Dojčenie a diabetes mellitus závislý na inzulíne

Výsledky viacerých prác nasvedčujú tomu, že dojčenie má ochranný účinok pred následným rozvojom inzulín-dependentného diabetes mellitus. Naopak, zdá sa, že príliš skoré zavádzanie kravského mlieka a tuhej stravy do výživy dojčaťa zvyšuje riziko vzniku diabetes mellitus I.typu. Jednoznačné potvrdenie protektívneho účinku pri detskom diabete si však vyžiada ďalšie klinické štúdie.
 
Diabetes Care 1999 Jun;22(6):928-32
Perinatal and neonatal determinants of childhood type 1 diabetes. A case-control study in Yorkshire, U.K. 
McKinney PA, Parslow R, Gurney KA, Law GR, Bodansky HJ, Williams R 
Paediatric Epidemiology Group, University of Leeds, U.K.
OBJECTIVE: To identify environmental factors that exert their effect in the perinatal and neonatal period and influence the subsequent onset of insulin dependent (type 1) diabetes during childhood. RESEARCH DESIGN AND METHODS: A population-based case-control study of data abstracted from the hospital obstetric and neonatal records of 196 children with type 1 diabetes and 325 age- and sex-matched control subjects. Analysis of matched sets by conditional logistic regression was conducted for a range of perinatal and neonatal factors. RESULTS: A significantly raised risk was observed for illnesses in the neonatal period (OR 1.61, 95% CI 1.06-2.44), the majority of which were infections and respiratory difficulties. Exclusive breast feeding as the initial feeding method was significantly protective (OR 0.65, 95% CI 0.45-0.94). There were no significant associations with high- or low-birth weight, being firstborn or small-for-dates. All factors significant (5% level) for the entire dataset, that is, maternal age, type 1 diabetes in mothers, preeclampsia, delivery by cesarean section, neonatal illnesses, and initial breast feeding were modeled and the OR remained significant for all variables other than cesarean section. CONCLUSIONS: The findings are based on medical record data that cannot be subject to biased recall of mothers. Neonatal illnesses increased and initial breast feeding decreased the risk of childhood type 1 diabetes. Further determinants of risk are mothers with type 1 diabetes, older mothers, and preeclampsia during pregnancy.
 
Diabetes Care 1998 Aug;21 Suppl 2:B138-41
Long-term effects of the intrauterine environment, birth weight, and breast-feeding in Pima Indians. 
Pettitt DJ, Knowler WC 
Diabetes and Arthritis Epidemiology Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona, USA. dpettitt@sansumres.com
The objectives of this study were to evaluate the long-term effect of the diabetic pregnancy on Pima Indian offspring and to see how the prevalence of diabetes during pregnancy is influenced by early life events, such as birth weight and type of infant feeding, that are known to influence the prevalence of diabetes in nonpregnant Pima adults. A modified 75-g oral glucose tolerance test was administered to women during each pregnancy. These women and, from the age of 5 years, their children were followed biennially with a standardized examination that includes measurement of height and weight and a standard 75-g oral glucose tolerance test administered in the morning after an overnight fast. We found that diabetes during pregnancy is a major risk factor for diabetes and hyperglycemia in the offspring. Diabetes in the next generation is less common among breast-fed children (6.9 and 30.1% among offspring of nondiabetic and diabetic women, respectively) than among bottle-fed children (11.9 and 43.6%, respectively). The prevalence of diabetes during pregnancy is influenced by conditions, such as birth weight, known to influence the prevalence of diabetes in this population in general. The highest rates of diabetes during pregnancy at 25-34 years of age (25%) were found among women with a birth weight below 2.5 kg. The infant of the woman with diabetes during pregnancy is at risk of becoming obese and of developing type 2 diabetes at a young age. The prevalence of diabetes in women of childbearing age is influenced by factors occurring early in life (i.e., birth weight and type of infant feeding). Whether or not the long-term adverse outcomes, including diabetic pregnancies in the next generation, can be lessened or prevented by meticulous control of diabetes during pregnancy, careful attention to intrauterine growth, or more general infant breast-feeding remains unknown.
 
