Early infant diet and islet autoimmunity in the TEDDY study

Research output: Contribution to journalArticle

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 childrenwith 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 glutenwas associatedwith 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 4months 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.

Details

Authors
  • Ulla Uusitalo
  • Hye Seung Lee
  • Carin Andrén Aronsson
  • Kendra Vehik
  • Jimin Yang
  • Sandra Hummel
  • Katherine Silvis
  • Åke Lernmark
  • Marian Rewers
  • William Hagopian
  • Jin Xiong She
  • Olli Simell
  • Jorma Toppari
  • Anette G. Ziegler
  • Beena Akolkar
  • Jeffrey Krischer
  • Suvi M. Virtanen
  • Jill M. Norris
Organisations
External organisations
  • University of South Florida
  • Klinikum rechts der Isar
  • Georgia Regents University
  • University of Colorado School of Medicine
  • Pacific Northwest Diabetes Research Institute
  • University of Turku
  • Turku University Hospital
  • National Institute of Diabetes and Digestive and Kidney Diseases
  • University of Tampere
  • Colorado School of Public Health
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Endocrinology and Diabetes
Original languageEnglish
Pages (from-to)522-530
Number of pages9
JournalDiabetes Care
Volume41
Issue number3
Publication statusPublished - 2018 Mar 1
Publication categoryResearch
Peer-reviewedYes