Weight gain in early life predicts risk of islet autoimmunity in children with a first-degree relative with type 1 diabetes.
OBJECTIVE
In a prospective birth cohort study, we followed infants who had a first-degree relative with type 1 diabetes to investigate the relationship between early growth and infant feeding and the risk of islet autoimmunity.


METHODS
Infants with a first-degree relative with type 1 diabetes were identified during their mother's pregnancy. Dietary intake was recorded prospectively to determine duration of breast-feeding and age at introduction of cow's milk protein, cereals, meat, fruit, and vegetables. At 6-month reviews, length (or height) and weight, antibodies to insulin, GAD65, the tyrosine phosphatase-like insulinoma antigen, and tissue transglutaminase were measured. Islet autoimmunity was defined as persistent elevation of one or more islet antibodies at consecutive 6-month intervals, including the most recent measure, and was the primary outcome measure.


RESULTS
Follow-up of 548 subjects for 5.7 +/- 3.2 years identified 46 children with islet autoimmunity. Weight z score and BMI z score were continuous predictors of risk of islet autoimmunity (adjusted hazard ratios 1.43 [95% CI 1.10-1.84], P = 0.007, and 1.29 [1.01-1.67], P = 0.04, respectively). The risk of islet autoimmunity was greater in subjects with weight z score >0 than in those with weight z score < or =0 over time (2.61 [1.26-5.44], P = 0.01). Weight z score and BMI z score at 2 years and change in weight z score between birth and 2 years, but not dietary intake, also predicted risk of islet autoimmunity.


CONCLUSIONS
Weight gain in early life predicts risk of islet autoimmunity in children with a first-degree relative with type 1 diabetes.
Department of Diabetes and Endocrinology, Women's and Children's Hospital and Discipline of Paediatrics, University of Adelaide, Adelaide, Australia. jennifer.couper@adelaide.edu.au
Jennifer J
JJ
Couper
Sarah
S
Beresford
Craig
C
Hirte
Peter A
PA
Baghurst
Angie
A
Pollard
Brian D
BD
Tait
Leonard C
LC
Harrison
Peter G
PG
Colman
D001323:Autoantibodies / Q000097:blood; D015551:Autoimmunity; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000196:embryology / Q000453:epidemiology / Q000235:genetics* / Q000382:microbiology; D005220:Fathers; D005260:Female; D015234:HLA-A Antigens / Q000276:immunology; D015235:HLA-B Antigens / Q000276:immunology; D006684:HLA-DR Antigens / Q000235:genetics / Q000276:immunology; D006801:Humans; D007515:Islets of Langerhans / Q000276:immunology*; D008297:Male; D009035:Mothers; D009679:Nuclear Family; D011237:Predictive Value of Tests; D011247:Pregnancy; D018570:Risk Assessment; D035781:Siblings; D013601:T-Lymphocytes / Q000276:immunology; D015430:Weight Gain
D001323:Autoantibodies; D015234:HLA-A Antigens; D015235:HLA-B Antigens; D006684:HLA-DR Antigens