

    Clinical Trial
    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    15838685

    Citation

    Akerblom, H K., et al. "Dietary Manipulation of Beta Cell Autoimmunity in Infants at Increased Risk of Type 1 Diabetes: a Pilot Study." Diabetologia, vol. 48, no. 5, 2005, pp. 829-37.
    Akerblom HK, Virtanen SM, Ilonen J, et al. Dietary manipulation of beta cell autoimmunity in infants at increased risk of type 1 diabetes: a pilot study. Diabetologia. 2005;48(5):829-37.
    Akerblom, H. K., Virtanen, S. M., Ilonen, J., Savilahti, E., Vaarala, O., Reunanen, A., ... Knip, M. (2005). Dietary manipulation of beta cell autoimmunity in infants at increased risk of type 1 diabetes: a pilot study. Diabetologia, 48(5), pp. 829-37.
    Akerblom HK, et al. Dietary Manipulation of Beta Cell Autoimmunity in Infants at Increased Risk of Type 1 Diabetes: a Pilot Study. Diabetologia. 2005;48(5):829-37. PubMed PMID: 15838685.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Dietary manipulation of beta cell autoimmunity in infants at increased risk of type 1 diabetes: a pilot study. AU - Akerblom,H K, AU - Virtanen,S M, AU - Ilonen,J, AU - Savilahti,E, AU - Vaarala,O, AU - Reunanen,A, AU - Teramo,K, AU - Hämäläinen,A-M, AU - Paronen,J, AU - Riikjärv,M-A, AU - Ormisson,A, AU - Ludvigsson,J, AU - Dosch,H-M, AU - Hakulinen,T, AU - Knip,M, AU - ,, Y1 - 2005/04/19/ PY - 2004/09/28/received PY - 2005/01/15/accepted PY - 2005/4/20/pubmed PY - 2005/9/21/medline PY - 2005/4/20/entrez SP - 829 EP - 37 JF - Diabetologia JO - Diabetologia VL - 48 IS - 5 N2 - AIMS/HYPOTHESIS: We aimed to assess the feasibility of a dietary intervention trial with weaning to hydrolysed formula in infants at increased risk of type 1 diabetes and to study the effect of the intervention on the emergence of diabetes-associated autoantibodies in early childhood. METHODS: We studied 242 newborn infants who had a first-degree relative with type 1 diabetes and carried risk-associated HLA-DQB1 alleles. After exclusive breastfeeding, the infants underwent a double-blind, randomised pilot trial of either casein hydrolysate (Nutramigen; Mead Johnson) or conventional cow's milk-based formula until the age of 6-8 months. During a mean observation period of 4.7 years, autoantibodies to insulin, anti-glutamic acid decarboxylase and insulinoma-associated antigen-2 were measured by radiobinding assays, and islet cell antibodies (ICA) by immunofluorescence. RESULTS: The feasibility of screening and identifying a cohort of first-degree relatives with HLA-conferred disease susceptibility, enrolling them in a dietary intervention trial and following them for seroconversion to autoantibody positivity is established. The cumulative incidence of autoantibodies was somewhat smaller in the casein hydrolysate vs control formula group, suggesting the need for a larger well-powered study. After adjustment for duration of study formula feeding, life-table analysis showed a significant protection by the intervention from positivity for ICA (p=0.02) and at least one autoantibody (p=0.03). CONCLUSIONS/INTERPRETATION: The present study provides the first evidence ever in man, despite its limited power, that it may be possible to manipulate spontaneous beta cell autoimmunity by dietary intervention in infancy. SN - 0012-186X UR - https://www.unboundmedicine.com/medline/citation/15838685/full_citation L2 - https://dx.doi.org/10.1007/s00125-005-1733-3 DB - PRIME DP - Unbound Medicine ER -