Abstract
Background
Infant feeding practices, particularly the type of milk feeding, have been associated with the development of type 1 diabetes.
Aim of the study
We studied the relationship between early infant feeding (during the first year of life) and diabetes in a large population-based cohort.
Methods
In 1994–1995, 6,209 healthy full-term newborns participated in a study examining the effect of supplementary feeding, on development of allergy to cow’s milk, in maternity hospitals. All supplements in the maternity hospitals were known. Mothers recorded the feeding of infants prospectively at home. In August 2006, from a nationwide diabetes registry, 45 children from our cohort were listed as having type 1 diabetes.
Results
The distribution of cases was similar in the randomized feeding groups: 9/1,789 in the group that received adapted cow’s milk-based formula; 12/1,737 in those who received extensively hydrolyzed formula; 16/1,859 in those who received banked human milk; and 8 among those 824 exclusively breast-fed in the hospital. When children who had received cow’s milk-based formula in the maternity hospital were compared with those without such exposure, less number of children in the former group had diabetes by age 8 (P = 0.026), but by the end of the follow-up (11.5 years) the difference disappeared (P = 0.16). Length of breast-feeding and introduction of cereals and other solid foods were similar among those developing type 1 diabetes and those remaining healthy, while early regular daily feeding with cow’s milk-based formula tended to associate with lower risk for type 1 diabetes (OR 0.66; 95% confidence interval 0.38–1.13; P = 0.08).
Conclusions
In an extended, secondary analysis of a population-based cohort, very early exposure to cow’s milk is not a risk factor for type 1 diabetes; it may in fact diminish its appearance before age 8.
Similar content being viewed by others
Abbreviations
- CM:
-
Cow’s milk
References
Akerblom HK, Virtanen SM, Ilonen J, Savilahti E, Vaarala O, Reunanen A, Teramo K, Hämäläinen AM, Paronen J, Riikjarv MA, Ormisson A, Ludvigsson J, Dosch HM, Hakulinen T, Knip M (2005) Dietary manipulation of beta cell autoimmunity in infants at increased risk of type 1 diabetes: a pilot study. Diabetologia 48:829–837
Bach JF (2002) The effect of infections on susceptibility to autoimmune and allergic diseases. N Engl J Med 347:911–920
Borch-Johnsen K, Joner G, Nadrup-Paulsen T, Christy M, Zachau-Christiansen B, Kastrup K, Nerup J (1984) Relation between breast-feeding and incidence rates of insulin-dependent diabetes mellituls. Lancet 2:1083–1086
Daneman D (2006) Type 1 diabetes. Lancet 367:847–858
Gerstein HC (1994) Cow’s milk exposure and type I diabetes mellitus. a critical overview of the clinical literature. Diabetes Care 17:13–19
Harjutsalo V, Sjöberg L, Tuomilehto J (2008) Time trends in the incidence of type 1 diabetes in Finnish children: a cohort study. Lancet 371:1777–1782
Hasunen K, Ryynänen S (2006) Infant feeding in Finland 2005. Reports of the Ministry of Social Affairs and Health, vol 19, pp 1–70
Hoffjan S, Nicolae D, Ostrovnaya I, Roberg K, Evans M, Mirel DB, Steiner L, Walker K, Shult P, Gangnon RE, Gern JE, Martinez FD, Lemanske RF, Ober C (2005) Gene–environment interaction effects on the development of immune responses in the 1st year of life. Am J Hum Genet 76:696–704
Hummel M, Fuchtenbusch M, Schenker M, Ziegler AG (2000) No major association of breast-feeding, vaccinations, and childhood viral diseases with early islet autoimmunity in the German BABYDIAB Study. Diabetes Care 23:969–974
Hyttinen V, Kaprio J, Kinnunen L, Koskenvuo M, Tuomilehto J (2003) Genetic liability of type 1 diabetes and the onset age among 22,650 young Finnish twin pairs: a nationwide follow-up study. Diabetes 52:1052–1055
