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Cited by 515Diabetes and associated disordersCeliac Disease Research and ManagementDiabetes Management and Research

Timing of initial cereal exposure in infancy and risk of islet autoimmunity

Norris, Jill M.·2003·JAMA
DOI 10.1001/jama.290.13.1713
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Abstract

CONTEXT: Dietary exposures in infancy have been implicated, albeit inconsistently, in the etiology of type 1 diabetes mellitus (DM). OBJECTIVE: To examine the association between cereal exposures in the infant diet and appearance of islet autoimmunity (IA). DESIGN: Birth cohort study conducted from 1994 to 2002 with a mean follow-up of 4 years. SETTING: Newborn screening for HLA was done at St Joseph's Hospital in Denver, Colo. First-degree relatives of type 1 DM individuals were recruited from the Denver metropolitan area. PARTICIPANTS: We enrolled 1183 children at increased type 1 DM risk, defined as either HLA genotype or having a first-degree relative with type 1 DM, at birth and followed them prospectively. We obtained exposure and outcome measures for 76% of enrolled children. Participants had variable lengths of follow-up (9 months to 9 years). MAIN OUTCOME MEASURES: Blood draws for the detection of insulin autoantibody, glutamic acid decarboxylase autoantibody, or IA-2 autoantibody were performed at 9, 15, and 24 months and annually thereafter. Children with IA (n = 34) were defined as those testing positive for at least 1 of the autoantibodies on 2 or more consecutive visits and who tested positive or had diabetes on their most recent visit. RESULTS: Children initially exposed to cereals between ages 0 and 3 months (hazard ratio [HR], 4.32; 95% confidence interval [CI], 2.0-9.35) and those who were exposed at 7 months or older (HR, 5.36; 95% CI, 2.08-13.8) had increased hazard of IA compared with those who were exposed during the fourth through sixth month, after adjustment for HLA genotype, family history of type 1 DM, ethnicity, and maternal age. In children who were positive for the HLA-DRB1*03/04,DQB8 genotype, adjusted HRs were 5.55 (95% CI, 1.92-16.03) and 12.53 (95% CI, 3.19-49.23) for initial cereal exposure between ages 0 to 3 months and at 7 months or older, respectively. CONCLUSION: There may be a window of exposure to cereals in infancy outside which initial exposure increases IA risk in susceptible children.

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  • Evidence on whether early introduction of cow's milk or protective effects of breast milk contribute to childhood type 1 diabetes is equivocal and may depend on genetic susceptibility.

    “Evidence regarding early introduction of cow’s milk (or protective effects of breast milk consumption) in infants contributing to the development of childhood T1D is equivocal73–76 and may depend on genetic susceptibility77.”

    From Epidemiology of type 1 diabetes (2010) · cites this paper as [77]

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Authors
Norris, J. M.
Affiliations
University of Colorado Health (US)
Corresponding author
Norris, Jill M.
ORCID
Norris, Jill M.
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2003-10-01
Volume
290
Issue
13
Pages
1713
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.290.13.1713
OpenAlex
W2125269047
Cited by
515
References
29
Citations by year
2026: 5 · 2025: 5 · 2024: 10 · 2023: 21 · 2022: 9 · 2021: 27 · 2020: 17 · 2019: 19 · 2018: 11 · 2017: 20 · 2016: 28 · 2015: 23 · 2014: 31 · 2013: 27 · 2012: 28
FWCI
16.56
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK32493, R01DK049654, R01DK032493, R01-DK-49654)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
  • Health Sciences › Medicine › Gastroenterology › Celiac Disease Research and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
type 1 diabetes, islet autoimmunity, insulin autoantibodies, glutamic acid decarboxylase antibodies, IA-2 autoantibodies, first-degree relatives, HLA screening, infant nutrition, type 1 diabetes prevention
MeSH terms
Animals, Autoantibodies, Edible Grain, Child, Child, Preschool, Diabetes Mellitus, Type 1, Genotype, Glutamate Decarboxylase, HLA-DR Antigens, Humans, Infant, Infant Food, Infant Nutritional Physiological Phenomena, Infant, Newborn, Insulin Antibodies, Islets of Langerhans, Milk, Risk Factors, Time Factors, Cohort Studies, Autoimmunity, Proportional Hazards Models, Genetic Predisposition to Disease, HLA-DRB1 Chains

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