Early infant diet and islet autoimmunity in the TEDDY study

Ulla Uusitalo, Hye Seung Lee, Carin Andrén Aronsson, Kendra Vehik, Jimin Yang, Sandra Hummel, Katherine Silvis, Åke Lernmark, Marian Rewers, William Hagopian, Jin Xiong She, Olli Simell, Jorma Toppari, Anette G. Ziegler, Beena Akolkar, Jeffrey Krischer, Suvi M. Virtanen, Jill M. Norris

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)522-530
Number of pages9
JournalDiabetes Care
Volume41
Issue number3
DOIs
StatePublished - Mar 1 2018

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Autoimmunity
Diet
Glutens
Type 1 Diabetes Mellitus
Insulin Antibodies
Insulinoma
Probiotics
Finland
Breast Feeding
Proportional Hazards Models
Sweden
Germany
Research Design
Genotype
Parturition
Antigens
Food

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Uusitalo, U., Lee, H. S., Aronsson, C. A., Vehik, K., Yang, J., Hummel, S., ... Norris, J. M. (2018). Early infant diet and islet autoimmunity in the TEDDY study. Diabetes Care, 41(3), 522-530. https://doi.org/10.2337/dc17-1983

Early infant diet and islet autoimmunity in the TEDDY study. / Uusitalo, Ulla; Lee, Hye Seung; Aronsson, Carin Andrén; Vehik, Kendra; Yang, Jimin; Hummel, Sandra; Silvis, Katherine; Lernmark, Åke; Rewers, Marian; Hagopian, William; She, Jin Xiong; Simell, Olli; Toppari, Jorma; Ziegler, Anette G.; Akolkar, Beena; Krischer, Jeffrey; Virtanen, Suvi M.; Norris, Jill M.

In: Diabetes Care, Vol. 41, No. 3, 01.03.2018, p. 522-530.

Research output: Contribution to journalArticle

Uusitalo, U, Lee, HS, Aronsson, CA, Vehik, K, Yang, J, Hummel, S, Silvis, K, Lernmark, Å, Rewers, M, Hagopian, W, She, JX, Simell, O, Toppari, J, Ziegler, AG, Akolkar, B, Krischer, J, Virtanen, SM & Norris, JM 2018, 'Early infant diet and islet autoimmunity in the TEDDY study', Diabetes Care, vol. 41, no. 3, pp. 522-530. https://doi.org/10.2337/dc17-1983
Uusitalo U, Lee HS, Aronsson CA, Vehik K, Yang J, Hummel S et al. Early infant diet and islet autoimmunity in the TEDDY study. Diabetes Care. 2018 Mar 1;41(3):522-530. https://doi.org/10.2337/dc17-1983
Uusitalo, Ulla ; Lee, Hye Seung ; Aronsson, Carin Andrén ; Vehik, Kendra ; Yang, Jimin ; Hummel, Sandra ; Silvis, Katherine ; Lernmark, Åke ; Rewers, Marian ; Hagopian, William ; She, Jin Xiong ; Simell, Olli ; Toppari, Jorma ; Ziegler, Anette G. ; Akolkar, Beena ; Krischer, Jeffrey ; Virtanen, Suvi M. ; Norris, Jill M. / Early infant diet and islet autoimmunity in the TEDDY study. In: Diabetes Care. 2018 ; Vol. 41, No. 3. pp. 522-530.
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abstract = "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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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.

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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.

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