Couper J J, Steele C, Beresford S, Powell T, McCaul K, Pollard A, Gellert S, Tait B, Harrison L C, Colman P G
Department of Endocrinology, Women's and Children's Hospital, North Adelaide SA, Australia.
Diabetes. 1999 Nov;48(11):2145-9. doi: 10.2337/diabetes.48.11.2145.
The hypothesis that early exposure to cow's milk or lack of breast-feeding predisposes to type 1 diabetes remains controversial. We aimed to determine prospectively the relationship of, first, duration of exclusive breast-feeding and total duration of breast-feeding, and second, introduction of cow's milk protein as infant formula, cow's milk, or dairy products, to the development of islet antibodies in early life. Some 317 children with a first-degree relative with type 1 diabetes were followed prospectively from birth for 29 months (4-73). Mothers kept a home diary and answered infant feeding questionnaires at 6-month intervals. No systematic feeding advice was given. Insulin autoantibodies (normal range <5.5%), anti-GAD antibodies (<5.0 U), and anti-IA2 antibodies (<3.0 U) were measured at 6-month intervals. Cox proportional hazards model of survival analysis detected no significant difference between children who did not develop islet antibodies (225 of 317 [71%]), children with one islet antibody raised once (52 of 317 [16.4%]), children with one antibody raised repeatedly (18 of 317 [5.7%]), or children with two or more antibodies raised (22 of 317 [6.9%]), in terms of duration of exclusive breast-feeding, total duration of breast-feeding, or introduction of cow's milk-based infant formulas, cow's milk, or dairy products (relative risk: 0.91-1.09). Four of the children with two or more islet antibodies developed type 1 diabetes. We conclude that there is no prospective association between duration of breast-feeding or introduction of cow's milk and the development of islet autoimmunity in high-risk children.
早期接触牛奶或缺乏母乳喂养易导致1型糖尿病这一假说仍存在争议。我们旨在前瞻性地确定，首先，纯母乳喂养持续时间和母乳喂养总时长，其次，将牛奶蛋白作为婴儿配方奶粉、牛奶或乳制品引入，与生命早期胰岛抗体产生之间的关系。约317名有1型糖尿病一级亲属的儿童从出生开始接受了29个月的前瞻性随访（4 - 73个月）。母亲们记家庭日记，并每隔6个月回答婴儿喂养问卷。未给予系统性喂养建议。每隔6个月测量胰岛素自身抗体（正常范围<5.5%）、抗谷氨酸脱羧酶（GAD）抗体（<5.0 U）和抗胰岛细胞抗原2（IA2）抗体（<3.0 U）。生存分析的Cox比例风险模型未发现未产生胰岛抗体的儿童（317名中的225名[71%]）、胰岛抗体升高一次的儿童（317名中的52名[16.4%]）、一种抗体反复升高的儿童（317名中的18名[5.7%]）或两种或更多抗体升高的儿童（317名中的22名[6.9%]）在纯母乳喂养持续时间、母乳喂养总时长或引入以牛奶为基础的婴儿配方奶粉、牛奶或乳制品方面存在显著差异（相对风险：0.91 - 1.09）。4名有两种或更多胰岛抗体的儿童患了1型糖尿病。我们得出结论，在高危儿童中，母乳喂养持续时间或引入牛奶与胰岛自身免疫的发生之间不存在前瞻性关联。
