Does dietary intervention in infancy affect risk for DM1?

January 01, 0001

Does dietary intervention in infancy affect risk for DM1?

Early exposure to complex dietary proteins may increase the risk of beta-cell autoimmunity and type 1 diabetes in children with genetic susceptibility. These Finnish and Canadian investigators tested the hypothesis that supplementing breast milk with highly hydrolyzed milk formula would decrease the cumulative incidence of diabetes-associated autoantibodies in such children in a double-blind, randomized trial. They assigned 230 infants with HLA-conferred susceptibility to type 1 diabetes and at least one family member with type 1 diabetes to receive either a casein hydrolysate formula or a conventional, cow's-milk-based formula (control) whenever breast milk was not available during the first 6 to 8 months of life. Autoantibodies to insulin, glutamic acid decarboxylase (GAD), the insulinoma-associated 2 molecule (IA-2), and zinc transporter 8 were analyzed with the use of radiobinding assays, and islet-cell antibodies were analyzed with the use of immunofluorescence, during a median observation period of 10 years (mean, 7.5). The children were monitored for incident type 1 diabetes until they were 10 years of age.

They found: "The unadjusted hazard ratio for positivity for one or more autoantibodies in the casein hydrolysate group, as compared with the control group, was 0.54, and the hazard ratio adjusted for an observed difference in the duration of exposure to the study formula was 0.51. The unadjusted hazard ratio for positivity for two or more autoantibodies was 0.52, and the adjusted hazard ratio was 0.47. The rate of reported adverse events was similar in the two groups."

The authors concluded: "Dietary intervention during infancy appears to have a long-lasting effect on markers of beta-cell autoimmunity — markers that may reflect an autoimmune process leading to type 1 diabetes."

A difference in incidence of type 1 diabetes was not established in this study.

For the full abstract, click here.

N Engl J Med 363:1900-1908, 11 November 2010
© 2010 to the Massachusetts Medical Society
Dietary Intervention in Infancy and Later Signs of Beta-Cell Autoimmunity. mikael Knip, Suvi M. Virtanen, Karri Seppa, et al. Correspondence to Dr. Knip: [email protected]

Category: T. Endocrine/Metabolic/Nutritional, B. Blood/Blood Forming Organs/Immune Keywords: autoantibodies, type 1 diabetes, genetic predisposition, casein hydrolystate formula, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 30 November 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.