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Early infant diet and islet autoimmunity in the TEDDY study

Uusitalo, Ulla; Lee, Hye Seung; Aronsson, Carin Andrén LU ; Vehik, Kendra; Yang, Jimin; Hummel, Sandra; Silvis, Katherine; Lernmark, Åke LU ; Rewers, Marian and Hagopian, William, et al. (2018) In Diabetes Care 41(3). p.522-530
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... (More)

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.

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Diabetes Care
volume
41
issue
3
pages
9 pages
publisher
American Diabetes Association
external identifiers
  • scopus:85042624469
ISSN
0149-5992
DOI
10.2337/dc17-1983
language
English
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yes
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eb43fd72-0597-402c-9dec-cefecbbf38ee
date added to LUP
2018-03-17 19:34:49
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2019-05-21 04:02:00
@article{eb43fd72-0597-402c-9dec-cefecbbf38ee,
  abstract     = {<p>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 &lt;4, 4-9, and &gt;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.</p>},
  author       = {Uusitalo, Ulla and Lee, Hye Seung and Aronsson, Carin Andrén and Vehik, Kendra and Yang, Jimin and Hummel, Sandra and Silvis, Katherine and Lernmark, Åke and Rewers, Marian and Hagopian, William and She, Jin Xiong and Simell, Olli and Toppari, Jorma and Ziegler, Anette G. and Akolkar, Beena and Krischer, Jeffrey and Virtanen, Suvi M. and Norris, Jill M.},
  issn         = {0149-5992},
  language     = {eng},
  month        = {03},
  number       = {3},
  pages        = {522--530},
  publisher    = {American Diabetes Association},
  series       = {Diabetes Care},
  title        = {Early infant diet and islet autoimmunity in the TEDDY study},
  url          = {http://dx.doi.org/10.2337/dc17-1983},
  volume       = {41},
  year         = {2018},
}