Int J Epidemiol 1998 Jun;27(3):444-9
Pre-natal and early life risk factors for childhood onset diabetes mellitus: a record linkage study. 
Jones ME, Swerdlow AJ, Gill LE, Goldacre MJ 
Epidemiological Monitoring Unit, London School of Hygiene & Tropical Medicine, University of London, UK.
BACKGROUND: Using data from the Oxford Record Linkage Study (ORLS) we conducted a case-control study to examine pre-natal and early life risk factors for childhood and adolescent onset diabetes mellitus. METHODS: We identified 160 boys and 155 girls born 1965-1986 and admitted to hospital with a diagnosis of diabetes during 1965-1987 in the ORLS area. Up to eight controls were matched to each case on sex, year of birth and hospital or place of birth. We linked the hospital records for each child to all of that child's hospital records and to his or her mother's maternity record. RESULTS: There were no significant associations between subsequent diabetes and birthweight, gestational age, birthweight for gestational age, maternal age and parity. There were increased risks with not breastfeeding (relative risk [RR] = 1.33; 95% CI: 0.76-2.34), and with diabetes recorded in the mother during pregnancy (RR = 5.87; 95% CI : 0.90-38.3), but these were not statistically significant. There was a significantly raised risk with pre-eclampsia or eclampsia during pregnancy (RR = 1.48; 95% CI: 1.05-2.10). CONCLUSIONS: Pre-eclampsia may be the result of an immunogenetic incompatibility between mother and fetus, and this early immunological disturbance might be related to incidence of diabetes in later life.
 
Diabetes Care 1997 Aug;20(8):1256-60
IDDM and milk consumption. A case-control study in Sao Paulo, Brazil. 
Gimeno SG, de Souza JM 
Department of Preventive Medicine, Federal University of Sao Paulo, Brazil. suely@medprev.epm.br
OBJECTIVE: To test the hypothesis that breast-feeding is a protective factor against IDDM and that early exposure to cow's milk is a risk factor for the disease. RESEARCH DESIGN AND METHODS: A case-control study was conducted in Sao Paulo, Brazil. A total of 346 diabetic children, aged < 18 years, were identified in two institutions in the city of Sao Paulo. Duration of exclusive breast-feeding and age of introduction to cow's milk products in infant diet were compared with 346 sex-, age-, and neighborhood-matched control children. All comparisons between diabetic and control children were done using paired tests. RESULTS: Statistically significant differences were found for the duration of exclusive breast-feeding (P = 0.007) and for the age of introduction to cow's milk products (P = 0.047). Control children had a longer time of exclusive breast-feeding and had received cow's milk later in their diet than the case children. CONCLUSIONS: The results suggest that a shorter duration of exclusive breast-feeding is a risk factor for IDDM (odds ratio [OR] 2.13; 95% CI 1.8-3.55) and that the introduction to cow's milk products before age 8 days is a risk factor for the disease.
 
Lancet 1997 Jul 19;350(9072):166-8
Breastfeeding and incidence of non-insulin-dependent diabetes mellitus in Pima Indians. 
Pettitt DJ, Forman MR, Hanson RL, Knowler WC, Bennett PH 
Diabetes and Arthritis Epidemiology Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ 85014, USA.
BACKGROUND: Early exposure to cow's milk has been implicated in the occurrence of insulin-dependent diabetes mellitus but there is little information about infant-feeding practices and subsequent non-insulin-dependent diabetes mellitus (NIDDM). We examined the association between breastfeeding and NIDDM in a population with a high prevalence of this disorder, the Pima Indians. METHODS: Glucose-tolerance status was obtained from a 75 g oral glucose-tolerance test. A standard questionnaire given to mothers was used to classify infant-feeding practices for the first 2 months of life into three groups; exclusively breastfed, some breastfeeding, or exclusively bottlefed. The association between the three infant-feeding groups and NIDDM was analysed by multiple logistic regression. FINDINGS: Data were available for 720 Pima Indians aged between 10 and 39 years. 325 people who were exclusively bottlefed had significantly higher age-adjusted and sex-adjusted mean relative weights (146%) than 144 people who were exclusively breastfed (140%) or 251 people who had some breastfeeding (139%) (p = 0.019). People who were exclusively breastfed had significantly lower rates of NIDDM than those who were exclusively bottlefed in all age-groups (age 10-19, 0 of 56 vs 6 [3.6%] of 165; age 20-29, 5 [8.6%] of 58 vs 17 [14.7%] of 116]; age 30-39, 6 [20.0%] of 30 vs 13 [29.6%] of 44). The odds ratio for NIDDM in exclusively breastfed people, compared with those exclusively bottlefed, was 0.41 (95% CI 0.18-0.93) adjusted for age, sex, birthdate, parental diabetes, and birthweight. INTERPRETATION: Exclusive breastfeeding for the first 2 months of life is associated with a significantly lower rate of NIDDM in Pima indians. The increase in prevalence of diabetes in some populations may be due to the concomitant decrease in breastfeeding.
 
