Weight gain in early life predicts risk of islet autoimmunity in children with a first-degree relative with type 1 diabetes

OBJECTIVE — In a prospective birth cohort study, we followed infants who had a first-degree relative with type 1 diabetes to investigate the relationship between early growth and infant feeding and the risk of islet autoimmunity. RESEARCH DESIGNANDMETHODS — Infants with a first-degree relative with type 1 diabetes were identified during their mother’s pregnancy. Dietary intake was recorded pro-spectively to determine duration of breast-feeding and age at introduction of cow’s milk protein, cereals, meat, fruit, and vegetables. At 6-month reviews, length (or height) and weight, antibod-ies to insulin, GAD65, the tyrosine phosphatase-like insulinoma antigen, and tissue transglu-taminase were measured. Islet autoimmunity was defined as persistent elevation of one or more islet antibodies at consecutive 6-month intervals, including the most recent measure, and was the primary outcome measure. RESULTS — Follow-up of 548 subjects for 5.7 3.2 years identified 46 children with islet autoimmunity. Weight z score and BMI z score were continuous predictors of risk of islet autoimmunity (adjusted hazard ratios 1.43 [95 % CI 1.10–1.84], P 0.007, and 1.29 [1.01– 1.67], P 0.04, respectively). The risk of islet autoimmunity was greater in subjects with weigh