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- Title
Timing of Initial Cereal Exposure in Infancy and Risk of Islet Autoimmunity.
- Authors
Norris, Jill M.; Barriga, Katherine; Klingensmith, Georgeanna; Hoffman, Michelle; Eisenbarth, George S.; Erlich, Henry A.; Rewers, Marian
- Abstract
Context: Dietary exposures in infancy have been implicated, albeit inconsistently, in the etiology of type 1 diabetes mellitus (DM). Objective: To examine the association between cereal exposures in the infant diet and appearance of islet autoimmunity (IA). Design: Birth cohort study conducted from 1994 to 2002 with a mean follow-up of 4 years. Setting: Newborn screening for HLA was done at St Joseph's Hospital in Denver, Colo. First-degree relatives of type 1 DM individuals were recruited from the Denver metropolitan area. Participants: We enrolled 1183 children at increased type 1 DM risk, defined as either HLA genotype or having a first-degree relative with type 1 DM, at birth and followed them prospectively. We obtained exposure and outcome measures for 76% of enrolled children. Participants had variable lengths of follow-up (9 months to 9 years). Main Outcome Measures: Blood draws for the detection of insulin autoantibody, glutamic acid decarboxylase autoantibody, or IA-2 autoantibody were performed at 9, 15, and 24 months and annually thereafter. Children with IA (n = 34) were defined as those testing positive for at least 1 of the autoantibodies on 2 or more consecutive visits and who tested positive or had diabetes on their most recent visit. Results: Children initially exposed to cereals between ages 0 and 3 months (hazard ratio [HR], 4.32; 95% confidence interval [CI], 2.0-9.35) and those who were exposed at 7 months or older (HR, 5.36; 95% CI, 2.08-13.8) had increased hazard of IA compared with those who were exposed during the fourth through sixth month, after adjustment for HLA genotype, family history of type 1 DM, ethnicity, and maternal age. In children who were positive for the HLA-DRB1*03/04,DQB8 genotype, adjusted HRs were 5.55 (95% CI, 1.92-16.03) and 12.53 (95% CI, 3.19-49.23) for initial cereal exposure between ages 0 to 3 months and at 7 months or older, respectively. Conclusion: There may be a window of exposure to cereals in infancy outsi...
- Subjects
DIABETES; INFANT care; NUTRITION; AUTOIMMUNITY; ENDOCRINE diseases
- Publication
JAMA: Journal of the American Medical Association, 2003, Vol 290, Issue 13, p1713
- ISSN
0098-7484
- Publication type
Article
- DOI
10.1001/jama.290.13.1713