Early Infant Diet in Children at High Risk for Type 1 Diabetes

Abstract

Infant diet affects health and development. The aim of our study was to investigate WHO infant feeding compliance in children who have a first degree family history of type 1 diabetes (T1D). One hundred and fifty children who were first degree relatives of patients with T1D were intensively followed from birth in the BABYDIET intervention study. Infant feeding, infections, and medication were recorded daily by participating families. Weight and length of children were obtained from paediatric records. Only 5% of the families followed the WHO recommendations for infant feeding that include full breastfeeding for at least 6 months (18.8% of children) and introduction of complementary foods under continued breastfeeding thereafter (22.2% of children). Maternal age in the first quartile (<29 years; p<0.0001), and maternal smoking (p<0.0001) were associated with an earlier introduction of solid food and reduced breastfeeding. Full breastfeeding ≥6 months was associated with reduced frequency of gastrointestinal infections (12 vs. 38%, p=0.02) and antibiotic treatment (24 vs. 48%, p=0.04). Our findings indicate that WHO infant feeding recommendations were poorly followed by families with a family history of T1D. Action to improve levels of infant feeding behaviour is essential, especially among young mothers with T1D.

Key words

diabetes mellitus - infant feeding - breastfeeding - infections - antibiotic treatment

References

• 1 Agostoni C, Decsi T, Fewtrell M, Goulet O, Kolacek S, Koletzko B, Michaelsen KF, Moreno L, Puntis J, Rigo J, Shamir R, Szajewska H, Turck D, van Goudoever J. Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition.  J Pediatr Gastroenterol Nutr. 2008;  46 (1) 99-110
• 2 WHO . WHO report of the expert consultion on the optimal duration of exclusive breastfeeding: A systemic review  2001; 
• 3 Baker JL, Michaelsen KF, Sorensen TI, Rasmussen KM. High prepregnant body mass index is associated with early termination of full and any breastfeeding in Danish women.  Am J Clin Nutr. 2007;  86 404-411
• 4 Doherty T, Chopra M, Jackson D, Goga A, Colvin M, Persson LA. Effectiveness of the WHO/UNICEF guidelines on infant feeding for HIV-positive women: results from a prospective cohort study in South Africa.  Aids. 2007;  21 1791-1797
• 5 Hummel S, Winkler C, Schoen S, Knopff A, Marienfeld S, Bonifacio E, Ziegler AG. Breastfeeding habits in families with Type 1 diabetes.  Diabet Med. 2007;  24 (6) 671-676
• 6 Kimpimaki T, Erkkola M, Korhonen S, Kupila A, Virtanen SM, Ilonen J, Simell O, Knip M. Short-term exclusive breastfeeding predisposes young children with increased genetic risk of Type I diabetes to progressive beta-cell autoimmunity.  Diabetologia. 2001;  44 (1) 63-69
• 7 Norris JM, Barriga K, Klingensmith G, Hoffman M, Eisenbarth GS, Erlich HA, Rewers M. Timing of initial cereal exposure in infancy and risk of islet autoimmunity.  JAMA. 2003;  290 (13) 1713-1720
• 8 Ziegler AG, Schmid S, Huber D, Hummel M, Bonifacio E. Early infant feeding and risk of developing type 1 diabetes-associated autoantibodies.  JAMA. 2003;  290 1721-1728
• 9 Schmid S, Buuck D, Knopff A, Bonifacio E, Ziegler AG. BABYDIET, a feasibility study to prevent the appearance of islet autoantibodies in relatives of patients with Type 1 diabetes by delaying exposure to gluten.  Diabetologia. 2004;  47 1130-1131
• 10 Kromeyer-Hauschild K, Wabitsch M, Kunze D, Geller F, Geiß H, Hesse V. Perzentile für den Body-mass-Index für das Kinder- und Jugendalter unter Heranziehung verschiedener Stichproben.  Monatsschr Kinderh. 2001;  8 807-818
• 11 WHO . Guiding principles for complementary feeding of the breastfed child  2001; 
• 12 Lange C, Schenk L, Bergmann R. [Distribution, duration and temporal trend of breastfeeding in Germany. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)].  Bundesgesundheitsbl. 2007;  50 624-633
• 13 Ryan AS, Wenjun Z. Acosta A. Breastfeeding continues to increase into the new millennium.  Pediatrics. 2002;  110 1103-1109
• 14 Freeman V, van’t Hof M, Haschke F. Patterns of milk and food intake in infants from birth to age 36 months: The Euro-growth study.  J Pediatr Gastroenterol Nutr. 2000;  31 ((Suppl 1)) S76-S85
• 15 Erkkola M, Pigg HM, Virta-Autio P, Hekkala A, Hypponen E, Knip M, Virtanen SM. Infant feeding patterns in the Finnish type I diabetes prediction and prevention nutrition study cohort.  Eur J Clin Nutr. 2005;  59 (1) 107-113
• 16 Lande B, Andersen LF, Baerug A, Trygg KU, Lund-Larsen K, Veierod MB, Bjorneboe GE. Infant feeding practices and associated factors in the first six months of life: The Norwegian infant nutrition survey.  Acta Paediatr. 2003;  92 (2) 152-161
• 17 Fewtrell MS, Lucas A, Morgan JB. Factors associated with weaning in full term and preterm infants.  Arch Dis Child Fetal Neonatal Ed. 2003;  88 F296-F301
• 18 BfR . Empfehlung der Nationalen Stillkommission am BfR vom 1. März 2004  2004; 
• 19 Yngve A, Sjostrom M. Breastfeeding in countries of the European Union and EFTA: Current and proposed recommendations, rationale, prevalence, duration and trends.  Public Health Nutr. 2001;  4 ((2B)) 631-645
• 20 Schoen S, Sichert-Hellert W, Hummel S, Ziegler AG, Kersting M. Breastfeeding duration in families with type 1 diabetes compared to non-affected families: Results from BABYDIAB and DONALD studies in Germany.  Breastfeed Med. 2008;  3 171-175
• 21 Kreichauf S, Pfluger M, Hummel S, Ziegler AG. [Effect of breastfeeding on the risk of becoming overweight in offspring of mothers with type 1 diabetes].  Dtsch Med Wochenschr. 2008;  133 1173-1177
• 22 Marjamaki L, Rasanen M, Uusitalo L, Ahonen S, Veijola R, Knip M, Virtanen SM. Use of vitamin D and other dietary supplements by Finnish children at the age of 2 and 3 years.  Int J Vitam Nutr Res. 2004;  74 27-34
• 23 Dratva J, Merten S, Ackermann-Liebrich U. Vitamin D supplementation in Swiss infants.  Swiss Med Wkly. 2006;  136 473-481
• 24 Hypponen E, Laara E, Reunanen A, Jarvelin MR. Virtanen SM. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study.  Lancet. 2001;  358 ((9292)) 1500-1503
• 25 Kramer MS, Kakuma R. The optimal duration of exclusive breastfeeding: a systematic review.  Adv Exp Med Biol. 2004;  554 63-77
• 26 Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, Trikalinos T, Lau J. Breastfeeding and maternal and infant health outcomes in developed countries.  Evid Rep Technol Assess (Full Rep). 2007;  ((153)) 1-186
• 27 Touger L, Looker HC, Krakoff J, Lindsay RS, Cook V, Knowler WC. Early growth in offspring of diabetic mothers.  Diabetes Care. 2005;  28 585-589

Correspondence