title: Regional differences in milk and complementary feeding patterns in infants participating in an international nutritional type 1 diabetes prevention trial.
abstract: Differences in breastfeeding, other milk feeding and complementary feeding patterns were evaluated in infants at increased genetic risk with and without maternal type 1 diabetes (T1D). The Trial to Reduce IDDM in the Genetically at Risk is an international nutritional primary prevention double-blinded randomized trial to test whether weaning to extensively hydrolyzed vs. intact cow's milk protein formula will decrease the development of T1D-associated autoantibodies and T1D. Infant diet was prospectively assessed at two visits and seven telephone interviews between birth and 8 months. Countries were grouped into seven regions: Australia, Canada, Northern Europe, Southern Europe, Central Europe I, Central Europe II and the United States. Newborn infants with a first-degree relative with T1D and increased human leukocyte antigen-conferred susceptibility to T1D were recruited. A lower proportion of infants born to mothers with than without T1D were breastfed until 6 months of age in all regions (range, 51% to 60% vs. 70% to 80%). Complementary feeding patterns differed more by region than by maternal T1D. In Northern Europe, a higher proportion of infants consumed vegetables and fruits daily compared with other regions. Consumption of meat was more frequent in all European regions, whereas cereal consumption was most frequent in Southern Europe, Canada and the United States. Maternal T1D status was associated with breastfeeding and other milk feeding patterns similarly across regions but was unrelated to the introduction of complementary foods. Infant feeding patterns differed significantly among regions and were largely inconsistent with current recommended guidelines.
authors.affiliation: Department of Nutrition, Georgia State University, Atlanta, Georgia, USA.
authors.forename: Anita M
authors.initials: AM
authors.lastname: Nucci
authors.affiliation: Nutrition Unit, National Institute for Health and Welfare, Helsinki, Finland.|School of Health Sciences, University of Tampere, Tampere, Finland.|Center for Child Health Research, Tampere University Hospital, University of Tampere, Tampere, Finland.|The Science Center of Pirkanmaa Hospital District, Tampere, Finland.
authors.forename: Suvi M
authors.initials: SM
authors.lastname: Virtanen
authors.affiliation: Nutrition Unit, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Susa
authors.initials: S
authors.lastname: Sorkio
authors.affiliation: Nutrition Unit, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Sonja
authors.initials: S
authors.lastname: Bärlund
authors.affiliation: Pediatrics Epidemiology Center, University of South Florida, Tampa, Florida, USA.
authors.forename: David
authors.initials: D
authors.lastname: Cuthbertson
authors.affiliation: Pediatrics Epidemiology Center, University of South Florida, Tampa, Florida, USA.
authors.forename: Ulla
authors.initials: U
authors.lastname: Uusitalo
authors.affiliation: Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Lawson
authors.affiliation: Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
authors.forename: Marja
authors.initials: M
authors.lastname: Salonen
authors.affiliation: Mead Johnson Nutrition, Evansville, Indiana, USA.
authors.forename: Carol L
authors.initials: CL
authors.lastname: Berseth
authors.affiliation: Department of Paediatrics, University of Tartu, Tartu, Estonia.
authors.forename: Anne
authors.initials: A
authors.lastname: Ormisson
authors.affiliation: Nutrition Unit, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Eveliina
authors.initials: E
authors.lastname: Lehtonen
authors.affiliation: Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
authors.forename: Erkki
authors.initials: E
authors.lastname: Savilahti
authors.affiliation: Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.|University of Pittsburgh, Pittsburgh, PA.
authors.forename: Dorothy J
authors.initials: DJ
authors.lastname: Becker
authors.affiliation: Robarts Research Institute, London, Ontario, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Dupré
authors.affiliation: Pediatrics Epidemiology Center, University of South Florida, Tampa, Florida, USA.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Krischer
authors.affiliation: Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.|Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.|Folkhälsan Research Center, Helsinki, Finland.|Department of Pediatrics, Tampere University Hospital, Tampere, Finland.
authors.forename: Mikael
authors.initials: M
authors.lastname: Knip
authors.affiliation: Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
authors.forename: Hans K
authors.initials: HK
authors.lastname: Åkerblom
mesh_terms: D000818:Animals; D002170:Canada; D003922:Diabetes Mellitus, Type 1 / Q000517:prevention & control*; D004032:Diet; D004311:Double-Blind Method; D005060:Europe; D006801:Humans; D007223:Infant; D007225:Infant Food / Q000032:analysis; D007227:Infant Nutritional Physiological Phenomena; D008892:Milk / Q000737:chemistry*; D015596:Nutrition Assessment; D018673:Nutrition Policy; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014481:United States
keywords: breastfeeding; breastfeeding duration; complementary feeding; infant feeding; infant formula; type 1 diabetes