PT  - JOURNAL ARTICLE
AU  - Uusitalo, Ulla
AU  - Lee, Hye-Seung
AU  - Andrén Aronsson, Carin
AU  - Vehik, Kendra
AU  - Yang, Jimin
AU  - Hummel, Sandra
AU  - Silvis, Katherine
AU  - Lernmark, Åke
AU  - Rewers, Marian
AU  - Hagopian, William
AU  - She, Jin-Xiong
AU  - Simell, Olli
AU  - Toppari, Jorma
AU  - Ziegler, Anette-G.
AU  - Akolkar, Beena
AU  - Krischer, Jeffrey
AU  - Virtanen, Suvi M.
AU  - Norris, Jill M.
AU  - , 
TI  - Early Infant Diet and Islet Autoimmunity in the TEDDY Study
AID  - 10.2337/dc17-1983
DP  - 2018 Mar 01
TA  - Diabetes Care
PG  - 522--530
VI  - 41
IP  - 3
4099  - http://care.diabetesjournals.org/content/41/3/522.short
4100  - http://care.diabetesjournals.org/content/41/3/522.full
SO  - Diabetes Care2018 Mar 01; 41
AB  - OBJECTIVE To examine duration of breastfeeding and timing of complementary foods and risk of islet autoimmunity (IA).RESEARCH DESIGN AND METHODS The Environmental Determinants of Diabetes in the Young (TEDDY) study prospectively follows 8,676 children with increased genetic risk of type 1 diabetes (T1D) in the U.S., Finland, Germany, and Sweden. This study included 7,563 children with at least 9 months of follow-up. Blood samples were collected every 3 months from birth to evaluate IA, defined as persistent, confirmed positive antibodies to insulin (IAAs), GAD, or insulinoma antigen-2. We examined the associations between diet and the risk of IA using Cox regression models adjusted for country, T1D family history, HLA genotype, sex, and early probiotic exposure. Additionally, we investigated martingale residuals and log-rank statistics to determine cut points for ages of dietary exposures.RESULTS Later introduction of gluten was associated with increased risk of any IA and IAA. The hazard ratios (HRs) for every 1-month delay in gluten introduction were 1.05 (95% CI 1.01, 1.10; P = 0.02) and 1.08 (95% CI 1.00, 1.16; P = 0.04), respectively. Martingale residual analysis suggested that the age at gluten introduction could be grouped as <4, 4–9, and >9 months. The risk of IA associated with introducing gluten before 4 months of age was lower (HR 0.68; 95% CI 0.47, 0.99), and the risk of IA associated with introducing it later than the age of 9 months was higher (HR 1.57; 95% CI 1.07, 2.31) than introduction between 4 and 9 months of age.CONCLUSIONS The timing of gluten-containing cereals and IA should be studied further.