Early Infant Diet and Islet Autoimmunity in the TEDDY Study
Article Figures & Tables
Tables
- Table 1
Description of foods and food groups studied in relation to the risk of IA
Dietary Exposures Breastfeeding and food exposures that were each studied separately Selected foods: foods associated with IA in previous studies; they were studied as one combined variable Any solid food: all solid foods that were studied as one combined variable Exclusive breastfeeding Any breastfeeding Infant formula Cow’s milk (any cow’s milk exposure) All cereals All cereals All cereals Gluten-containing cereals Gluten-containing cereals Gluten-containing cereals Rice Rice Rice Fruits and berries Fruits and berries Fruits and berries Potatoes Potatoes Potatoes Root vegetables Root vegetables Root vegetables Meat (beef, pork, poultry, game) Meat (beef, pork, poultry, game) Fish and seafood Fish and seafood Egg Egg Egg Milk products (yogurt, sour cream, cheese, commercial baby foods containing yogurt, cottage cheese) Spinach Peas, green beans Cabbages (Chinese cabbage, red cabbage, cauliflower, broccoli, kale, cabbage turnip, collard, mustard green, turnip greens) Squash, pumpkin Tomato, tomato sauce Corn Other vegetable Sausage, hot dogs Variables studied are shown in bold.
- Table 2
Characteristics associated with any IA
Study population, Any IA (N = 703) IAA (N = 272) GADA (N = 299) N N (%) HR (95% CI) P value N (%) HR (95% CI) P value N (%) HR (95% CI) P value Country Finland 1,654 180 (25.6) 1.40 (1.15, 1.71) <0.001 89 (32.7) 2.28 (1.67, 3.11) <0.001 110 (36.8) 1.00 (0.72, 1.39) 0.999 Germany 510 54 (7.7) 1.30 (0.96, 1.76) 0.092 20 (7.4) 1.36 (0.82, 2.25) 0.234 60 (20.1) 0.82 (0.47, 1.42) 0.471 Sweden 2,283 240 (34.1) 1.30 (1.08, 1.56) 0.005 83 (30.5) 1.38 (1.02, 1.89) 0.039 15 (5.0) 1.25 (0.96, 1.62) 0.103 U.S. 3,116 229 (32.6) 1 80 (29.4) 1 114 (38.1) 1 High-risk HLA genotype (DR3/4) Yes 2,956 344 (48.9) 1.61 (1.38, 1.88) <0.001 128 (47.1) 1.54 (1.21, 1.96) <0.001 150 (50.2) 1.65 (1.31, 2.07) <0.001 No 4,607 359 (51.1) 1 144 (52.9) 1 149 (49.8) 1 FDR with T1D Yes 857 136 (19.4) 1.99 (1.64, 2.43) <0.001 58 (21.3) 2.32 (1.71, 3.15) <0.001 52 (17.4) 1.85 (1.36, 2.53) <0.001 No 6,706 567 (80.6) 1 214 (78.7) 1 247 (82.6) 1 Sex of the child Female 3,698 322 (45.8) 0.87 (0.75, 1.00) 0.056 152 (44.1) 0.81 (0.64, 1.03) 0.079 144 (48.2) 0.95 (0.76, 1.19) 0.661 Male 3,865 381 (54.2) 1 120 (55.9) 1 155 (51.8) 1 Probiotics, age at first exposure <28 days 538 41 (5.8) 0.70 (0.50, 0.97) 0.022 15 (5.5) 0.53 (0.31, 0.91) 0.021 15 (5.0) 0.72 (0.42, 1.24) 0.237 ≥28 days 7,025 662 (94.2) 1 257 (94.5) 1 284 (95.0) 1 - Table 3
Association of timing of dietary exposures with the risk of IA (any IA, IAA, or GADA)
