TY - JOUR
T1 - Early infant diet and islet autoimmunity in the TEDDY study
AU - Uusitalo, Ulla
AU - Lee, Hye Seung
AU - Aronsson, Carin Andrén
AU - Vehik, Kendra
AU - Yang, Jimin
AU - Hummel, Sandra
AU - Silvis, Katherine
AU - Lernmark, Åke
AU - Rewers, Marian
AU - Hagopian, William
AU - She, Jin Xiong
AU - Simell, Olli
AU - Toppari, Jorma
AU - Ziegler, Anette G.
AU - Akolkar, Beena
AU - Krischer, Jeffrey
AU - Virtanen, Suvi M.
AU - Norris, Jill M.
N1 - Funding Information:
The TEDDY Studyis funded by the National Institute of Diabetes and Digestive and Kidney Diseases grantsU01-DK-63829,U01-DK-63861,U01-DK- 63821, U01-DK-63865, U01-DK-63863, U01-DK- 63836, U01-DK-63790, UC4-DK-63829, UC4-DK- 63861, UC4-DK-63821, UC4-DK-63865, UC4-DK- 63863, UC4-DK-63836, UC4-DK-95300, UC4-DK- 100238, and UC4-DK-106955, and Contract No. HHSN267200700014C; the National Institute of Allergy and Infectious Diseases; theNational Instituteof ChildHealth andHumanDevelopment; theNational Institute of Environmental Health Sciences; JDRF; and the Centers for Disease Control and Prevention. This work was supported in part by theNational Institutes ofHealth/NationalCenterforAdvancingTranslational Sciences Clinical and Translational Science Awards to the University of Florida (UL1-TR-000064) and the University of Colorado (UL1-TR-001082).
Funding Information:
Funding.TheTEDDYStudyisfundedbytheNational Institute of Diabetes and Digestive and Kidney Diseases grants U01-DK-63829, U01-DK-63861, U01-DK-63821, U01-DK-63865, U01-DK-63863, U01-DK-63836, U01-DK-63790, UC4-DK-63829, UC4-DK-63861, UC4-DK-63821, UC4-DK-63865, UC4-DK-63863, UC4-DK-63836, UC4-DK-95300, UC4-DK-100238, and UC4-DK-106955, and Contract No. HHSN267200700014C; the National Institute of Allergy and Infectious Diseases; the National Institute of Child Health and Human Development; the National Institute of Environmental Health Sciences; JDRF; and the Centers for Disease Control and Prevention. This work was supported in part by the National Institutes ofHealth/NationalCenterforAdvancingTranslational Sciences Clinical and Translational Science Awards to the University of Florida (UL1-TR-000064) and the University of Colorado (UL1-TR-001082). Duality of Interest. No potential conflicts of interest relevant to this article were reported. Author Contributions. U.U. contributed to the study design and the acquisition, analysis, and interpretation of data and drafted the article. H.-S.L.performedstatisticalanalysisandcontributed to the interpretation of data and the drafting of the manuscript. C.A.A., K.V., J.Y., S.H., and K.S. contributed to the acquisition and interpretation of the data and critically reviewed the manuscript. Å.L., M.R., W.H., J.-X.S., O.S., J.T., A.-G.Z., B.A., J.K., S.M.V., and J.M.N. contributed to the study concept and design and the acquisition and interpretation of data and critically reviewed the manuscript. U.U. and H.-S.L. are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Publisher Copyright:
© 2017 by The American Diabetes Association.
PY - 2018/3/1
Y1 - 2018/3/1
N2 - 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.
AB - 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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U2 - 10.2337/dc17-1983
DO - 10.2337/dc17-1983
M3 - Article
C2 - 29343517
AN - SCOPUS:85042624469
SN - 0149-5992
VL - 41
SP - 522
EP - 530
JO - Diabetes Care
JF - Diabetes Care
IS - 3
ER -