title: Age at introduction of new foods and advanced beta cell autoimmunity in young children with HLA-conferred susceptibility to type 1 diabetes.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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
  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.
authors.affiliation: Department of Health Promotion and Chronic Disease Prevention, National Public Health Institute, Mannerheimintie 166, 00300, Helsinki, Finland. suvi.virtanen@ktl.fi
authors.forename: S M
authors.initials: SM
authors.lastname: Virtanen
authors.forename: M G
authors.initials: MG
authors.lastname: Kenward
authors.forename: M
authors.initials: M
authors.lastname: Erkkola
authors.forename: S
authors.initials: S
authors.lastname: Kautiainen
authors.forename: C
authors.initials: C
authors.lastname: Kronberg-Kippilä
authors.forename: T
authors.initials: T
authors.lastname: Hakulinen
authors.forename: S
authors.initials: S
authors.lastname: Ahonen
authors.forename: L
authors.initials: L
authors.lastname: Uusitalo
authors.forename: S
authors.initials: S
authors.lastname: Niinistö
authors.forename: R
authors.initials: R
authors.lastname: Veijola
authors.forename: O
authors.initials: O
authors.lastname: Simell
authors.forename: J
authors.initials: J
authors.lastname: Ilonen
authors.forename: M
authors.initials: M
authors.lastname: Knip
mesh_terms: D000367:Age Factors; D015551:Autoimmunity / Q000235:genetics; D001942:Breast Feeding; D003922:Diabetes Mellitus, Type 1 / Q000235:genetics* / Q000276:immunology / Q000517:prevention & control; D004034:Diet Surveys; D018450:Disease Progression; D005260:Female; D020022:Genetic Predisposition to Disease; D006683:HLA-DQ Antigens / Q000235:genetics*; D059866:HLA-DQ beta-Chains; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D050417:Insulin-Secreting Cells / Q000276:immunology*; D008297:Male
chemical_list: D006683:HLA-DQ Antigens; D059866:HLA-DQ beta-Chains; C069051:HLA-DQB1 antigen