Infant nutrition and development of type 1 diabetes

Previous studies have indicated that early exposure to complex foreign proteins, such as cow’s milk proteins, increases the risk of type 1 diabetes in predisposed individuals.

“Therefore, In 2002, we embarked on a large-scale study on more than 2100 infants with a family member affected by type 1 diabetes and with genetic disease susceptibility to find an answer to the question whether delaying the exposure to complex foreign proteins will decrease the risk of diabetes”, tells Professor Mikael Knip from the University of Helsinki, the leader of the TRIGR Study.

After breastfeeding the babies were either weaned to a special formula, where the cow’s milk proteins were split into small peptides, or to a conventional infant formula with the regular cow’s milk proteins.

The first study endpoint was positivity for at least two diabetes-associated autoantibodies by the age of six years.

The results show that there was no difference in the appearance of autoantibodies between the two study groups. However, the disease process resulting in clinical diabetes has clearly two phases, the first being the appearance of autoantibodies and the other the progression from autoantibody positivity to clinical disease.

Infant feeding and the risk of type 1 diabetes.
Type 1 diabetes is generally considered to be a chronic, immune-mediated disease with a subclinical prodrome during which beta cell autoimmunity becomes overt disease at a variable rate in genetically susceptible individuals. Accumulated evidence supports a critical role of environmental factors in its development. Prospective birth cohort studies show that the first signs of beta cell autoimmunity may be initiated during the first year of life. This implies that risk factors for beta cell autoimmunity and type 1 diabetes must be operative in infancy. Early nutrition provides essential exogenous exposures in that period. This article discusses the role of factors related to infant nutrition in the development of beta cell autoimmunity and type 1 diabetes and the potential mechanistic pathways involved. So far, no specific dietary factor has been shown to be an unequivocal risk factor for beta cell autoimmunity or type 1 diabetes, and there are a number of contradictory observations with regard to the effect of various foods. This may reflect geographic and cultural differences in infant-feeding practices. Most studies suggest that the early introduction of complex foreign proteins may be a risk factor for beta cell autoimmunity, and a pilot intervention trial has implied that weaning to a highly hydrolyzed formula may decrease the risk of beta cell autoimmunity. Lack of vitamin D supplementation and accelerated growth might increase the risk of type 1 diabetes. Additional work, which includes the application of modern approaches such as metabolomics and epigenomics, is needed to discern the contribution of dietary factors in infancy to the diabetic disease process.

Knip M1, Virtanen SM, Akerblom HK.

Infant nutrition and development of <a rel=type 1 diabetes" align="right" /> “The current results do not exclude the possibility that the early dietary modification may affect the latter phase, and therefore it is extremely important to continue to follow the study participants into the final endpoint, which is the age of ten years. That endpoint will be reached in 2017”, Professor Knip states.


The study is published in JAMA (June 11, 2014) and mainly funded by the National Institutes of Health (NIH) and the Canadian Institutes of Health Research (CIHR).

B aby Food Exchanges and Feeding the Diabetic Infant
Diabetes in infancy,  although rare,  does occur. Unfortunately,  very little has been written about the treatment of diabetes occurring in infancy.  In feeding the diabetic infant,  it is important to consider the following points: the rapid growth that occurs during the first year of life;  the developmental changes in eating patterns during this period;  and the danger of hypoglycemia to the developing brain.  To satisfy these needs and still provide the infant with an eating pattern to complement the insulin regimen,  the baby food exchange list was devised.  The use of the exchange list helps to translate the regimen into daily eating habits and to introduce families to the exchanges they will use as the infant grows into a child.

The exchanges are based on the American Diabetes Association (ADA)  Exchange List and represent the same categories. The exchanges were simplified to use the jar measurements of the strained and junior baby foods as purchased.

The rationale is to make the feedings as uncomplicated as possible, since the family must deal with so many other problems with diabetes at this age.  Recognition is given to wide variation in baby food contents.  Precise analysis of each item would require an exchange list too lengthy for practical use.
The values given are from Gerber products.

These represent as precise an indication in content level as is needed for the baby food exchange list.

Throughout the creation and implementation of the baby food exchange list, much attention has been paid to treating the infant with diabetes differently from an adult or even an older child with diabetes.  This concept is viewed as extremely important in improving and maintaining the care of these infants.  Translating the infant and toddler foods into ADA exchanges enables the dietitian to instruct families within the basic guidelines of the usual diabetic dietary education program.  The baby food exchanges then become the first step in the teaching program that emphasizes development of an optimum lifetime eating pattern.  This program can be translated into exchanges that are used by the diabetologist and dietitian in their interpretations for the families.




Mikael Knip, M.D., Ph.D.
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University of Helsinki

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