Diabetes Care 1994 Dec;17(12):1381-9
Environmental factors in childhood IDDM. A population-based, case-control study. 
Verge CF, Howard NJ, Irwig L, Simpson JM, Mackerras D, Silink M 
Ray Williams Institute for Pediatric Endocrinology, Royal Alexandra Hospital for Children, Sydney, Australia.
OBJECTIVE--To identify environmental factors involved in the etiology of insulin-dependent diabetes mellitus (IDDM). RESEARCH DESIGN AND METHODS--An estimated 90% of all incident cases of IDDM in patients 0-14 years of age in New South Wales, Australia, were ascertained over 18 months. For each IDDM patient, two age- and sex-matched control subjects were randomly selected from the population. Past environmental exposures were determined with a questionnaire completed by the parents. Response rates were 92% for the IDDM patients (217 of 235) and 55% for the control subjects (258 of 470). The relative risk associated with each exposure was estimated with the odds ratio (OR) adjusted for confounding factors using multiple logistic regression. RESULTS--The introduction of cow's milk-based infant formula into the diet before 3 months of age was associated with an increased risk (OR 1.52, 95% confidence interval [CI] 1.04-2.24). Exclusive breast-feeding for > or = 3 months was associated with a protective effect (OR 0.66, 95% CI 0.45-0.97). High dietary intake of cow's milk protein in the 12 months before the onset of diabetic symptoms was also associated with an increased risk (OR 1.84, 95% CI 1.12-3.00). A recent infection (during the 3 months before onset of diabetic symptoms) was more common in the patients than the control subjects (OR 2.92, 95% CI 1.96-4.35), as was day care attendance before the age of 3 (OR 1.73, 95% CI 1.00-3.00). When two age-groups, defined by the median age at onset of diabetes, were compared, the associations with early infant-feeding were stronger among the younger group (< 9.2 years), and associations with recent diet and recent infection were stronger among the older group (> or = 9.2 years). CONCLUSIONS--These results indicate an increased risk of IDDM associated with early dietary exposure to cow's milk-containing formula, short duration of exclusive breast-feeding, high intake of cow's milk protein in the recent diet, recent infection, and early attendance at day care.
 
