Infant cereal exposure/DM linked

[Guest guest]

FYI

Jan Patenaude

Timing of Initial Cereal Exposure in Infancy and Risk of Islet

Autoimmunity. JAMA 2003;290:1713-1720.

Jill M. Norris, Barriga, anna Klingensmith,

Hoffman, S. Eisenbarth, Henry A. Erlich, and n Rewers

http://jama.ama-assn.org/cgi/content/abstract/290/13/1713

http://jama.ama-assn.org/cgi/content/full/290/13/1713

Age at First Exposure to Cereal Linked to Risk of Diabetes

NEW YORK (Reuters Health) Sept 30 - The timing of initial exposure to

cereal during infancy may affect the risk of developing type 1

diabetes mellitus (DM)-associated autoantibodies, according to two

prospective studies published in the October 1st issue of the Journal

of the American Medical Association.

Ensuring that parents comply with infant feeding guidelines that

suggest waiting until after the age of 3 months to introduce solid

foods could perhaps reduce the prevalence of pancreatic islet

autoantibodies, both research teams suggest.

For the Diabetes Autoimmunity Study in the Young (DAISY), Dr. Jill M.

Norris, at the University of Colorado Health Sciences Center in

Denver, and colleagues enrolled 1183 children at increased risk for

type 1 diabetes, either because of HLA genotype or having a

first-degree relative with type 1 DM.

Thirty-four newborns tested positive for autoantibody against at

least one of three pancreatic islet antigens (insulin, glutamic acid

decarboxylase or IA-2) over an average 4-year period. The

investigators estimated risk after adjusting for HLA genotype, family

history, ethnicity and maternal age.

The hazard ratio for developing autoantibodies was 4.3 for those

initially exposed to cereals between ages 0 and 3 months or after 7

months compared with those exposed during months 4 through 6. There

appears to be "a window of exposure to cereals outside which an

increase of IA risk exists in susceptible children," Dr. Norris and

colleagues suggest.

Dr. Anette-G. Ziegler of the Diabetes Research Institute in Munich,

Germany, and colleagues enrolled 1610 newborns that had a parent with

type 1 DM in the BABYDIAB trial. Eighty-five children developed islet

autoantibodies by 5 years of age.

The adjusted hazard ratio for islet autoantibodies was 5.2 (p =

0.003) for infants receiving gluten-containing foods prior to age 3

months compared with those not fed gluten until age 3 to 6 months.

"Early introduction of gluten-containing foods should be avoided in

children who are genetically predisposed to type 1 DM," Dr. Ziegler's

group maintains.

In neither study was there an association between islet autoantibody

risk and breastfeeding or exposure to cow's milk.

In an accompanying editorial, Drs. Mark Atkinson and Edwin A. M. Gale

urge "cautious interest" in these findings. They especially caution

that the evidence not be misinterpreted as "infant cereal causes

diabetes."

Dr. Atkinson, at the University of Florida in Gainesville, and Dr.

Gale, at the University of Bristol, England, note that the most

critical outcome is the development of diabetes. Therefore, "current

infant feeding guidelines should not be changed."

JAMA 2003;290:1713-1720,1721-1728,1771-1772.

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