Neonatal Nutritional Interventions in the Prevention of Type 1 Diabetes

After completing this article, readers should be able to: 1. Outline the current concepts of the pathogenesis of type 1 diabetes (T1D) with regard to dietary triggers and genetic susceptibility. 2. Discuss the evidence, both epidemiologic and that derived from studies of animal models, that supports the association between infant feeding practices and T1D. 3. Describe the roles for intestinal immunity and permeability in supporting the hypothetical model of cow milk protein mediation of T1D autoimmunity. 4. Delineate the goals and rationale for prospective clinical trials evaluating neonatal nutrition and the development of T1D. 5. List the putative dietary modulators of T1D. Type 1 diabetes (T1D), a disease that has unacceptably high morbidity and mortality, is increasing in incidence, prompting the redoubling of efforts toward its prevention. Progress toward prevention and cure relies on elucidation of the disease’s pathogenesis, which, to date, has remained poorly defined. The defining features of T1D, insulin deficiency and hyperglycemia, result from an immune-mediated destruction of insulin-secreting beta cells in the pancreatic islets. The loss of beta cell mass is believed to be gradual for most individuals, accounting for the sometimes prolonged asymptomatic periods of autoimmunity preceding overt diabetes (Fig. 1). Indeed, the chronic autoimmune nature of the disease is well established, as is the genetic predisposition. Specific associations with molecules of the human lymphocyte antigen (HLA) define both susceptibility to and protection from T1D. However, T1D is a polygenic disorder with more than 20 loci associated with susceptibility or resistance to the disease, of which the HLA may account for less than 50% of the genetic predisposition. Genetics clearly comprises a major component of the development of T1D, but the interaction between the environment and the immune system abnormalities is believed to weigh heavily in disease development. Indeed, trends in T1D incidence, both geographic and temporal, suggest a strong …

[1]  M. Melbye,et al.  Childhood vaccination and type 1 diabetes. , 2004, The New England journal of medicine.

[2]  J. Strubbe,et al.  The diabetes prone BB rat model of IDDM shows duration of breastfeeding to influence Type 1 diabetes development later in life , 2003, Diabetologia.

[3]  J. Palmer.  Manipulating the type 1 diabetes disease process, man versus mouse. , 2002, Diabetes care.

[4]  Jorma Ilonen,et al.  Environmental factors in the etiology of type 1 diabetes. , 2002, American journal of medical genetics.

[5]  O. Vaarala.  The Gut Immune System and Type 1 Diabetes , 2002, Annals of the New York Academy of Sciences.

[6]  P. McKinney,et al.  Trends in the incidence of childhood diabetes in south Asians and other children in Bradford, UK , 2002, Diabetic medicine : a journal of the British Diabetic Association.

[7]  M. Atkinson,et al.  Type 1 diabetes: new perspectives on disease pathogenesis and treatment , 2001, The Lancet.

[8]  J. Ilonen,et al.  Short-term exclusive breastfeeding predisposes young children with increased genetic risk of Type I diabetes to progressive beta-cell autoimmunity , 2001, Diabetologia.

[9]  H. Kolb,et al.  Cow’s milk and immune-mediated diabetes , 2000, Proceedings of the Nutrition Society.

[10]  J. Tuomilehto,et al.  Worldwide increase in incidence of Type I diabetes – the analysis of the data on published incidence trends , 1999, Diabetologia.

[11]  M. Knip,et al.  Putative environmental factors in Type 1 diabetes. , 1998, Diabetes/metabolism reviews.

[12]  H. Kolb,et al.  Potential Mechanisms by Which Certain Foods Promote or Inhibit the Development of Spontaneous Diabetes in BB Rats: Dose, Timing, Early Effect on Islet Area, and Switch in Infiltrate From Th1 to Th2 Cells , 1997, Diabetes.

[13]  H. Dosch,et al.  Immunological Aspects of Nutritional Diabetes Prevention in NOD Mice: A Pilot Study for the Cow's Milk–Based IDDM Prevention Trial , 1997, Diabetes.

[14]  P. Pozzilli,et al.  Cell-mediated immune response to β casein in recent-onset insulin-dependent diabetes: implications for disease pathogenesis , 1996, The Lancet.

[15]  G. Mancosu,et al.  Steadily High IDDM Incidence Over 4 Years in Sardinia , 1995, Diabetes Care.

[16]  D. Greiner,et al.  Human autoimmune diabetes mellitus: lessons from BB rats and NOD mice--Caveat emptor. , 1995, Clinical immunology and immunopathology.

[17]  J. Petersen,et al.  Neonatal Tolerization With Glutamic Acid Decarboxylase But Not With Bovine Serum Albumin Delays the Onset of Diabetes in NOD Mice , 1994, Diabetes.

[18]  M. Atkinson,et al.  The pathogenesis of insulin-dependent diabetes mellitus. , 1994, The New England journal of medicine.

[19]  R. Leslie,et al.  Early Environmental Events as a Cause of IDDM: Evidence and Implications , 1994, Diabetes.

[20]  H. Gerstein.  Cow's Milk Exposure and Type I Diabetes Mellitus: A critical overview of the clinical literature , 1994, Diabetes Care.

[21]  M. A. Bowman,et al.  Lack of immune responsiveness to bovine serum albumin in insulin-dependent diabetes. , 1993, The New England journal of medicine.

[22]  J. Ilonen,et al.  The case for elimination of cow's milk in early infancy in the prevention of type 1 diabetes: the Finnish experience. , 1993, Diabetes/metabolism reviews.

[23]  M. Rewers,et al.  Early Exposure to Cow's Milk and Solid Foods in Infancy, Genetic Predisposition, and Risk of IDDM , 1993, Diabetes.

[24]  K. Dahl-Jørgensen,et al.  Relationship Between Cows' Milk Consumption and Incidence of IDDM in Childhood , 1991, Diabetes Care.

[25]  D. Coleman,et al.  Effect of Diet on Incidence of Diabetes in Nonobese Diabetic Mice , 1990, Diabetes.

[26]  F. Lifshitz,et al.  Breast feeding and insulin-dependent diabetes mellitus in children. , 1986, Journal of the American College of Nutrition.

[27]  P. Beisswenger,et al.  Granuloma Annulare Secondary to Self-Monitoring of Blood Glucose , 1985, Diabetes Care.

[28]  Geir Joner,et al.  RELATION BETWEEN BREAST-FEEDING AND INCIDENCE RATES OF INSULIN-DEPENDENT DIABETES MELLITUS A Hypothesis , 1984, The Lancet.

[29]  V. Gurewich.  HÆMOSTASIS, FIBRINOLYSIS, AND DEEP-VEIN THROMBOSIS , 1973 .