Diabet Med 1992 Nov;9(9):815-9
Feeding in infancy and the risk of type 1 diabetes mellitus in Finnish children. The 'Childhood Diabetes in Finland' Study Group. 
Virtanen SM, Rasanen L, Aro A, Ylonen K, Lounamaa R, Tuomilehto J, Akerblom HK 
Department of Applied Chemistry and Microbiology, Children's Hospital, Helsinki, Finland.
In a case-control design the feeding in infancy of newly diagnosed 7- to 14-year-old diabetic children (n = 426) was compared with that of age- and sex-matched non-diabetic children (n = 426) randomly selected from the Finnish population registry. All 7- to 14-year-old diabetic children diagnosed from September 1986 to the end of April 1989 from all hospitals which treat diabetic children in Finland were invited to participate in the study. Breast-feeding was initiated in almost all children, but during the birth years of this study population (1972-1982), an increase was observed in the duration of breast-feeding (whether alone or in combination with supplementary feeding) and in the age of introduction of supplementary milk feeding. The risk of Type 1 diabetes was decreased in the children who were totally breast-fed for at least 2 months (odds ratio (OR) 0.64, 95% confidence interval (CI) 0.42-0.98) or 3 months (OR 0.67, 95% CI 0.48-0.95) or exclusively breast-fed for at least 2 months (OR 0.60, 95% CI 0.41-0.89) or 3 months (OR 0.63, 95% CI 0.43-0.93). Those children who were younger than 2 months (OR 1.54, 95% CI 1.08-2.18) or 3 months (OR 1.52, 95% CI 1.11-2.08) at the time when supplementary milk feeding was begun had an increased risk of Type 1 diabetes. These associations remained significant after adjusting for the mother's education. The results suggest that early infant feeding patterns are associated with the risk of Type 1 diabetes developing at the age of 7 to 14 years.
 
Diabetes 1993 Feb;42(2):288-95
Early exposure to cow's milk and solid foods in infancy, genetic predisposition, and risk of IDDM. 
Kostraba JN, Cruickshanks KJ, Lawler-Heavner J, Jobim LF, Rewers MJ, Gay EC, Chase HP, Klingensmith G, Hamman RF 
Department of Preventive Medicine and Biometrics, University of Colorado School of Medicine, Denver 80262.
Using a case-control study design, we examined the hypothesis that early exposure to cow's milk and solid foods increased the risk of IDDM. An infant diet history was collected from 164 IDDM subjects from the Colorado IDDM Registry with a mean birth year of 1973, and 145 nondiabetic population control subjects who were frequency matched to diabetic subjects on age, sex, and ethnicity. Early exposure was defined as exposure occurring before 3 mo of age. After controlling for ethnicity, birth order, and family income, more diabetic subjects were exposed early to cow's milk (OR 4.5, 95% CI 0.9-21.4) and solid foods (OR 2.5, CI 1.4-4.3) than control subjects. To examine this association while accounting for the genetic susceptibility to IDDM, we defined individuals as high and low risk by an HLA-DQB1 molecular marker. Early exposure to cow's milk was not associated with elevated risk for IDDM in low-risk individuals. Relative to unexposed low-risk individuals, early exposure to cow's milk was strongly associated in individuals with a high risK marker (OR 11.3, CI 1.2-102.0). Similar findings were observed for early exposure to solid foods. These data indicate that early exposure to cow's milk and solid foods may be associated with increased risk of IDDM. The inclusion of HLA-encoded risk in the analyses demonstrates the combined effect of genetic and environmental factors.
 
Ann Med 1994 Dec;26(6):469-78
Dietary factors in the aetiology of diabetes. 
Virtanen SM, Aro A 
Department of Applied Chemistry and Microbiology, University of Helsinki, Finland.
Quite different nutrition-related environmental factors influence the development of type 1 insulin-dependent diabetes (IDDM) and type 2 non-insulin-dependent diabetes (NIDDM). IDDM is characterized by progressive beta-cell destruction which leads to complete insulin deficiency; at the time of diagnosis 80-90% of beta cells have been destroyed. In children there is epidemiological evidence that high intake of nitrites and N-nitroso compounds, early introduction of cow's milk to the diet and short duration or absence of breastfeeding increase the risk of IDDM. Studies in experimental animals suggest that cow's milk and soy proteins may be diabetogenic. There is current interest in the effects of free radical scavengers, particularly niacin and natural and synthetic antioxidants on the incidence of IDDM. These findings from ecological, animal, and human case-control studies remain to be evaluated in prospective cohort studies covering infancy and childhood and finally in human intervention trials. NIDDM is characterized by insulin resistance which is complicated by impaired insulin secretion at the time of appearance of hyperglycaemia and clinical diabetes. Its preclinical development is insidious and poorly defined, and there is little direct evidence that the same factors which influence metabolic control in clinical diabetes also affect the preclinical development of the disorder. Obesity, particularly of the abdominal type, is common in people who develop NIDDM, and weight control by appropriate diet and physical activity is probably the most important measure for preventing NIDDM. High (saturated) fat intake seems to be associated with insulin resistance, obesity and increased risk of NIDDM, and diets high in carbohydrate seem to protect from glucose intolerance and diabetes, mainly owing to their high fibre content.
 
