European Journal of Pediatrics

, Volume 165, Issue 2, pp 114–119 | Cite as

Absence of breast-feeding is associated with the risk of type 1 diabetes: a case–control study in a population with rapidly increasing incidence

  • Hana Malcova
  • Zdenek Sumnik
  • Pavel Drevinek
  • Jitrenka Venhacova
  • Jan Lebl
  • Ondrej CinekEmail author
Original Paper


There are indications that the effect of environmental factors on the risk of type 1 diabetes mellitus (T1DM) is increasing over time. This can be documented by the rapid increase of T1DM incidence in genetically stable populations. Our aim was to study an association of T1DM with the variable factors of the perinatal period and of early infancy, using data from children born over a period of changing exposure to some of the studied factors. A case–control dataset was analysed, consisting of 868 diabetic children and 1,466 anonymous controls, mostly schoolmates of the children with T1DM. The data were collected using structured questionnaires completed by parents. After performing univariate analyses, the associations were analysed using multiple logistic regression adjusted for potential confounders, including the year of birth. The risk of T1DM decreased with increasing duration of breast-feeding, while no breast-feeding was associated with an increased T1DM risk, OR=1.93 [95% CI: 1.33–2.80], breast-feeding for more than 12 months was protective, OR=0.42 [95% CI: 0.22–0.81], both being relative to the reference category of breast-feeding for 1–3 months. A short duration of day-care attendance (none or less than 1 year) was weakly associated with the risk of T1DM, OR=1.65 [95% CI: 1.05–2.62]. No association was detected between T1DM and signs of prenatal infections, perinatal stress factors, birth size and weight, indicators of crowding or the presence of a domestic pet in the household. Short breast-feeding period and short attendance to day care is associated with the risk of T1DM in Czech children.


Diabetes mellitus Type 1 Epidemiology Risk factors Infant nutrition 


95% CI

95% confidence interval


Odds ratio


Type 1 diabetes mellitus



The members of the Czech Childhood Diabetes Registry Study Group are acknowledged for an excellent collaboration and we also thank the participating families for their continuing support. We thank especially: S. Kolouskova, M. Snajderova, L. Brazdova, I. Titzova, M. Sykora, M. Svojsik, M. Machalkova, J. Bartosova, L. Tyce, H. Safarikova, J. Maly, P. Skala, V. Janstova, J. Kopriva, R. Machytka, E. Novakova, V. Kratochvil, A. Martiskova, L. Kocinova, P. Mikyska, H. Nemcova, M. Hromadkova, H. Strmenova, J. Soucek, P. Eichl, K. Fiklik, A. Benesova, A. Filakova, E. Hladakova, Z. Jezova, S. Pokorny, B. Cervickova, I. Velesikova, H. Vavrova, J. Fromel, M. Honkova, V. Prokop, J. Havlicek, Y. Ptoszkova, J. Klabochova, R. Zemanova, J. Berankova, J. Gayer, L. Zlamalova, J. Brozova, M. Imramovska, S. Hyckova, J. Skvor, M. Gregora, E. Senkyrova, V. Jamelska, P. Mokros, J. Matejkova, J. Bazant and M. Schubert. The study was supported by the Ministry of Education of the Czech Republic (grant MSM 0021620814) and a grant from the Czech Diabetes Society.


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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Hana Malcova
    • 1
  • Zdenek Sumnik
    • 1
  • Pavel Drevinek
    • 1
  • Jitrenka Venhacova
    • 2
  • Jan Lebl
    • 3
  • Ondrej Cinek
    • 1
    Email author
  1. 1.Department of Paediatrics, Motol University HospitalCharles UniversityPrague 5Czech Republic
  2. 2.Department of Pediatrics, Faculty of MedicinePalacky UniversityOlomoucCzech Republic
  3. 3.Department of Pediatrics, 3rd Faculty of MedicineCharles UniversityPragueCzech Republic

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