title: Infant exposures and development of type 1 diabetes mellitus: The Diabetes Autoimmunity Study in the Young (DAISY).
abstract: OBJECTIVE
  The incidence of type 1 diabetes mellitus (T1DM) is increasing worldwide, with the most rapid increase among children younger than 5 years of age.
  
  
  OBJECTIVE
  To examine the associations between perinatal and infant exposures, especially early infant diet, and the development of T1DM.
  
  
  METHODS
  The Diabetes Autoimmunity Study in the Young (DAISY) is a longitudinal, observational study.
  
  
  METHODS
  Newborn screening for human leukocyte antigen (HLA) was done at St. Joseph's Hospital in Denver, Colorado. First-degree relatives of individuals with T1DM were recruited from the Denver metropolitan area.
  
  
  METHODS
  A total of 1835 children at increased genetic risk for T1DM followed up from birth with complete prospective assessment of infant diet. Fifty-three children developed T1DM.
  
  
  METHODS
  Early (<4 months of age) and late (≥6 months of age) first exposure to solid foods compared with first exposures at 4 to 5 months of age (referent).
  
  
  METHODS
  Risk for T1DM diagnosed by a physician.
  
  
  RESULTS
  Both early and late first exposure to any solid food predicted development of T1DM (hazard ratio [HR], 1.91; 95% CI, 1.04-3.51, and HR, 3.02; 95% CI, 1.26-7.24, respectively), adjusting for the HLA-DR genotype, first-degree relative with T1DM, maternal education, and delivery type. Specifically, early exposure to fruit and late exposure to rice/oat predicted T1DM (HR, 2.23; 95% CI, 1.14-4.39, and HR, 2.88; 95% CI, 1.36-6.11, respectively), while breastfeeding at the time of introduction to wheat/barley conferred protection (HR, 0.47; 95% CI, 0.26-0.86). Complicated vaginal delivery was also a predictor of T1DM (HR, 1.93; 95% CI, 1.03-3.61).
  
  
  CONCLUSIONS
  These results suggest the safest age to introduce solid foods in children at increased genetic risk for T1DM is between 4 and 5 months of age. Breastfeeding while introducing new foods may reduce T1DM risk.
authors.affiliation: Colorado School of Public Health, University of Colorado, Aurora.
authors.forename: Brittni
authors.initials: B
authors.lastname: Frederiksen
authors.forename: Miranda
authors.initials: M
authors.lastname: Kroehl
authors.forename: Molly M
authors.initials: MM
authors.lastname: Lamb
authors.forename: Jennifer
authors.initials: J
authors.lastname: Seifert
authors.forename: Katherine
authors.initials: K
authors.lastname: Barriga
authors.forename: George S
authors.initials: GS
authors.lastname: Eisenbarth
authors.forename: Marian
authors.initials: M
authors.lastname: Rewers
authors.forename: Jill M
authors.initials: JM
authors.lastname: Norris
mesh_terms: D001942:Breast Feeding; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000209:etiology* / Q000235:genetics; D004032:Diet; D004034:Diet Surveys; D005247:Feeding Behavior; D005260:Female; D005819:Genetic Markers; D059866:HLA-DQ beta-Chains / Q000235:genetics; D015803:HLA-DR3 Antigen / Q000235:genetics; D015804:HLA-DR4 Antigen / Q000235:genetics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D005819:Genetic Markers; D059866:HLA-DQ beta-Chains; C069051:HLA-DQB1 antigen; D015803:HLA-DR3 Antigen; D015804:HLA-DR4 Antigen