Pol Arch Med Wewn 1998 Aug;100(2):106-10
Frequency of appearance of antibodies to bovine serum albumin in children with diabetes type I. 
Cislak D, Dorant B, Wojcikowski C 
D.L. Instytutu Poloznictwa i Chorob Kobiecych A.M. w Gdansku.
It has been suggested that antibodies to bovine serum albumin may participate in the autoimmune process leading to the destruction of pancreatic islets. In the present study the frequency of antibodies to bovine serum albumin (BSA-Ab) in 45 children with newly diagnosed diabetes type 1, 32 children with diabetes lasting from 1-10 years and 65 healthy children was evaluated. BSA-Ab were determined by fluoroimmunometric method. The average value of fluorescence intensity 19 children with newly diagnosed diabetes type 1, who feeding mother's milk was 2037 x 10(3) +/- 898 x 10(3) impulse of fluorescence per minute (IMF) and was significant lower than the average value of fluorescence intensity of children with newly diagnosed diabetes type 1, who feeding artificiality. Antibodies to bovine serum albumin were found in 10% of children with newly diagnosed diabetes type 1, who feeding at the first six months of their life mother's milk, in 42% of children with newly diagnosed diabetes type 1, who feeding artificially and 3% of healthy children.
 
Diabetes 1999 Nov;48(11):2145-9
Lack of association between duration of breast-feeding or introduction of cow's milk and development of islet autoimmunity. 
Couper JJ, Steele C, Beresford S, Powell T, McCaul K, Pollard A, Gellert S, Tait B, Harrison LC, Colman PG 
Department of Endocrinology, Women's and Children's Hospital, North Adelaide SA, Australia. jcouper@medicine.adelaide.edu.au
The hypothesis that early exposure to cow's milk or lack of breast-feeding predisposes to type 1 diabetes remains controversial. We aimed to determine prospectively the relationship of, first, duration of exclusive breast-feeding and total duration of breast-feeding, and second, introduction of cow's milk protein as infant formula, cow's milk, or dairy products, to the development of islet antibodies in early life. Some 317 children with a first-degree relative with type 1 diabetes were followed prospectively from birth for 29 months (4-73). Mothers kept a home diary and answered infant feeding questionnaires at 6-month intervals. No systematic feeding advice was given. Insulin autoantibodies (normal range <5.5%), anti-GAD antibodies (<5.0 U), and anti-IA2 antibodies (<3.0 U) were measured at 6-month intervals. Cox proportional hazards model of survival analysis detected no significant difference between children who did not develop islet antibodies (225 of 317 [71%]), children with one islet antibody raised once (52 of 317 [16.4%]), children with one antibody raised repeatedly (18 of 317 [5.7%]), or children with two or more antibodies raised (22 of 317 [6.9%]), in terms of duration of exclusive breast-feeding, total duration of breast-feeding, or introduction of cow's milk-based infant formulas, cow's milk, or dairy products (relative risk: 0.91-1.09). Four of the children with two or more islet antibodies developed type 1 diabetes. We conclude that there is no prospective association between duration of breast-feeding or introduction of cow's milk and the development of islet autoimmunity in high-risk children.
 
Biol Neonate 1998;74(2):177-91
Early and late effects of breast-feeding: does breast-feeding really matter? 
Villalpando S, Hamosh M 
Unidad de Investigacion en Nutricion, Hospital de Pediatria, Centro Medico Nacional, Instituto Mexicano del Seguro Social, Mexico, D.F.
Breast-feeding protects the newborn against infectious diseases in developing as well as in industrialized countries. Protection is conferred against gastrointestinal and respiratory tract diseases as well as against otitis media. This protection provided by specific (antibody dependent) and broad, nonspecific protective factors in human milk (proteins, glycoproteins, and lipids) is associated with lower global morbidity and mortality of breast-fed infants as compared with formula-fed infants. While protection against diseases that develop later in life, such as insulin-dependent diabetes mellitus, inflammatory bowel disease, and childhood cancer, has been reported, well-planned prospective studies are essential in order to confirm these observations. Similar studies are essential in order to ascertain the small but consistently reported higher cognitive ability of breast-fed infants.
 
