Waiting to add milk, gluten, fruit to an infant’s diet may lower type 1 diabetes risk
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Length of breastfeeding and timing of introducing certain foods to an infant’s diet — cow’s milk, gluten and fruit, in particular — may affect type 1 diabetes risk, according to results of a systematic review and meta-analysis.
“Dietary factors that might be protective [against type 1 diabetes] according to evidence with high or moderate certainty include longer and exclusive breastfeeding, and later introduction to gluten, cow’s milk and fruit,” Anna-Maria Lampousi, MSc, a PhD student in the epidemiology unit, Institute of Environmental Medicine at Karolinska Institutet in Solna, Sweden, told Healio. “Other observed associations between diet and type 1 diabetes were of low certainty. Our study highlights how limited our knowledge base still is regarding the influence of diet on the development of type 1 diabetes.”
Lampousi and colleagues performed a literature search of Medline, Embase and Cochrane Library databases from inception until October 2020 for case-control, cohort or randomized controlled studies with islet autoimmunity or type 1 diabetes as an outcome. Summary RR was calculated based on random-effects models.
Lampousi presented results at the European Association for the Study of Diabetes Annual Meeting.
There were 152 eligible studies included in the review with estimated RRs calculated for 27 dietary components. Infants introduced to cow’s milk at age 2 to 3 months or later had a lower risk for type 1 diabetes compared with those introduced earlier (RR = 0.69; 95% CI, 0.59-0.81). Similarly, infants who began to eat gluten at age 3 to 6 months had a lower type 1 diabetes risk than those introduced earlier (RR = 0.46; 95% CI, 0.25-0.84). Introduction to fruits at age 4 to 6 months was associated with a lower type 1 diabetes risk compared with eating fruit before age 4 to 5 months (RR = 0.47; 95% CI, 0.25-0.86).
Infants consuming two to three portions of cow’s milk products per day had an increased risk for islet autoimmunity (RR = 1.25; 95% CI, 1.06-1.47) and type 1 diabetes (RR = 1.78; 95% CI, 1.36-2.33) compared with those eating or drinking fewer than two portions daily. Breastfeeding for 6 to 12 months or longer was associated with a lower type 1 diabetes risk than those who breastfed for less than 6 months (RR = 0.39; 95% CI, 0.26-0.58), and infants who exclusively breastfed for at least 2 to 3 months had a lower risk for type 1 diabetes than those who exclusively breastfed for less than 2 months (RR = 0.69; 95% CI, 0.58-0.81). There was no increased risk for type 1 diabetes observed for infant formula, cereal, meat and vegetables and maternal intake of gluten, iron and vitamin D.
Lampousi cautioned that all of the studies in the meta-analysis were observational and about half had a serious risk of bias. Additionally, six randomized controlled trials identified in the literature search could not be used in the meta-analysis since they assessed unique dietary exposures. These limitations make it important for researchers to conduct stronger studies in the future to confirm the findings of the meta-analysis, Lampousi said.
“Future studies should preferably have prospective design, consider the assessment of nutritional biomarkers, and carefully adjust for potential confounders,” Lampousi said. “Randomized controlled trials are needed to clarify if the relationships we observed are causal. Remaining questions concern whether diet influences the progression from preclinical to clinical type 1 diabetes and if it interacts with genetic susceptibility in the development of the disease.”
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Lampousi AM, et al. Oral presentation 73. Presented at: European Association for the Study of Diabetes Annual Meeting; Sept. 27-Oct. 1, 2021 (virtual meeting).
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