Janatuinen EK, Kemppainen TA, Julkunen RJ, Kosma VM, Mäki M, Heikkinen M, Uusitupa MI (2002) No harm from five year ingestion of oats in coeliac disease. Gut 50:332–335
Kimpimäki T, Erkkola M, Korhonen S, Kupila A, Virtanen SM, Ilonen J, Simell O, Knip M (2001) Short-term exclusive breast-feeding predisposes young children with increased genetic risk of type I diabetes to progressive beta-cell autoimmunity. Diabetologia 44:63–69
Lefebvre DE, Powell KL, Strom A, Scott FW (2006) Dietary proteins as environmental modifiers of type 1 diabetes mellitus. Annu Rev Nutr 26:175–202
Mathis D, Vence L, Benoist C (2001) Beta-cell death during progression to diabetes. Nature 414:792–798
Menezes Jda S, Mucida DS, Cara DC, Alvarez-Leite JI, Russo M, Vaz NM, de Faria AM (2003) Stimulation by food proteins plays a critical role in the maturation of the immune system. Int Immunol 15:447–455
Mowat AM (2003) Anatomical basis of tolerance and immunity to intestinal antigens. Nat Rev Immunol 3:331–341
Norris JM, Beaty B, Klingensmith G (1996) Lack of association between early exposure to cow′s milk protein and beta-cell autoimmunity. JAMA 276:609–614
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. JAMA 290:1713–1720
Rakoff-Nahoum S, Paglino J, Eslami-Varzaneh F, Edberg S, Medzhitov R (2004) Recognition of commensal microflora by toll-like receptors is required for intestinal homeostasis. Cell 118:229–241
Saarinen KM, Juntunen-Backman K, Järvenpää AL, Kuitunen P, Lope L, Renlund M, Siivola M, Savilahti E (1999) Supplementary feeding in maternity hospitals and the risk of cow’s milk allergy: a prospective study of 6,209 infants. J Allergy Clin Immunol 104:457–461
Saukkonen T, Virtanen SM, Karppinen M, Reijonen H, Ilonen J, Räsänen L, Åkerblom HK, Savilahti E (1998) Significance of cow’s milk protein antibodies as risk factor for childhood IDDM: interactions with dietary cow’s milk intake and HLA-DQB1 genotype: Childhood Diabetes in Finland Study Group. Diabetologia 41:72–78
Siltanen M, Kajosaari M, Poussa T, Saarinen KM, Savilahti E (2003) A dual long-term effect of breast-feeding on atopy in relation to heredity in children at 4 years of age. Allergy 58:524–530
Simpson A, John SL, Jury F, Niven R, Woodcock A, Ollier WE, Custovic A (2006) Endotoxin exposure, CD14, and allergic disease: an interaction between genes and the environment. Am J Respir Crit Care Med 174:386–392
Tuomilehto J, Virtala E, Karvonen M, Lounamaa R, Pitkäniemi J, Reunanen A, Tuomilehto-Wolf E, Toivanen L (1995) Increase in incidence of insulin-dependent diabetes mellitus among children in Finland. Int J Epidemiol 24:984–992
Virtanen SM, Räsänen L, Ylönen K, Aro A, Clayton D, Langholz B, Pitkäniemi J, Savilahti E, Lounamaa R, Tuomilehto J, Åkerblom HK (1993) Early introduction of dairy products is associated with increased risk of insulin-dependent diabetes mellitus in Finnish children. Diabetes 42:1786–1790
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 49:1512–1521
Wahlberg J, Vaarala O, Ludvigsson J (2006) Dietary risk factors for the emergence of type 1 diabetes-related autoantibodies in 21/2-year-old Swedish children. Br J Nutr 95:603–608
Ziegler AG, Schmid S, Huber D, Hummel M, Bonifacio E (2003) Early infant feeding and risk of developing type 1 diabetes-associated autoantibodies. JAMA 290:1721–1728
Acknowledgments
We thank Professor Seppo Sarna for his advice on survival analysis. Fund support was from the Sigrid Juselius Foundation and State Special Funds for Research at the University Central Hospital, Helsinki (EVO).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Savilahti, E., Saarinen, K.M. Early infant feeding and type 1 diabetes. Eur J Nutr 48, 243–249 (2009). https://doi.org/10.1007/s00394-009-0008-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00394-009-0008-z