Diabetes Care 1997 Mar;20(3):340-2
IDDM and early infant feeding. Sardinian case-control study. 
Meloni T, Marinaro AM, Mannazzu MC, Ogana A, La Vecchia C, Negri E, Colombo C 
Istituto di Clinica Pediatrica e Neonatologica, University of Sassar, Italy.
OBJECTIVE: To further investigate the association between the type of feeding in infancy and the development of IDDM. RESEARCH DESIGN AND METHODS: We have carried out a case-control study in the area of Sassari (northern Sardinia, Italy), which is characterized by an ethnically homogenous population at high risk of IDDM. The study subjects comprised 100 IDDM patients and 100 control subjects, matched for sex and age and selected from children admitted at the Department of Pediatrics of the University of Sassari. Diabetic children (53 boys, 47 girls) had been diagnosed between 1983 and 1994, and their age at diagnosis ranged between 1 and 15 years. Information on feeding patterns during the 1st year of life was collected through questionnaires administered to the mothers. The questionnaire was designed to evaluate the duration of complete or partial breast-feeding and the age at which dietary products containing cow's milk were introduced into the diet. RESULTS: A larger proportion of the diabetic children rather than the control children had been breast-fed, and the risk of IDDM among children who had not been breast-fed was below unity (odds ratio [OR] 0.41; 95% CI 0.19-0.91). No clear difference was observed between diabetic and control subjects in the duration of breast-feeding (medians: 3 and 2 months, respectively), even if, overall, the data suggested a slight increase in the risk of IDDM with longer duration of breast-feeding (OR 1.10; 95% CI 0.99-1.22 per month). Although a larger proportion of control children rather than diabetic children had been given cow's milk-derived formula and solid food before the age of 3 months, there was no time-risk relationship. CONCLUSIONS: Our data do not support the existence of a protective effect of breast-feeding on the risk of IDDM, nor do the data indicate that early exposure to cow's milk and dairy products has any influence on the development of IDDM in a high-risk population.
 
JAMA 1996 Aug 28;276(8):609-14
Lack of association between early exposure to cow's milk protein and beta-cell autoimmunity. Diabetes Autoimmunity Study in the Young. 
Norris JM, Beaty B, Klingensmith G, Yu Liping, Hoffman M, Chase HP, Erlich HA, Hamman RF, Eisenbarth GS, Rewers M 
Department of Preventive Medicine and Biometrics, University of Colorado School of Medicine, Denver 80262, USA.
OBJECTIVE: To examine whether infant dietary exposure to cow's milk is associated with beta-cell autoimmunity (BCA), an early predictor of insulin-dependent diabetes mellitus (IDDM). SETTING: Denver, Colo. DESIGN: Cross-sectional with retrospective analysis. PARTICIPANTS: Between January 1994 and December 1995, 253 children from 171 families of persons with IDDM were screened for BCA. All children were between the ages of 9 months and 7 years. MAIN OUTCOME MEASURES: BCA was defined as elevated levels of insulin autoantibody, glutamic acid decarboxylase autoantibody, or insulinoma-associated islet tyrosine phosphatases autoantibody (IA-2) above the 99th percentile of 198 normal subjects. RESULTS: Eighteen cases of BCA were detected; 153 unrelated autoantibody-negative children were selected from the cohort as controls. There were no differences in the proportion of cases and controls who were exposed to cow's milk or foods containing cow's milk or to cereal, fruit and vegetable, or meat protein by 3 months or by 6 months of age. Children with BCA were breast-fed for a slightly longer duration than controls (median duration 10 vs 8 months, P=.07). CONCLUSIONS: These data suggest that early exposure to cow's milk or other dietary protein is not associated with BCA. This calls into question the importance of cow's milk avoidance as a preventive measure for IDDM.
 
