Infant nutrition and development of type 1 diabetes – is it possible to prevent the disease by splitting the cow’s milk proteins in baby formula?

A large international study shows that splitting the cow’s milk proteins in baby formula does not prevent the initiation of the disease process of type 1 diabetes in predisposed children. However, these results do not exclude the possibility that the early dietary modification may affect the later phase in the disease process and so prevent progression to actual illness. – We can answer this question after some years, says Professor Mikael Knip form the University of Helsinki, Finland.

Previous studies have indicated that early exposure to complex foreign proteins, such as cow’s milk proteins, increases the risk of type 1 diabetes in predisposed individuals. “In 2002, we therefore embarked on a large-scale study in more than 2100 infants with a family member affected by type 1 diabetes and with genetic disease susceptibility to find an answer to the question whether delaying the exposure to complex foreign proteins will decrease the risk of diabetes”, tells Professor Mikael Knip from the University of Helsinki, the leader of the TRIGR Study.

After breastfeeding the study participants were either weaned to a special formula, where the cow’s milk proteins were split into small peptides, or a conventional infant formula with intact cow’s milk proteins. The first study endpoint was positivity for at least two diabetes-associated autoantibodies by the age of six years.

The results show that there was no difference in the appearance of autoantibodies between the two study groups. However, the disease process resulting in clinical diabetes has clearly two phases, the first being the appearance of autoantibodies and the other the progression from autoantibody positivity to clinical disease.

“The current results do not exclude the possibility that the early dietary modification may affect the latter phase, and therefore it is extremely important to continue to follow the study participants to the final endpoint, which is clinical diabetes by the age of ten years. That endpoint will be reached in 2017”, Professor Knip states.

The study is mainly funded by the National Institutes of Health (NIH) and the Canadian Institutes of Health Research (CIHR).

Article: Knip M, Akerblom HK, Becker D, Dosch HM, Dupre J, Fraser W, Howard N, Ilonen J, Krischer JP, Kordonouri O, Lawson ML, Palmer JP, Savilahti E, Vaarala O, Virtanen SM for the TRIGR Study Group. Hydrolyzed infant formula and early β-cell autoimmunity – A randomized clinical trial. JAMA 2014; 311(22): 2279-87. doi:10.1001/jama.2014.5610.