Virtanen S M, Kenward M G, Erkkola M, Kautiainen S, Kronberg-Kippilä C, Hakulinen T, Ahonen S, Uusitalo L, Niinistö S, Veijola R, Simell O, Ilonen J, Knip M
Department of Health Promotion and Chronic Disease Prevention, National Public Health Institute, Mannerheimintie 166, 00300, Helsinki, Finland.
Diabetologia. 2006 Jul;49(7):1512-21. doi: 10.1007/s00125-006-0236-1. Epub 2006 Apr 5.
AIMS/HYPOTHESIS: Evidence for the role of infant feeding in the development of beta cell autoimmunity is inconsistent. We set out to study the effects of breastfeeding and of age at introduction of supplementary foods on the development of beta cell autoimmunity.
A prospective birth cohort of 3,565 infants with HLA-DQB1-conferred susceptibility to type 1 diabetes was recruited between 1996 and 2001 from two university hospital areas in Finland. Blood samples were collected at 3- to 12-month intervals to measure antibodies against islet cells, insulin, glutamate dehydroxylase and islet antigen 2. The families kept a record on the age at introduction of new foods, and for each visit completed a structured dietary questionnaire. The endpoint was repeated positivity for islet cell antibodies together with at least one of the other three antibodies.
The overall or exclusive duration of breastfeeding was not associated with the risk of developing the endpoint. An early age at introduction of fruits and berries (< or =4 months) was related to increased risk of developing positivity for the endpoint (hazard ratio [95% CI] for earliest tertile 2.02 [1.03-3.95] and for midtertile 1.97 [1.06-3.64] compared with latest tertile >4 months). Also, introducing roots between 3 and 3.9 months (midtertile) was related to increased risk of the endpoint (hazard ratio [95% CI] for the earliest tertile 1.04 [0.57-1.90] and for midtertile 1.82 [1.19-2.79] compared with latest tertile). These associations were independent of several putative socio-demographic and perinatal confounding factors.
CONCLUSIONS/INTERPRETATION: Our findings suggest that an early age at introduction of fruits and berries and roots associates independently with beta cell autoimmunity, contradicting earlier findings from smaller birth cohort studies.
目的/假设：关于婴儿喂养在β细胞自身免疫发展中作用的证据并不一致。我们着手研究母乳喂养及添加辅食的年龄对β细胞自身免疫发展的影响。
1996年至2001年间，从芬兰两个大学医院地区招募了3565名携带HLA - DQB1基因、易患1型糖尿病的婴儿组成前瞻性出生队列。每隔3至12个月采集血样，检测抗胰岛细胞、胰岛素、谷氨酸脱氢酶和胰岛抗原2的抗体。家庭记录新食物引入的年龄，每次访视时完成一份结构化饮食问卷。终点指标为胰岛细胞抗体以及其他三种抗体中至少一种抗体呈重复阳性。
母乳喂养的总时长或纯母乳喂养时长与达到终点指标的风险无关。过早引入水果和浆果（≤4个月）与达到终点指标阳性的风险增加有关（最早三分位数的风险比[95%置信区间]为2.02[1.03 - 3.95]，中间三分位数为1.97[1.06 - 3.64]，与最晚三分位数＞4个月相比）。此外，在3至3.9个月（中间三分位数）引入根茎类食物也与终点指标风险增加有关（最早三分位数的风险比[95%置信区间]为1.04[0.57 - 1.90]，中间三分位数为1.82[1.19 - 2.79]，与最晚三分位数相比）。这些关联独立于一些假定的社会人口学和围产期混杂因素。
结论/解读：我们的研究结果表明，过早引入水果和浆果以及根茎类食物与β细胞自身免疫独立相关，这与之前较小出生队列研究的结果相矛盾。
