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Early Infant Diet and Islet Autoimmunity in the TEDDY Study.
Diabetes Care 2018; 41(3):522-530DC

Abstract

OBJECTIVE

To examine duration of breastfeeding and timing of complementary foods and risk of islet autoimmunity (IA).

RESEARCH DESIGN AND METHODS

The Environmental Determinants of Diabetes in the Young (TEDDY) study prospectively follows 8,676 children with increased genetic risk of type 1 diabetes (T1D) in the U.S., Finland, Germany, and Sweden. This study included 7,563 children with at least 9 months of follow-up. Blood samples were collected every 3 months from birth to evaluate IA, defined as persistent, confirmed positive antibodies to insulin (IAAs), GAD, or insulinoma antigen-2. We examined the associations between diet and the risk of IA using Cox regression models adjusted for country, T1D family history, HLA genotype, sex, and early probiotic exposure. Additionally, we investigated martingale residuals and log-rank statistics to determine cut points for ages of dietary exposures.

RESULTS

Later introduction of gluten was associated with increased risk of any IA and IAA. The hazard ratios (HRs) for every 1-month delay in gluten introduction were 1.05 (95% CI 1.01, 1.10; P = 0.02) and 1.08 (95% CI 1.00, 1.16; P = 0.04), respectively. Martingale residual analysis suggested that the age at gluten introduction could be grouped as <4, 4-9, and >9 months. The risk of IA associated with introducing gluten before 4 months of age was lower (HR 0.68; 95% CI 0.47, 0.99), and the risk of IA associated with introducing it later than the age of 9 months was higher (HR 1.57; 95% CI 1.07, 2.31) than introduction between 4 and 9 months of age.

CONCLUSIONS

The timing of gluten-containing cereals and IA should be studied further.

Authors

No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo 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, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

29343517

Citation

Uusitalo, Ulla, et al. "Early Infant Diet and Islet Autoimmunity in the TEDDY Study." Diabetes Care, vol. 41, no. 3, 2018, pp. 522-530.
Uusitalo U, Lee HS, Andrén Aronsson C, et al. Early Infant Diet and Islet Autoimmunity in the TEDDY Study. Diabetes Care. 2018;41(3):522-530.
Uusitalo, U., Lee, H. S., Andrén Aronsson, C., Vehik, K., Yang, J., Hummel, S., ... Norris, J. M. (2018). Early Infant Diet and Islet Autoimmunity in the TEDDY Study. Diabetes Care, 41(3), pp. 522-530. doi:10.2337/dc17-1983.
Uusitalo U, et al. Early Infant Diet and Islet Autoimmunity in the TEDDY Study. Diabetes Care. 2018;41(3):522-530. PubMed PMID: 29343517.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early Infant Diet and Islet Autoimmunity in the TEDDY Study. AU - Uusitalo,Ulla, AU - Lee,Hye-Seung, AU - Andrén Aronsson,Carin, AU - Vehik,Kendra, AU - Yang,Jimin, AU - Hummel,Sandra, AU - Silvis,Katherine, AU - Lernmark,Åke, AU - Rewers,Marian, AU - Hagopian,William, AU - She,Jin-Xiong, AU - Simell,Olli, AU - Toppari,Jorma, AU - Ziegler,Anette-G, AU - Akolkar,Beena, AU - Krischer,Jeffrey, AU - Virtanen,Suvi M, AU - Norris,Jill M, AU - ,, Y1 - 2018/01/17/ PY - 2017/09/22/received PY - 2017/12/08/accepted PY - 2018/1/19/pubmed PY - 2018/7/3/medline PY - 2018/1/19/entrez SP - 522 EP - 530 JF - Diabetes care JO - Diabetes Care VL - 41 IS - 3 N2 - OBJECTIVE: To examine duration of breastfeeding and timing of complementary foods and risk of islet autoimmunity (IA). RESEARCH DESIGN AND METHODS: The Environmental Determinants of Diabetes in the Young (TEDDY) study prospectively follows 8,676 children with increased genetic risk of type 1 diabetes (T1D) in the U.S., Finland, Germany, and Sweden. This study included 7,563 children with at least 9 months of follow-up. Blood samples were collected every 3 months from birth to evaluate IA, defined as persistent, confirmed positive antibodies to insulin (IAAs), GAD, or insulinoma antigen-2. We examined the associations between diet and the risk of IA using Cox regression models adjusted for country, T1D family history, HLA genotype, sex, and early probiotic exposure. Additionally, we investigated martingale residuals and log-rank statistics to determine cut points for ages of dietary exposures. RESULTS: Later introduction of gluten was associated with increased risk of any IA and IAA. The hazard ratios (HRs) for every 1-month delay in gluten introduction were 1.05 (95% CI 1.01, 1.10; P = 0.02) and 1.08 (95% CI 1.00, 1.16; P = 0.04), respectively. Martingale residual analysis suggested that the age at gluten introduction could be grouped as <4, 4-9, and >9 months. The risk of IA associated with introducing gluten before 4 months of age was lower (HR 0.68; 95% CI 0.47, 0.99), and the risk of IA associated with introducing it later than the age of 9 months was higher (HR 1.57; 95% CI 1.07, 2.31) than introduction between 4 and 9 months of age. CONCLUSIONS: The timing of gluten-containing cereals and IA should be studied further. SN - 1935-5548 UR - https://www.unboundmedicine.com/medline/citation/29343517/Early_Infant_Diet_and_Islet_Autoimmunity_in_the_TEDDY_Study_ L2 - http://care.diabetesjournals.org/cgi/pmidlookup?view=long&amp;pmid=29343517 DB - PRIME DP - Unbound Medicine ER -