短期纯母乳喂养会使患1型糖尿病遗传风险增加的幼儿易发生进行性β细胞自身免疫。

Short-term exclusive breastfeeding predisposes young children with increased genetic risk of Type I diabetes to progressive beta-cell autoimmunity.

作者信息

Kimpimäki T, Erkkola M, Korhonen S, Kupila A, Virtanen S M, Ilonen J, Simell O, Knip M

机构信息

Department of Pediatrics, Tampere University Hospital, Finland.

出版信息

Diabetologia. 2001 Jan;44(1):63-9. doi: 10.1007/s001250051581.

DOI:10.1007/s001250051581

PMID:11206413

Abstract

AIMS/HYPOTHESIS: This study aimed to establish the relation between early infant nutrition and signs of beta-cell autoimmunity in young children.

METHODS

We identified and observed from birth 2949 infants with increased genetic risk of Type I (insulin-dependent) diabetes mellitus (HLA DQB1*02/ 0302 or DQB10302/x, x = other than *02, *0301 or *0602) and monitored them for islet cell antibodies at 3 to 6 month intervals. If an infant seroconverted to islet cell antibody positivity, all of his or her samples were also analysed for autoantibodies to insulin, GAD65 (GADA) and to the protein tyrosine phosphatase related IA-2 molecule (IA-2A). Our case-control study comprises the first 65 children who seroconverted to islet cell antibody positivity before the age of 4 years and 390 control children who were islet cell antibody-negative (six control children/ case). We monitored the duration of exclusive and total breastfeeding and the age at which cows' milk was introduced.

RESULTS

Infants who had been breastfed exclusively for at least 4 months had lower risk of seroconversion to positivity for IA-2A or all four autoantibodies [odds ratio (OR) 0.24; 95 % CI 0.06-0.94 and OR 0.17; 95 % CI 0.03-0.86, respectively] than those infants who had been breastfed exclusively for less than 2 months. The risk of seroconversion to positivity for IA-2A or all four autoantibodies was higher in those younger than 2 months (OR 4.37; 95 % CI 1.33-14.42 and OR 5.02; 95 % CI 1.27-19.89) or aged 2 to 3.9 months (OR 5.50; 95 % CI 1.21-25.04 and 6.19; 95% CI 1.10-34.84) when they first received cows' milk than in those aged 4 months or older.

CONCLUSIONS/INTERPRETATION: These observations suggest that short-term breastfeeding and the early introduction of cows' milk-based infant formula predispose young children who are genetically susceptible to Type I diabetes to progressive signs of beta-cell autoimmunity.

摘要

目的/假设：本研究旨在确立幼儿早期营养与β细胞自身免疫迹象之间的关系。

方法

我们从出生起识别并观察了2949名患I型（胰岛素依赖型）糖尿病遗传风险增加的婴儿（HLA DQB102/0302或DQB10302/x，x为02、0301或0602以外的其他类型），并每隔3至6个月对他们进行胰岛细胞抗体监测。如果婴儿血清转化为胰岛细胞抗体阳性，则对其所有样本也进行胰岛素、谷氨酸脱羧酶65（GADA）和蛋白酪氨酸磷酸酶相关IA-2分子（IA-2A）自身抗体分析。我们的病例对照研究包括4岁前血清转化为胰岛细胞抗体阳性的前65名儿童和390名胰岛细胞抗体阴性的对照儿童（6名对照儿童/病例）。我们监测了纯母乳喂养和完全母乳喂养的持续时间以及引入牛奶的年龄。

结果

纯母乳喂养至少4个月的婴儿血清转化为IA-2A阳性或所有四种自身抗体阳性的风险低于纯母乳喂养少于2个月的婴儿[比值比（OR）分别为0.24；95%可信区间0.06 - 0.94和OR 0.17；95%可信区间0.03 - 0.86]。首次摄入牛奶时年龄小于2个月（OR 4.37；95%可信区间1.33 - 14.42和OR 5.02；95%可信区间1.27 - 19.89）或2至3.9个月（OR 5.50；95%可信区间1.21 - 25.04和6.19；95%可信区间1.10 - 34.84）的婴儿血清转化为IA-2A阳性或所有四种自身抗体阳性的风险高于4个月及以上的婴儿。

结论/解读：这些观察结果表明，短期母乳喂养和过早引入以牛奶为基础的婴儿配方奶粉会使遗传易患I型糖尿病的幼儿出现β细胞自身免疫的进展迹象。