Weight gain in early life predicts risk of islet autoimmunity in children with a first degree relative with type 1 diabetes

  1. Jennifer J Couper, MD (jennifer.couper{at}adelaide.edu.au)1,
  2. Sarah Beresford, Dip N1,
  3. Craig Hirte, BSc (Hons)2,
  4. Peter A Baghurst, PhD2,
  5. Angie Pollard, Dip Tech3,
  6. Brian D Tait, PhD4,
  7. Leonard C Harrison, PhD5 and
  8. Peter G Colman, PhD6
  1. 1. Dept Diabetes and Endocrinology, Women's & Children's Hospital and Discipline of Paediatrics, University of Adelaide,
  2. 2. Public Health Research Unit, Women's & Children's Hospital, Adelaide,
  3. 3. Discipline of Paediatrics, University of Adelaide,
  4. 4. Royal Melbourne Hospital, Melbourne,
  5. 5. Autoimmunity and Transplantation Division, Walter & Eliza Hall Institute, Melbourne,
  6. 6. Dept Diabetes and Endocrinology and Dept Pathology, Royal Melbourne Hospital, Melbourne

    Abstract

    Objective In a prospective birth cohort study we followed infants, who had a first-degree relative with type 1 diabetes, to investigate the relationship between early growth and infant feeding, and the risk of islet autoimmunity.

    Research design and methods Infants with a first degree relative with type 1 diabetes were identified during the pregnancy. Dietary intake was recorded prospectively to determine duration of breast feeding and age at introduction of cows milk protein, cereals, meat, fruit and vegetables. At 6 monthly reviews, length (or height) and weight, antibodies to insulin, glutamic acid decarboxylase 65, the tyrosine phosphatase-like insulinoma antigen, IA2, and tissue transglutaminase were measured. Islet autoimmunity was defined as persistent elevation of one or more islet antibodies at consecutive 6 monthly intervals, including the most recent measure, and was the primary outcome measure.

    Results Follow-up of 548 infants for 5.7 (3.2) years identified 46 children with islet autoimmunity. Weight z-score and BMI z-score were continuous predictors of risk of islet autoimmunity [adjusted hazard ratio (95% CI) 1.43 (1.10-1.84) p=0.007; 1.29 (1.01-1.67) p=0.04 respectively]. Risk of islet autoimmunity was greater in subjects with weight z-score > 0 than ≤0 over time [adjusted hazard ratio (95% CI) 2.61 (1.26 – 5.44), p=0.01]. Weight z-score and BMI z-score at 2 years, and change in weight z-score between birth and 2 years, but not dietary intake, also predicted risk of islet autoimmunity.

    Conclusion Weight gain in early life predicts risk of islet autoimmunity in children with a first degree relative with type 1 diabetes.

    Footnotes

      • Received April 30, 2008.
      • Accepted September 17, 2008.

    This Article

    1. Published online before print October 3, 2008, doi: 10.2337/dc08-0821
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