Early Childhood Infections and the Risk of Islet Autoimmunity

The Diabetes Autoimmunity Study in the Young (DAISY)

  1. Marian Rewers, MD, PHD1
  1. 1Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
  2. 2Epidemiology Department, Colorado School of Public Health, University of Colorado, Aurora, Colorado
  3. 3Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
  4. 4Biostatistics and Informatics Department, Colorado School of Public Health, University of Colorado, Aurora, Colorado
  1. Corresponding author: Janet K. Snell-Bergeon, janet.snell-bergeon{at}


OBJECTIVE Type 1 diabetes is a common chronic childhood disease, and the incidence is increasing globally. Childhood infections are considered a potential environmental trigger of type 1 diabetes. Alternatively, improved hygiene and reduced childhood infections could explain the increase in type 1 diabetes in developed countries. The association of reported illnesses during infancy and later development of islet autoimmunity (IA) were examined in the Diabetes Autoimmunity Study in the Young.

RESEARCH DESIGN AND METHODS Complete illness interviews through 9 months of age were collected for 1,729 children, 1,174 without a family history of type 1 diabetes, and 555 children with a first-degree relative with type 1 diabetes. Persistent IA was defined as positive antibodies to insulin, glutamic acid decarboxylase, or tyrosine phosphatase on at least two consecutive study visits.

RESULTS There were 109 children with persistent IA among the 1,729 children with illness records. A greater number of gastrointestinal illnesses were associated with an increased risk of IA, but only among children who were exposed to gluten-containing grains (wheat or barley) either <4 months of age (hazard ratio 1.37 [95% CI 1.22–1.55]; P < 0.0001) or ≥7 months of age (1.12 [1.05–1.19]; P = 0.0005) compared with 4–6 months of age (P for interaction = 0.02). There were no associations of upper respiratory symptoms, respiratory illnesses, or fevers with IA.

CONCLUSIONS Specific pathogens such as enteroviruses or rotavirus may increase the risk of IA in the presence of existing inflammation induced by diet.

  • Received March 2, 2012.
  • Accepted June 25, 2012.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See for details.