Unit 2: Health Effects of Complementary Feeding

Type 1 Diabetes Mellitus (T1DM) is caused by a destructive autoimmune process that destroys insulin producing pancreatic islet cells and causes hyperglycaemia.

The European Food Safety Authority reported in 2009 that

“some studies found an association between T1DM and short duration of breastfeeding and introduction of solid food, soy milk formulas, gluten and wheat consumption at a young age.”
(EFSA Panel on Dietetic Products Nutrition and Allergies (NDA) 2009)

Furthermore, the risk of T1DM has been found to be associated with the time of gluten introduction into the infant’s diet (Hummel & Ziegler 2011).

A large prospective study (DAISY study) revealed that infants who were introduced to gluten containing cereals in the first 3 months or at 7 months or older, compared to introduction at 4-6 months had an increased risk for the development of islet cell auto antibodies (HR: 4.32; 95% CI:2.0 to 9.35 and HR: 5.36; 95% CI: 2.08 to13.8, respectively). However this risk was slightly but significantly reduced if infants were still being breast fed when cereals were introduced (HR: 0.5; 95% CI: 0.25-0.99) (Norris et al. 2003).

In support of the DAISY study, the BABYDIAB study conducted in Germany found that the risk of developing T1DM auto antibodies also increased when gluten containing foods were introduced in the first 3 months compared to those only breast fed (HR: 4.0; 95% CI:1.4 to 11.5). However this study found that this was not the case if gluten was introduced after 6 months (Ziegler et al. 2003).

Cow’s milk
Some studies have found an association between the early introduction of cow’s milk and the development of  T1DM. However, this association is not observed in all studies (Thorsdottir & Thorisdottir 2011). The hypothesis that cows' milk may contain a triggering factor for the development of T1DM which appeared from observational studies and two meta-analyses of case-control studies has not been confirmed by further studies (Przyrembel 2012). Finally, a systematic review by Patelarou et al. (2012) did not find an association between the early introduction of cow’s milk and the risk of TIDM (Patelarou et al. 2012).