title: First Infant Formula Type and Risk of Islet Autoimmunity in The Environmental Determinants of Diabetes in the Young (TEDDY) Study.
abstract: Studies on the introduction of infant formulas and its effect on the risk of islet autoimmunity and type 1 diabetes (T1D) have yielded inconsistent results. We investigated whether the introduction of formula based on hydrolyzed cow's milk as the first formula is associated with reduced islet autoimmunity risk in a large prospective cohort.
  
  
  
  The Environmental Determinants of Diabetes in the Young (TEDDY) study prospectively monitors 8,676 children at increased genetic risk for T1D. Autoantibodies to insulin, GAD65, and IA2 were measured regularly to define islet autoimmunity. Information on formula feeding was collected by questionnaires at 3 months of age.
  
  
  
  In survival analyses, after adjustment for family history with T1D, HLA genotype, sex, country, delivery mode, breast-feeding ≥3 months, and seasonality of birth, we observed no significant association with islet autoimmunity in infants who received extensively hydrolyzed compared with nonhydrolyzed cow's milk-based formula as the first formula during the first 3 months (adjusted hazard ratio 1.38 [95% CI 0.95; 2.01]), and a significantly increased risk for extensively hydrolyzed formula introduced during the first 7 days (adjusted hazard ratio 1.57 [1.04; 2.38]). Using a partially hydrolyzed or other formula as the first formula, or no formula, was not associated with islet autoimmunity risk.
  
  
  
  These results add to the existing evidence that islet autoimmunity risk is not reduced, and may be increased, by using hydrolyzed compared with nonhydrolyzed cow's milk-based infant formula as the first formula in infants at increased genetic risk for T1D.
authors.affiliation: Institute of Diabetes Research, Helmholtz Zentrum München, Munich, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Forschergruppe Diabetes e.V., Neuherberg, Germany sandra.hummel@lrz.uni-muenchen.de.
authors.forename: Sandra
authors.initials: S
authors.lastname: Hummel
authors.affiliation: Institute of Diabetes Research, Helmholtz Zentrum München, Munich, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Forschergruppe Diabetes e.V., Neuherberg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Beyerlein
authors.affiliation: Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL.
authors.forename: Roy
authors.initials: R
authors.lastname: Tamura
authors.affiliation: Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL.
authors.forename: Ulla
authors.initials: U
authors.lastname: Uusitalo
authors.affiliation: Department of Clinical Sciences, Lund University/Clinical Research Centre, Skåne University Hospital (SUS), Malmö, Sweden.
authors.forename: Carin
authors.initials: C
authors.lastname: Andrén Aronsson
authors.affiliation: Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL.
authors.forename: Jimin
authors.initials: J
authors.lastname: Yang
authors.affiliation: Unit of Nutrition, National Institute for Health and Welfare, Helsinki, and Faculty of Social Sciences, University of Tampere, Tampere, Finland.
authors.forename: Anne
authors.initials: A
authors.lastname: Riikonen
authors.affiliation: Department of Clinical Sciences, Lund University/Clinical Research Centre, Skåne University Hospital (SUS), Malmö, Sweden.
authors.forename: Åke
authors.initials: Å
authors.lastname: Lernmark
authors.affiliation: Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO.
authors.forename: Marian J
authors.initials: MJ
authors.lastname: Rewers
authors.affiliation: Pacific Northwest Diabetes Research Institute, Seattle, WA.
authors.forename: William A
authors.initials: WA
authors.lastname: Hagopian
authors.affiliation: Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA.
authors.forename: Jin-Xiong
authors.initials: JX
authors.lastname: She
authors.affiliation: Department of Pediatrics, Turku University Hospital, Turku, Finland.
authors.forename: Olli G
authors.initials: OG
authors.lastname: Simell
authors.affiliation: Department of Pediatrics, Turku University Hospital, Turku, Finland.|Department of Physiology, Institute of Biomedicine, University of Turku, Turku, Finland.
authors.forename: Jorma
authors.initials: J
authors.lastname: Toppari
authors.affiliation: Institute of Diabetes Research, Helmholtz Zentrum München, Munich, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Forschergruppe Diabetes e.V., Neuherberg, Germany.
authors.forename: Anette-G
authors.initials: AG
authors.lastname: Ziegler
authors.affiliation: National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD.
authors.forename: Beena
authors.initials: B
authors.lastname: Akolkar
authors.affiliation: Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Krischer
authors.affiliation: Unit of Nutrition, National Institute for Health and Welfare, Helsinki, and Faculty of Social Sciences, University of Tampere, Tampere, Finland.|Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, and The Science Center of Pirkanmaa Hospital District, Tampere, Finland.
authors.forename: Suvi M
authors.initials: SM
authors.lastname: Virtanen
authors.affiliation: Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO.
authors.forename: Jill M
authors.initials: JM
authors.lastname: Norris
mesh_terms: D000818:Animals; D001323:Autoantibodies / Q000097:blood; D015551:Autoimmunity; D001942:Breast Feeding; D002417:Cattle; D003922:Diabetes Mellitus, Type 1 / Q000209:etiology* / Q000235:genetics / Q000276:immunology*; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D020022:Genetic Predisposition to Disease; D006801:Humans; D007223:Infant; D041943:Infant Formula / Q000737:chemistry*; D007328:Insulin / Q000097:blood; D008297:Male; D008892:Milk; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D001323:Autoantibodies; D007328:Insulin