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DAISY: Early, late exposure to solid food linked to type 1 diabetes risk
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Infants introduced to solid foods before 3 months of age and after 6 months of age could be more likely to develop type 1 diabetes, according to data published in JAMA Pediatrics. Data also indicate that solid foods introduced between ages 4 to 5 months in conjunction with breast-feeding could attenuate the risk for type 1 diabetes.
Brittni Frederiksen, MPH, of the Colorado School of Public Health at the University of Colorado in Aurora, and colleagues examined the potential link between perinatal and infant exposures to solid food and the development of type 1 diabetes in a prospective analysis of the Diabetes Autoimmunity Study in the Young (DAISY).
They included 1,835 children with an increased genetic risk for type 1 diabetes who were followed from birth. First exposures were considered early if solid food was given to the infant at age <4 months and late if given at ≥6 months of age. This was compared with those exposed at ages 4 to 5 months. Ultimately, 53 children developed type 1 diabetes, researchers wrote.
After adjusting for the HLA-DR genotype, first-degree relatives with type 1 diabetes, maternal education and delivery type, researchers reported that early (HR=1.91; 95% CI, 1.04-3.51) and late (HR=3.02; 95% CI, 1.26-7.24) first exposure to any solid food predicted development of type 1 diabetes.
Further, early exposure to fruit (HR=2.23; 95% CI, 1.14-4.39) and late exposure to rice/oat products (HR=2.88; 95% CI, 1.36-6.11) predicted type 1 diabetes. However, breast-feeding at the time of introduction to wheat/barley appeared to reduce the risk for type 1 diabetes (HR=0.47; 95% CI, 0.26-0.86). If a complicated vaginal delivery transpired, the risk for type 1 diabetes also increased (HR=1.93; 95% CI, 1.03-3.61).
“In summary, there appears to be a safe window in which to introduce solid foods between 4 and 5 months of age; solid foods should be introduced while continuing to breast-feed to minimize type 1 diabetes risk in genetically susceptible children. These findings should be replicated in a larger cohort for confirmation,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Nancy Crimmins, MD
It is disheartening that the incidence of type 1 diabetes is increasing as we still don’t have a viable cure for this disease. Prevention is therefore an important focus of research, particularly in the identification of potentially modifiable environmental factors which contribute to the development of diabetes. This study provided evidence that the timing of solid food introduction could affect diabetes risk which should be taken seriously. It will be difficult to replicate these findings, as few studies will be as well-designed and powered as the DAISY study. However, it is certainly reasonable given these findings to encourage breastfeeding and proper timing of solid foods to parents of infants who have a first-degree relative with diabetes; there is no downside to doing either. At the same time, the incidence of type 1 diabetes at follow-up in this study is still relatively low (53 of 1,835, or 2.98%). Therefore, I don’t want my parents to feel like they have doomed their child to a life of diabetes if they introduced cereal late.
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