Dietary Intervention in Infancy and Later Signs of Beta-Cell Autoimmunity.
Dietary Intervention in Infancy and Later Signs of Beta-Cell Autoimmunity.
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DOI：
10.1056/nejmoa1004809
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发表时间：
2010-11-11
影响因子：
158.5
通讯作者：
Akerblom, Hans K.
中科院分区：
文献类型：
--
作者：
Knip, Mikael;Virtanen, Suvi M.;Akerblom, Hans K.
背景资料：早期暴露于复杂的膳食蛋白质可能会增加β细胞自身免疫和1型糖尿病的遗传易感性儿童的风险。我们检验了这样一个假设，即在母乳中添加高度水解的配方奶粉会降低这些儿童中糖尿病相关自身抗体的累积发生率。在这项双盲随机试验中，我们将230名具有HLA赋予的1型糖尿病易感性且至少有一名1型糖尿病家庭成员的婴儿分配给酪蛋白水解物配方奶粉或常规配方奶粉，在婴儿出生后的前6至8个月内，如果无法获得母乳，则喂养以牛奶为基础的配方奶粉（对照组）。在中位观察期10年（平均7.5年）内，使用放射结合试验分析胰岛素、谷氨酸脱羧酶（GAD）、胰岛素瘤相关2分子（IA-2）和锌转运蛋白8的自身抗体，并使用免疫荧光分析胰岛细胞抗体。这些儿童在10岁之前都要接受1型糖尿病的监测。与对照组相比，酪蛋白水解物组中一种或多种自身抗体阳性的未调整风险比为0.54（95%置信区间[CI]，0.29至0.95），根据观察到的暴露于研究配方的持续时间差异调整的风险比为0.51（95%CI，0.28至0.91）。两种或多种自身抗体阳性的未校正风险比为0.52（95% CI，0.21至1.17），校正风险比为0.47（95% CI，0.19至1.07）。报告的不良事件的发生率在两个groups.Conclusions：在婴儿期的饮食干预似乎有一个持久的影响β细胞自身免疫标记-标记，可能反映自身免疫过程导致1型糖尿病。（由欧盟委员会和其他机构资助; ClinicalTrials.gov编号，NCT 00570102。新英格兰医学杂志2010;363：1900-8。
Background: Early exposure to complex dietary proteins may increase the risk of beta-cell autoimmunity and type 1 diabetes in children with genetic susceptibility. We tested the hypothesis that supplementing breast milk with highly hydrolyzed milk formula would decrease the cumulative incidence of diabetes-associated autoantibodies in such children.Methods: In this double-blind, randomized trial, we assigned 230 infants with HLA-conferred susceptibility to type 1 diabetes and at least one family member with type 1 diabetes to receive either a casein hydrolysate formula or a conventional, cow's-milk-based formula (control) whenever breast milk was not available during the first 6 to 8 months of life. Autoantibodies to insulin, glutamic acid decarboxylase (GAD), the insulinoma-associated 2 molecule (IA-2), and zinc transporter 8 were analyzed with the use of radiobinding assays, and islet-cell antibodies were analyzed with the use of immunofluorescence, during a median observation period of 10 years (mean, 7.5). The children were monitored for incident type 1 diabetes until they were 10 years of age.Results: The unadjusted hazard ratio for positivity for one or more autoantibodies in the casein hydrolysate group, as compared with the control group, was 0.54 (95% confidence interval [CI], 0.29 to 0.95), and the hazard ratio adjusted for an observed difference in the duration of exposure to the study formula was 0.51 (95% CI, 0.28 to 0.91). The unadjusted hazard ratio for positivity for two or more autoantibodies was 0.52 (95% CI, 0.21 to 1.17), and the adjusted hazard ratio was 0.47 (95% CI, 0.19 to 1.07). The rate of reported adverse events was similar in the two groups.Conclusions: Dietary intervention during infancy appears to have a long-lasting effect on markers of beta-cell autoimmunity -- markers that may reflect an autoimmune process leading to type 1 diabetes. (Funded by the European Commission and others; ClinicalTrials.gov number, NCT00570102.)N Engl J Med 2010;363:1900-8.