We investigated whether food supplementation within the first year life or age at introduction of gluten-containing foods influenced the risk of developing islet autoimmunity and type 1 diabetes. A total of 2,291 children with a family history of type 1 diabetes were prospectively followed from birth for 28,983 patient years (median 13.1 years). Dietary exposure data were collected by questionnaires, food records and by family interview. Exposure to gluten-containing foods before age 3 months, which occurred in 19 children, increased the risk of developing islet autoantibodies (n = 4), multiple islet autoantibodies (n = 4), and type 1 diabetes (n = 3) compared to exclusive breastfeeding within the first 3 months [adjusted hazard ratio (HR) 3.97 (95 % confidence interval 1.41–11.17), 5.39 (1.89–15.35), and 3.45 (1.04–11.48), respectively] and also compared to first exposure to gluten between 3.1 and 6.0 months of age [adjusted HR 3.40 (1.19–9.70), 4.25 (1.47–12.26), and 3.43 (1.01–11.66), respectively]. Children who received infant formula or other solid food within the first 3 months and children who received gluten-containing foods after age 6 months did not have an increased risk of islet autoantibodies, multiple islet autoantibodies or type 1 diabetes. Our present data affirm that compliance to infant feeding guidelines is a possible way to reduce type 1 diabetes risk in genetically susceptible children.
This is a preview of subscription content,to check access.
Access this article
Ziegler AG, Bonifacio E, Group B-BS (2012) Age-related islet autoantibody incidence in offspring of patients with type 1 diabetes. Diabetologia 55(7):1937–1943. doi:10.1007/s00125-012-2472-x
Ziegler AG, Schmid S, Huber D, Hummel M, Bonifacio E (2003) Early infant feeding and risk of developing type 1 diabetes-associated autoantibodies. J Am Med Assoc 290(13):1721–1728. doi:10.1001/jama.290.13.1721
Norris JM, Barriga K, Klingensmith G, Hoffman M, Eisenbarth GS, Erlich HA, Rewers M (2003) Timing of initial cereal exposure in infancy and risk of islet autoimmunity. J Am Med Assoc 290(13):1713–1720. doi:10.1001/jama.290.13.1713
Virtanen SM, Kenward MG, Erkkola M, Kautiainen S, Kronberg-Kippila C, Hakulinen T, Ahonen S, Uusitalo L, Niinisto S, Veijola R, Simell O, Ilonen J, Knip M (2006) Age at introduction of new foods and advanced beta cell autoimmunity in young children with HLA-conferred susceptibility to type 1 diabetes. Diabetologia 49(7):1512–1521. doi:10.1007/s00125-006-0236-1
Frederiksen B, Kroehl M, Lamb MM, Seifert J, Barriga K, Eisenbarth GS, Rewers M, Norris JM (2013) Infant exposures and development of type 1 diabetes mellitus: the Diabetes Autoimmunity Study in the Young (DAISY). JAMA Pediatr 167(9):808–815. doi:10.1001/jamapediatrics.2013.317
Hummel S, Pfluger M, Hummel M, Bonifacio E, Ziegler AG (2011) Primary dietary intervention study to reduce the risk of islet autoimmunity in children at increased risk for type 1 diabetes: the BABYDIET study. Diabetes Care 34(6):1301–1305. doi:10.2337/dc10-2456
Marietta EV, Gomez AM, Yeoman C, Tilahun AY, Clark CR, Luckey DH, Murray JA, White BA, Kudva YC, Rajagopalan G (2013) Low incidence of spontaneous type 1 diabetes in non-obese diabetic mice raised on gluten-free diets is associated with changes in the intestinal microbiome. PLoS One 8(11):e78687. doi:10.1371/journal.pone.0078687
Endesfelder D, Castell WZ, Ardissone A, Davis-Richardson AG, Achenbach P, Hagen M, Pflueger M, Gano KA, Fagen JR, Drew JC, Brown CT, Kolaczkowski B, Atkinson M, Schatz D, Bonifacio E, Triplett EW, Ziegler AG (2014) Compromised gut microbiota networks in children with anti-islet cell autoimmunity. Diabetes. doi:10.2337/db13-1676
Ivarsson A, Persson LA, Nyström L, Ascher H, Cavell B, Danielsson L, Dannaeus A, Lindberg T, Lindquist B, Stenhammar L, Hernell O (2000) Epidemic of coeliac disease in Swedish children. Acta Paediatr 89(2):165–171. doi:10.1111/j.1651-2227.2000.tb01210.x
We thank Lorenz Lachmann, Claudia Matzke, Marlon Scholz, Joanna Stock, Stephanie Krause for data collection and expert technical assistance, Ramona Puff for laboratory management. We also thank all pediatricians and family doctors in Germany for participating in the BABYDIAB and BABYDIET study. The work was supported by grants from the Kompetenznetz Diabetes mellitus (Competence Network for Diabetes mellitus) funded by the Federal Ministry of Education and Research (FKZ 01GI0805-07), the Juvenile Diabetes Research Fund (No 17-2012-16), and funding from the German Federal Ministry of Education and Research (BMBF) to the German Center for Diabetes Research (DZD e.V.).
Conflict of interest
Ruth Chmiel, Andreas Beyerlein, Annette Knopff, Sandra Hummel, Anette-G. Ziegler and Christiane Winkler declare that they have no conflict of interest.
All investigations were carried out in accordance with the principles of the Declaration of Helsinki.
Human and animal rights
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.
Informed consent was obtained from all patients for being included in the study.
Managed by Antonio Secchi.
About this article
Cite this article
Chmiel, R., Beyerlein, A., Knopff, A. et al. Early infant feeding and risk of developing islet autoimmunity and type 1 diabetes. Acta Diabetol 52, 621–624 (2015). https://doi.org/10.1007/s00592-014-0628-5