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Early probiotic exposure may decrease islet autoimmunity risk in children
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Among children at the highest genetic risk for type 1 diabetes, early probiotic supplementation may reduce the risk for islet autoimmunity, according to recent study findings published in JAMA Pediatrics.
Ulla Uusitalo, PhD, of the University of South Florida, and colleagues evaluated data from the TEDDY study on 7,473 children aged 4 to 10 years to determine the association between supplemental probiotic use during the first year of life and islet autoimmunity.
Researchers found a decreased risk for islet autoimmunity among participants exposed to probiotics during the first 27 days of life (n = 540; HR = 0.66; 95% CI, 0.45-0.96) compared with exposure after 27 days or no exposure, even after adjustment for first-degree relative status (P < .001), HLA-DR-DQ genotype (P < .001), sex (P = .006), birth order (P = .15) and mode of delivery (P = .46).
A strong inverse relationship was found among participants with an HLA genotype of DR3/4 (HR = 0.4; 95% CI, 0.21-0.74) but not among other genotypes (HR = 0.97; 95% CI, 0.62-1.54) for early probiotic exposure and islet autoimmunity.
“Early exposure to supplemental probiotics may decrease the risk of [islet autoimmunity] among children at elevated risk of [type 1 diabetes],” the researchers wrote. “However, a randomized clinical trial should confirm the association, and mechanistic analyses are needed to identify potential environmental factors (eg, infections that could mediate the association). These results have to be confirmed before making recommendations to the use of probiotic supplementation.”
In an accompanying editorial, George M. Weinstock, PhD, of The Jackson Laboratory for Genomic Medicine in Farmington, Connecticut, wrote that the findings had a significantly measureable effect.
“This raises the questions of whether there are better bacterial strains for the prevention of [type 1 diabetes] and whether the current general-purpose organisms could be of benefit for other diseases, which in turn could have their own optimally protective organisms,” Weinstock wrote. – by Amber Cox
Disclosure: The researchers and Weinstock report no relevant financial disclosures.
Perspective
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Laura Jacobsen, MD
The Environmental Determinants of Diabetes in the Young (TEDDY) study is designed to follow a cohort of children with increased genetic risk for type 1 diabetes in an effort to elucidate environmental factors associated with the disease. Many have questioned whether or not early dietary exposures can augment the natural history of type 1 diabetes. Uusitalo and colleagues recently published in JAMA Pediatrics a notable observation from TEDDY. This study reported that exposure to probiotics given in the first 27 days of life was associated with a reduced risk for islet autoimmunity in children with the highest genetic risk (HLA-DR3/4). One important limitation of this study is that the risk of progression to diabetes is highly influenced by number of autoantibodies and age at conversion, which are not fully explained in this analysis. Nevertheless, the study did show a potential beneficial effect of probiotics in this specific subset. Proving causation and therefore recommending changes to clinical practice warrants randomized clinical trials to help deduce if the effect is attributable to probiotics or some other process; in addition, future studies are needed to evaluate whether type of probiotic, duration of use or local dietary customs are important factors. Additional biomarkers of probiotic use are also needed. This is an important observation and demonstrates the incredible value of the TEDDY study to inform future clinical trials in patients with specific genetic risk profiles for developing type 1 diabetes.
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