Association of Early Exposure of Probiotics and Islet Autoimmunity in the TEDDY Study | Complementary and Alternative Medicine | JAMA Pediatrics | JAMA Network
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    Infants at Risk of Type 1 Diabetes Maybe Not Only Benefit from Early Probiotics
    Li Peng,Jiaqing Shao | Department of Endocrinology, Jinling Hospital/Nanjing General Hospital of Nanjing Military Command
    Type 1 diabetes is the most frequent autoimmune disease in childhood, leading to disability and even mortality in young adults. The gut immune system play an important role in the development of type 1 diabetes, because that factors control the gut immune system are also regulators of beta-cell autoimmunity. This article found infants at risk of type 1 diabetes benefit from early probiotics influencing the gut microbiota. As we know, human milk contains substances that promote the maturation of the immune system and also influence the gut microbiota, which protect against the onset of type 1 diabetes. Influencing the gut microbiota might be more effective very early in life, before a robust microbiome is established, due to the effect of probiotic exposure or breastfeeding. In this article, the author did not find statistically significant difference between children gave with exclusive breastfeeding at least 3 month or not. Maybe children gave with exclusive breastfeeding during the first 27 days of life or not should also analyze with early exposure to probiotics.
    CONFLICT OF INTEREST: None Reported
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    Original Investigation
    January 2016

    Association of Early Exposure of Probiotics and Islet Autoimmunity in the TEDDY Study

    Author Affiliations
    • 1Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa
    • 2Department of Clinical Sciences, Lund University, Malmö, Sweden
    • 3Institute of Diabetes Research, Helmholtz Zentrum München and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München and Forschergruppe Diabetes e.V., Munich, Germany
    • 4Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora
    • 5Pacific Northwest Diabetes Research Institute, Seattle, Washington
    • 6Medical College of Georgia, Georgia Regents University, Augusta
    • 7Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
    • 8Department of Physiology, Institute of Biomedicine, University of Turku, Turku, Finland
    • 9National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
    • 10Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora
    • 11National Institute for Health and Welfare, Nutrition Unit, Helsinki, Finland
    • 12School of Health Sciences and Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
    • 13The Science Center of Pirkanmaa Hospital District, Tampere, Finland
    JAMA Pediatr. 2016;170(1):20-28. doi:10.1001/jamapediatrics.2015.2757
    Abstract

    Importance  Probiotics have been hypothesized to affect immunologic responses to environmental exposures by supporting healthy gut microbiota and could therefore theoretically be used to prevent the development of type 1 diabetes mellitus (T1DM)–associated islet autoimmunity.

    Objective  To examine the association between supplemental probiotic use during the first year of life and islet autoimmunity among children at increased genetic risk of T1DM.

    Design, Setting, and Participants  In this ongoing prospective cohort study that started September 1, 2004, children from 6 clinical centers, 3 in the United States (Colorado, Georgia/Florida, and Washington) and 3 in Europe (Finland, Germany, and Sweden), were followed up for T1DM-related autoantibodies. Blood samples were collected every 3 months between 3 and 48 months of age and every 6 months thereafter to determine persistent islet autoimmunity. Details of infant feeding, including probiotic supplementation and infant formula use, were monitored from birth using questionnaires and diaries. We applied time-to-event analysis to study the association between probiotic use and islet autoimmunity, stratifying by country and adjusting for family history of type 1 diabetes, HLA-DR-DQ genotypes, sex, birth order, mode of delivery, exclusive breastfeeding, birth year, child’s antibiotic use, and diarrheal history, as well as maternal age, probiotic use, and smoking. Altogether 8676 infants with an eligible genotype were enrolled in the follow-up study before the age of 4 months. The final sample consisted of 7473 children with the age range of 4 to 10 years (as of October 31, 2014).

    Exposures  Early intake of probiotics.

    Main Outcomes and Measures  Islet autoimmunity revealed by specific islet autoantibodies.

    Results  Early probiotic supplementation (at the age of 0-27 days) was associated with a decreased risk of islet autoimmunity when compared with probiotic supplementation after 27 days or no probiotic supplementation (hazard ratio [HR], 0.66; 95% CI, 0.46-0.94). The association was accounted for by children with the DR3/4 genotype (HR, 0.40; 95% CI, 0.21-0.74) and was absent among other genotypes (HR, 0.97; 95% CI, 0.62-1.54).

    Conclusions and Relevance  Early probiotic supplementation may reduce the risk of islet autoimmunity in children at the highest genetic risk of T1DM. The result needs to be confirmed in further studies before any recommendation of probiotics use is made.

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