Epidemiology 1996 Jan;7(1):87-92
A meta-analysis of infant diet and insulin-dependent diabetes mellitus: do biases play a role? 
Norris JM, Scott FW 
Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, 80262, USA.
We evaluated the relation between early infant diet and insulin-dependent diabetes risk with a meta-analysis of 17 case-control studies. A summary of all studies indicated a moderate effect for exposure to breast-milk substitutes [odds ratio (OR) = 1.38; 95% confidence interval (CI) = 1.18-1.61] and cow's milk-based substitutes (OR = 1.61; 95% CI = 1.31-1.98) before 3 months of age. Fourteen studies relied on retrospectively collected infant diet data based on long-term maternal recall, which may be biased or inaccurate; three studies used existing infant diet records to assess exposure, thus lessening the possibility of recall bias or inaccurate data. The studies using existing records demonstrated little association compared with the studies relying on long-term recall. Studies in which the controls had a participation rate that was more than 20% lower than that of the cases showed a stronger diabetogenic effect of never being breast-fed (OR = 1.58) than studies whose cases and controls had similar participation rates (OR = 1.06). Thus, differences in the participation rates of cases and controls may have biased the results of these studies. This meta-analysis indicates that the weak association between infant diet and risk of diabetes mellitus may have methodologic explanations.
 
Diabet Med 1994 Aug-Sep;11(7):663-5
Cow's milk and type 1 childhood diabetes: no increase in risk. 
Bodington MJ, McNally PG, Burden AC 
Diabetes Care, Leicester General Hospital, UK.
A retrospective case-control study was undertaken to investigate the relationship between the early introduction of cow's milk and the subsequent risk of developing Type 1 diabetes (< 15 years at diagnosis). A total of 268 children who developed diabetes during the period 1980-1990 (11 years inclusive) in Leicestershire were identified. Age-, sex-, and race-matched controls were identified using the Leicestershire population register. Parents of children with diabetes and their controls completed a structured questionnaire on infant feeding habits from birth. A total of 184 questionnaires (67%) were analysed. There was no difference between the diabetic and control children with respect to the introduction of cow's milk at an early age and the risk of developing diabetes (odds ratio: 0.98 (0.65-1.47)). In addition, short duration of breast-feeding (< 3 months) had no influence on the incidence of diabetes (1.05 (0.64-1.75)). This study does not support the hypothesis that the early introduction of cow's milk or a short duration of breast-feeding increases the risk of developing Type 1 diabetes.
 
Diabetes Res Clin Pract 1993 Mar;19(3):203-10
Breast-feeding seems to play a marginal role in the prevention of insulin-dependent diabetes mellitus. 
Samuelsson U, Johansson C, Ludvigsson J 
Department of Pediatrics, Hospital Ryhov, Jonkoping, Sweden.

In order to test the hypothesis that breast-feeding has a protective effect on the development of insulin-dependent diabetes (IDDM) during childhood we retrospectively studied 297 diabetic children age 15 years or less diagnosed 1974-88 at the 5 pediatric departments in the South-East region of Sweden. They were compared to 792 non-diabetic controls of the same age (year of birth), sex and geographical location. Files from the child welfare clinics were reviewed and the families answered questionnaires. Ten percent of the diabetic children and 11% of the control children had never been breast-fed. In the total material no obvious difference was seen regarding duration of breast-feeding between the diabetic children and their healthy controls. Only in the oldest maternal age group (> 35 years of age) control mothers tended to have a longer duration of breast-feeding (P < 0.01). There was also a trend that children with diagnosis of IDDM during winter had been breast-fed for a shorter period (4.1 +/- 3.4 months) than their controls (5.0 +/- 3.5 months, P < 0.09). We conclude, that breast-feeding has very little effect on preventing IDDM in children. If it has any effect, it might be to decrease the risk in certain subgroups.