Research paper

Infant feeding patterns in families with a diabetes history – observations from The Environmental Determinants of Diabetes in the Young (TEDDY) birth cohort study

Sandra Hummel^a1a2 c1, Kendra Vehik^a3, Ulla Uusitalo^a3, Wendy McLeod^a3, Carin Andrén Aronsson^a4, Nicole Frank^a5, Patricia Gesualdo^a5, Jimin Yang^a3, Jill M Norris^a6 and Suvi M Virtanen^a7a8a9a10 the TEDDY Study Group

 ^†

^a1 Institute of Diabetes Research, Helmholtz Zentrum München and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstaedter Landstrasse 1, D-85764 Neuherberg, Germany

^a2 Forschergruppe Diabetes eV, Neuherberg, Germany

^a3 Morsani College of Medicine, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, USA

^a4 Department of Clinical Sciences, Lund University, Malmo, Sweden

^a5 The Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO, USA

^a6 Colorado School of Public Health, University of Colorado, Aurora, CO, USA

^a7 Unit of Nutrition, National Institute for Health and Welfare, Helsinki, Finland

^a8 School of Health Sciences, University of Tampere, Tampere, Finland

^a9 Science Center of Pirkanmaa Hospital District, Tampere, Finland

^a10 Research Center for Child Health, Tampere University and University Hospital, Tampere, Finland

Abstract

Objective To assess the association between diabetes family history and infant feeding patterns.

Design Data on breast-feeding duration and age at first introduction of cow's milk and gluten-containing cereals were collected in 3-month intervals during the first 24 months of life.

Setting Data from the multicentre TEDDY (The Environmental Determinants of Diabetes in the Young) study, including centres in the USA, Sweden, Finland and Germany.

Subjects A total of 7026 children, including children with a mother with type 1 diabetes (T1D; n 292), gestational diabetes mellitus (GDM; n 404) or without diabetes but with a father and/or sibling with T1D (n 464) and children without diabetes family history (n 5866).

Results While exclusive breast-feeding ended earlier and cow's milk was introduced earlier in offspring of mothers with T1D and GDM, offspring of non-diabetic mothers but a father and/or sibling with T1D were exclusively breast-fed longer and introduced to cow's milk later compared with infants without diabetes family history. The association between maternal diabetes and shorter exclusive breast-feeding duration was attenuated after adjusting for clinical variables (delivery mode, gestational age, Apgar score and birth weight). Country-specific analyses revealed differences in these associations, with Sweden showing the strongest and Finland showing no association between maternal diabetes and breast-feeding duration.

Conclusions Family history of diabetes is associated with infant feeding patterns; however, the associations clearly differ by country, indicating that cultural differences are important determinants of infant feeding behaviour. These findings need to be considered when developing strategies to improve feeding patterns in infants with a diabetes family history.

(Received December 26 2012)

(Revised September 13 2013)

(Accepted October 15 2013)

Keywords

• Type 1 diabetes;
• Gestational diabetes;
• Infant diet;
• Breast-feeding

Correspondence

^c1 Corresponding author: Email sandra.hummel@lrz.uni-muenchen.de

Footnotes

^†   Members of the TEDDY Study Group are listed in the Appendix