Article

Diabetologia

, Volume 48, Issue 5, pp 829-837

First online:

Dietary manipulation of beta cell autoimmunity in infants at increased risk of type 1 diabetes: a pilot study

  • H. K. ÅkerblomAffiliated withHospital for Children and Adolescents, Biomedicum Helsinki, University of Helsinki Email author 
  • , S. M. VirtanenAffiliated withTampere School of Public Health, University of TampereTampere University Hospital Research UnitDepartment of Epidemiology and Health Promotion, National Public Health Institute
  • , J. IlonenAffiliated withDepartment of Virology, University of Turku
  • , E. SavilahtiAffiliated withHospital for Children and Adolescents, Biomedicum Helsinki, University of Helsinki
  • , O. VaaralaAffiliated withHospital for Children and Adolescents, Biomedicum Helsinki, University of HelsinkiClinical Research Centre, Faculty of Health Sciences, Linköping University
  • , A. ReunanenAffiliated withDepartment of Health and Functional Capacity, National Public Health Institute
  • , K. TeramoAffiliated withDepartment of Obstetrics and Gynaecology, University of Helsinki
  • , A.-M. HämäläinenAffiliated withDepartment of Paediatrics, University of Oulu
  • , J. ParonenAffiliated withHospital for Children and Adolescents, Biomedicum Helsinki, University of Helsinki
    • , M.-A. RiikjärvAffiliated withTallinn Children’s Hospital
    • , A. OrmissonAffiliated withDepartment of Paediatrics, University of Tartu
    • , J. LudvigssonAffiliated withDivision of Paediatrics, Department of Health and Environment, Faculty of Health Sciences, Linköping University
    • , H.-M. DoschAffiliated withThe Hospital for Sick Children, Research Institute, University of Toronto
    • , T. HakulinenAffiliated withFinnish Cancer Registry
    • , M. KnipAffiliated withHospital for Children and Adolescents, Biomedicum Helsinki, University of HelsinkiDepartment of Paediatrics, Tampere University Hospital
    • , National TRIGR Study Groups

Abstract

Aims/hypothesis

We aimed to assess the feasibility of a dietary intervention trial with weaning to hydrolysed formula in infants at increased risk of type 1 diabetes and to study the effect of the intervention on the emergence of diabetes-associated autoantibodies in early childhood.

Methods

We studied 242 newborn infants who had a first-degree relative with type 1 diabetes and carried risk-associated HLA-DQB1 alleles. After exclusive breastfeeding, the infants underwent a double-blind, randomised pilot trial of either casein hydrolysate (Nutramigen; Mead Johnson) or conventional cow’s milk-based formula until the age of 6–8 months. During a mean observation period of 4.7 years, autoantibodies to insulin, anti-glutamic acid decarboxylase and insulinoma-associated antigen-2 were measured by radiobinding assays, and islet cell antibodies (ICA) by immunofluorescence.

Results

The feasibility of screening and identifying a cohort of first-degree relatives with HLA-conferred disease susceptibility, enrolling them in a dietary intervention trial and following them for seroconversion to autoantibody positivity is established. The cumulative incidence of autoantibodies was somewhat smaller in the casein hydrolysate vs control formula group, suggesting the need for a larger well-powered study. After adjustment for duration of study formula feeding, life-table analysis showed a significant protection by the intervention from positivity for ICA (p=0.02) and at least one autoantibody (p=0.03).

Conclusions/interpretation

The present study provides the first evidence ever in man, despite its limited power, that it may be possible to manipulate spontaneous beta cell autoimmunity by dietary intervention in infancy.

Keywords

Beta cell autoimmunity Dietary manipulation Feasibility Infants Type 1 diabetes