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Diabetes Care 28:2809, 2005
© 2005 by the American Diabetes Association, Inc.

Letters: Observations

Should She or Shouldn’t She?

The relationship between infant feeding practices and type 1 diabetes in the genetically at risk

Lisa M. Rogers, PHD, RD1, Lois Jovanovic, MD2 and Dorothy J. Becker, MD3

1 Division of Neonatology and Developmental Biology, Department of Pediatrics, David Geffen School of Medicine at UCLA and Mattel Children’s Hospital, Los Angeles, California
2 Sansum Diabetes Research Institute, Santa Barbara, California
3 Division of Endocrinology, Department of Pediatrics, University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania

Address correspondence to Dr. Lisa M. Rogers, 10833 Le Conte Ave., Room B2-375 MDCC, Los Angeles, CA 90095-1752. E-mail: lrogers{at}mednet.ucla.edu

Now more than ever, women with type 1 diabetes are able to bear healthy children. Nevertheless, the concern that early infant nutrition plays a role in subsequent diabetes development in the offspring remains an important issue. Though we still do not know the exact causes of type 1 diabetes, recent research indicates that both genetic and environmental issues are contributing factors.

A possible link between early infant nutrition and the risk of developing type 1 diabetes is a topic of recent interest. The Trial to Reduce Type 1 Diabetes in the Genetically at Risk (TRIGR) is the first international, nutritional intervention, primary prevention study for type 1 diabetes. Specifically, the TRIGR study addresses whether the early ingestion of intact foreign proteins contained in cow’s milk may increase type 1 diabetes risk (1,2). The TRIGR has been designed to evaluate the hypothesis that weaning infants to an extensively hydrolyzed formula may delay or prevent the onset of type 1 diabetes in genetically susceptible children. Additional smaller studies (3,4) suggest that other food intake with variations in timing, quantity, and combination may be linked to type 1 diabetes autoimmunity in the high-risk infant.

Recent studies have also taken a closer look at breastfeeding newborns of diabetic mothers (5). Initial results indicate that newborns ingesting breast milk from their diabetic mothers may have a higher risk of becoming overweight and developing impaired glucose tolerance in childhood than if they were fed nondiabetic donor breast milk.

Substantiating the premise of linking diet during infancy to the development of type 1 diabetes in those with a genetic risk calls for a very large properly designed trial such as the TRIGR. Given the challenges of ascertaining eligible subjects in order to achieve the desired sample size of 2,032, it is crucial that all health providers who care for pregnant women who themselves have type 1 diabetes, or if the father or sibling of the baby has type 1 diabetes, help refer subjects to the TRIGR in order for the study to succeed (available at www.TRIGR.org). Then and only then will we be able to answer the very important question: "Should she or shouldn’t she?"

Footnotes

L.M.R. and D.J.B. have received grant/research support from Mead Johnson.

References

  1. Virtanen SM, Rasanen L, Ylonen K, Aro A, Clayton D, Langholz B, Pitkaniemi J, Savilahti E, Lounamaa R, Tuomilehto J, Åkerblom HK, the Childhood Diabetes in Finland Study Group: Early introduction of dairy products associated with increased risk of IDDM in Finnish children. Diabetes 42:1786–1790, 1993[Abstract]
  2. Åkerblom HK, Virtanen SM, Ilonen J, Savilahti E, Vaarala O, Reunanen A, Teramo K, Hämäläinen AM, Paronen J, Riikjärv MA, Ormisson A, Ludvigsson J, Dosch HM, Hakulinen T, Knip M, the Finnish TRIGR Study Group: Dietary manipulation of beta-cell autoimmunity in infants at increased risk for type 1 diabetes. Diabetologia 48:829–837, 2005[Medline]
  3. Ziegler A-G, Schmid S, Huber D, Hummel M, Bonifacio E: Early infant feeding and risk of developing type 1 diabetes-associated autoantibodies. JAMA 290:1721–1728, 2003[Abstract/Free Full Text]
  4. Norris JM, Barriga K, Klingensmith G, Hoffman M, Eisenbarth GS, Erlich HA, Rewers M: Timing of initial cereal exposure in infancy and risk of islet autoimmunity. JAMA 290:1713–1720, 2003[Abstract/Free Full Text]
  5. Rodekamp E, Harder T, Kohlhoff R, Franke K, Dudenhausen JW, Plagemann A: Long-term impact of breast-feeding on body weight and glucose tolerance in children of diabetic mothers: role of the late neonatal period and early infancy. Diabetes Care 28:1457–1462, 2005[Abstract/Free Full Text]

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