Dietary Intervention in Infancy and Later Signs of Beta-Cell Autoimmunity

Paparan dini terhadap protein tertentu pada bayi dengan genetic susceptibility untuk diabetes tipe 1 akan meningkatkan risiko timbulnya autoimun terhadap sel beta.

Penelitian ini menguji hipotesis bahwa susu formula protein terhidrolisa akan menurunkan insiden timbulnya autoantibodi untuk bayi2 tersebut.

Terbukti intervensi diet pada bayi2 tersebut mempengaruhi marker autoimun terhadap sel beta yang dalam jangka panjang akan menuju pada timbulnya diabetes tipe 1.

---

N Engl J Med 363:1900-1908, 11 November 2010 © 2010 to the Massachusetts Medical Society
Dietary Intervention in Infancy and Later Signs of Beta-Cell Autoimmunity.
Mikael Knip, Suvi M. Virtanen, Karri Seppa, et al.

BACKGROUND
Early exposure to complex dietary proteins may increase the risk of beta-cell autoimmunity and type 1 diabetes in children with genetic susceptibility. We tested the hypothesis that supplementing breast milk with highly hydrolyzed milk formula would decrease the cumulative incidence of diabetes-associated autoantibodies in such children.
METHODS
In this double-blind, randomized trial, we assigned 230 infants with HLA-conferred susceptibility to type 1 diabetes and at least one family member with type 1 diabetes to receive either a casein hydrolysate formula or a conventional, cow's-milk–based formula (control) whenever breast milk was not available during the first 6 to 8 months of life. Autoantibodies to insulin, glutamic acid decarboxylase (GAD), the insulinoma-associated 2 molecule (IA-2), and zinc transporter 8 were analyzed with the use of radiobinding assays, and islet-cell antibodies were analyzed with the use of immunofluorescence, during a median observation period of 10 years (mean, 7.5). The children were monitored for incident type 1 diabetes until they were 10 years of age.
RESULTS
The unadjusted hazard ratio for positivity for one or more autoantibodies in the casein hydrolysate group, as compared with the control group, was 0.54 (95% confidence interval [CI], 0.29 to 0.95), and the hazard ratio adjusted for an observed difference in the duration of exposure to the study formula was 0.51 (95% CI, 0.28 to 0.91). The unadjusted hazard ratio for positivity for two or more autoantibodies was 0.52 (95% CI, 0.21 to 1.17), and the adjusted hazard ratio was 0.47 (95% CI, 0.19 to 1.07). The rate of reported adverse events was similar in the two groups.
CONCLUSIONS
Dietary intervention during infancy appears to have a long-lasting effect on markers of beta-cell autoimmunity — markers that may reflect an autoimmune process leading to type 1 diabetes.