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Risk of type 1 diabetes not reduced by extensively hydrolysed cow’s milk-based formula

Rather than reducing the risk of islet autoimmunity development, use of extensively hydrolysed cow’s milk-based formula appears to be associated with increased risk compared to other formulas, particularly if this is introduced in the first 7 days of life, according to new data published by Hummel and colleagues from TEDDY (The Environmental Determinants of Diabetes in the Young) study.

By Pam Brown, Editor-in-Chief, Diabetes & Primary Care

Rather than reducing the risk of islet autoimmunity development, use of extensively hydrolysed cow’s milk-based formula appears to be associated with increased risk compared to other formulas, particularly if this is introduced in the first 7 days of life, according to new data published by Hummel and colleagues from TEDDY (The Environmental Determinants of Diabetes in the Young) study. Infant formulas containing hydrolysed cow’s milk protein are recommended for infants at increased allergy risk in some countries and these have been hypothesised to reduce the risk of developing islet autoimmunity, although previous studies have been inconsistent. 

After mean follow up of 8 years, the study demonstrated no increased risk of developing autoimmunity in those fed partially hydrolysed or non-hydrolysed formula as the first formula during the first 3 months of life, but increased risk (adjusted hazard ratio 1.57 [95% confidence intervals, 1.04–2.38]) from the extensively hydrolysed formula use in the first 7 days of life (which occurred mainly in Finland). Using a partially hydrolysed or other formula, or exclusively breast feeding during the first 7 days had no impact on risk.

Although exclusive breast feeding is recommended in all countries for infants during the first 4–6 months of life, this is not always achievable, particularly amongst new mothers with type 1 diabetes whose infants are particularly at risk of developing the disease. Around one third of the study population had been exclusively breast fed until 3 months with no data on first feed type for less than 20% of the cohort. 

TEDDY is a prospective cohort study, which follows 8676 children at increased risk of developing type 1 diabetes in the US, Germany, Finland and Sweden, by regular monitoring for islet cell autoimmunity and development of type 1 diabetes.

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