Dietary exposure IA Duration of breastfeeding or age at introduction of food (months) HR (95% CI)* P value* Among those who developed autoantibodies Among those who did not develop autoantibodies N Not breastfed or food was not introduced by the end of follow-up (%) Mean (SD) N Not breastfed or food was not introduced by the end of follow-up (%) Mean (SD) Exclusive breastfeeding Any IA 703 0 1.3 (1.9) 6,860 0 1.2 (1.8) 1.00 (0.96, 1.04) 0.980 IAA 272 1.4 (1.9) 7,291 1.2 (1.8) 1.01 (0.95, 1.07) 0.763 GADA 299 1.3 (1.9) 7,264 1.2 (1.8) 1.01 (0.95, 1.07) 0.810 Any breastfeeding Any IA 694 1.3 8.4 (7.3) 6,617 3.5 7.4 (6.4) 1.01 (1.00, 1.02) 0.118 IAA 270 8.5 (6.7) 7,041 7.5 (6.5) 1.01 (0.99, 1.03) 0.205 GADA 294 8.6 (8.2) 7,017 7.4 (6.5) 1.01 (1.00, 1.03) 0.123 Any infant formula Any IA 598 14.9 1.2 (2.5) 6,006 12.4 1.2 (2.3) 0.99 (0.96, 1.02) 0.522 IAA 235 1.4 (2.7) 6,369 1.2 (2.3) 1.02 (0.96, 1.05) 0.574 GADA 257 1.3 (2.5) 6,347 1.2 (2.3) 1.01 (0.96, 1.06) 0.696 Cow’s milk Any IA 701 0.3 2.1 (3.1) 6,824 0.5 1.8 (2.8) 1.01 (0.98, 1.04) 0.474 IAA 270 2.2 (3.2) 7,255 1.8 (2.8) 1.02 (0.98, 1.07) 0.301 GADA 299 2.0 (3.0) 7,226 1.9 (2.8) 1.01 (0.97, 1.05) 0.613 Any solid food Any IA 701 0.3 3.6 (1.4) 6,839 0.3 3.5 (1.4) 1.03 (0.97, 1.09) 0.384 IAA 272 3.5 (1.4) 7,268 3.5 (1.4) 0.99 (0.90, 1.08) 0.757 GADA 297 3.7 (1.3) 7,243 3.5 (1.4) 1.07 (0.97, 1.17) 0.159 Selected foods Any IA 701 0.3 3.7 (1.3) 6,838 0.3 3.6 (1.4) 1.03 (0.97, 1.09) 0.368 IAA 272 3.6 (1.3) 7,267 3.6 (1.4) 1.01 (0.91, 1.11) 0.873 GADA 297 3.7 (1.3) 7,242 3.6 (1.4) 1.00 (1.00, 1.01) 0.118 Cereals, any Any IA 699 0.6 4.4 (1.4) 6,810 0.7 4.2 (1.4) 1.03 (0.97, 1.10) 0.330 IAA 271 4.4 (1.4) 7,238 4.2 (1.4) 1.01 (0.91, 1.14) 0.789 GADA 296 4.3 (1.3) 7,213 4.2 (1.4) 1.03 (0.94, 1.14) 0.525 Gluten-containing cereals Any IA 699 0.6 5.8 (2.1) 6,708 2.2 5.7 (2.0) 1.05 (1.01, 1.10) 0.023 IAA 271 5.9 (2.1) 7,136 5.7 (2.0) 1.08 (1.00, 1.16) 0.038 GADA 296 5.8 (2.0) 7,111 5.7 (2.0) 1.06 (0.99, 1.13) 0.121 Rice Any IA 699 0.6 5.0 (1.9) 6,755 1.5 4.8 (1.8) 1.02 (0.97, 1.07) 0.445 IAA 271 5.1 (2.0) 7,183 4.8 (1.8) 1.01 (0.93, 1.10) 0.779 GADA 296 4.8 (1.7) 7,158 4.8 (1.8) 1.00 (0.93, 1.08) 0.936 Root vegetables Any IA 701 0.3 4.3 (1.2) 6,806 0.8 4.3 (1.3) 1.03 (0.96, 1.10) 0.464 IAA 272 4.2 (1.2) 7,235 4.3 (1.3) 1.00 (0.90, 1.12) 0.942 GADA 297 4.4 (1.3) 7,210 4.3 (1.3) 1.05 (0.95, 1.16) 0.352 Potatoes Any IA 699 0.6 5.2 (2.2) 6,698 2.4 5.3 (2.4) 1.05 (1.00, 1.10) 0.051 IAA 271 5.1 (2.1) 7,126 5.3 (2.4) 1.05 (0.97, 1.14) 0.200 GADA 296 5.4 (2.4) 7,101 5.3 (2.3) 1.06 (0.99, 1.13) 0.116 Fruits or berries Any IA 700 0.4 4.3 (1.4) 6,806 0.8 4.2 (1.5) 1.04 (0.98, 1.10) 0.167 IAA 272 4.3 (1.5) 7,234 4.2 (1.5) 1.04 (0.95, 1.14) 0.372 GADA 296 4.4 (1.4) 7,210 4.2 (1.5) 1.05 (0.96, 1.14) 0.315 Meat Any IA 692 1.6 6.0 (1.8) 6,676 2.7 6.1 (2.0) 1.02 (0.97, 1.08) 0.457 IAA 269 6.0 (1.7) 7,099 6.1 (2.0) 1.03 (0.94, 1.12) 0.564 GADA 292 6.1 (2.0) 7,076 6.1 (2.0) 1.04 (0.96, 1.12) 0.364 Egg Any IA 684 2.7 8.9 (2.5) 6,458 5.9 8.7 (2.5) 1.02 (0.99, 1.05) 0.288 IAA 266 8.9 (2.7) 6,876 8.7 (2.5) 1.00 (0.95, 1.06) 0.878 GADA 290 8.9 (2.4) 6,852 8.7 (2.5) 1.04 (0.99, 1.09) 0.140 Fish or other seafood Any IA 662 5.8 8.6 (3.6) 6,210 9.5 8.6 (3.6) 1.01 (0.98, 1.04) 0.537 IAA 256 8.5 (3.8) 6,616 8.6 (3.6) 0.99 (0.94, 1.05) 0.810 GADA 280 8.7 (3.6) 6,592 8.6 (3.6) 1.03 (0.98, 1.08) 0.258 ↵*HR and corresponding P value were obtained from the Cox regression model adjusted for country, HLA genotype, FDR status, sex of the child, and probiotic use <28 days. HRs reflect the change in the risk with 1-month longer breastfeeding or 1-month delay in food introduction.
