STUDY: Infants who consume grain products before the age of three months are most at risk of having pancreas damage and becoming diabetic.

JOURNAL: Journal of the American Medical Association (2003;290:1713–28)

AUTHORS:

ABSTRACT: Introducing grains early in infants’ diets may increase their risk of developing childhood-onset diabetes (type 1 or insulin-dependent diabetes mellitus), according to two separate studies in Journal of the American Medical Association (2003;290:1713–28).

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These findings suggest that infants who consume grain products before the age of three months are most at risk of having pancreas damage and becoming diabetic.

COMMENTARY: In the first new study, 1,183 children at increased risk of developing IDDM (born to at least one parent with IDDM or a carrier of a gene that predisposes to IDDM) were followed for an average of four years. Information on the infant’s diet was collected every three months for 15 months, including the dates foods were introduced, frequency of exposure to various foods, and types of foods consumed. Blood samples were collected periodically to measure antibodies that attack the pancreas.

Infants exposed to any grains before the age of four months or after the age of six months had a higher risk of developing antibodies to the pancreas compared with children who were introduced to grains between the ages of four and six months.

This suggests that there may be an optimal window to introduce grain products without increasing IDDM risk. Several studies have found an association between IDDM and early consumption of gluten, a protein found primarily in wheat, oats, rye, and barley.

As a result, some physicians have recommended rice-based cereals instead. However, no significant difference was observed between gluten and rice grain products, suggesting that introducing any grains outside of the two-month window may increase IDDM risk.

In the second new study, 1,610 children born of IDDM parents were followed for up to 11 years. Dietary questionnaires were taken at birth, at age nine months, and at 2, 5, 8 and 11 years. In addition to measuring antibodies to the pancreas, other tests to evaluate gluten sensitivity were also performed, since some studies suggest an association between IDDM and gluten sensitivity (celiac disease).

Antibody production against cells in the pancreas was significantly increased in children who were fed gluten-containing foods in their first three months of life. However, no significant rise in antibodies against the pancreas occurred when children received gluten after six months.

Although the timing of introducing grains into an infant’s diet continues to be debated among physicians, both new studies showed that feeding grains to a child under the age of three months may increase the risk of IDDM. No increase in risk was observed in children who were breast-fed or formula fed, suggesting these may be the best food sources early in life.