- Table 4
Categorized duration of breastfeeding and timing of introduction of complementary foods and risk of IA (any IA or GADA)
IA Dietary exposure* Timing in months* Number of children who developed any IA or GADA, N (%) Number of children who did not develop any IA or GADA, N (%) Unadjusted HR (95% CI) P value Adjusted† HR (95% CI) P value Any IA Gluten-containing cereals <4 28 (6) 445 (94) 0.68 (0.47, 0.99) 0.047 0.67 (0.54, 0.98) 0.037 4–9 637 (10) 6,048 (90) 1 1 >9 31 (14) 185 (86) 1.57 (1.07, 2.31) 0.022 1.44 (0.97, 2.16) 0.074 Any breastfeeding ≤7 334 (9) 3,575 (91) 0.93 (0.80, 1.08) 0.326 0.94 (0.81, 1.09) 0.426 >7 360 (11) 3,042 (89) 1 1 Cow’s milk ≤5 584 (10) 5,922(91) 0.83 (0.68, 1.00) 0.055 0.85 (0.69, 1.04) 0.115 >5 117 (11) 902 (89) 1 1 Cereals ≤4 483 (9) 4,765 (91) 0.99 (0.85, 1.17) 0.945 1.09 (0.92, 1.30) 0.309 >4 216 (10) 2,045 (90) 1 1 Rice ≤7 618 (9) 6,196 (91) 0.79 (0.63, 0.99) 0.046 0.87 (0.69, 1.10) 0.233 >7 75 (13) 502 (87) 1 1 Fruit and berries ≤4 460 (9) 4,552 (91) 0.99 (0.85, 1.15) 0.868 1.00 (0.85, 1.18) 0.999 >4 240 (10) 2,254 (90) 1 1 Potato ≤7 578 (10) 5,345 (90) 1.19 (0.98, 1.45) 0.077 0.98 (0.77, 1.25) 0.898 >7 121 (8) 1,353 (92) 1 1 Meat ≤8 615 (10) 5,762 (90) 1.27 (1.01, 1.59) 0.040 1.13 (0.88, 1.45) 0.344 >8 77 (8) 914 (92) 1 1 Egg ≤9 282 (9) 3,002 (91) 0.86 (0.74, 0.99) 0.045 0.84 (0.72, 0.99) 0.035 >9 402 (10) 3,456 (90) 1 1 GADA Any breastfeeding ≤6 120 (3) 3,476 (97) 1.20 (0.95, 1.52) 0.126 1.17 (0.92, 1.49) 0.196 >6 174 (5) 3,541 (95) 1 1 Rice ≤6 264 (4) 6,435 (96) 1.25 (0.87, 1.78) 0.224 1.10 (0.76, 1.58) 0.623 >6 28 (4) 664 (96) 1 1 Fish and seafood ≤9 188 (4) 4,538 (96) 0.88 (0.70, 1.12) 0.290 1.11 (0.81, 1.53) 0.507 >9 92 (4) 2,054 (96) 1 1 ↵*Dietary exposure: timing of breastfeeding or food; categorization of timing of gluten-containing cereals’ introductions was based on martingale residuals whereas dichotomizations of timing of other dietary exposures in relation to the risk of any IA or GADA were based on change-point methods using log-rank test (28); only statistically significant (P < 0.05) cut points are shown. No statistically significant cut point of timing of a dietary exposure for IAA was detected.
↵†The Cox regression model was adjusted for country, HLA genotype, FDR status, sex of the child, and probiotic use <28 days.