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Context Cod liver oil supplements in infancy have been associated with a decreased risk of type 1 diabetes mellitus in a retrospective study. Objective To examine whether intakes of omega-3 and omega-6 fatty acids are associated with the development of islet autoimmunity (IA) in children. Design, Setting, and Participants A longitudinal, observational study, the Diabetes Autoimmunity Study in the Young (DAISY), conducted in Denver, Colorado, between January 1994 and November 2006, of 1770 children at increased risk for type 1 diabetes, defined as either possession of a high diabetes risk HLA genotype or having a sibling or parent with type 1 diabetes. The mean age at follow-up was 6.2 years. Islet autoimmunity was assessed in association with reported dietary intake of polyunsaturated fatty acids starting at age 1 year. A case-cohort study (N=244) was also conducted in which risk of IA by polyunsaturated fatty acid content of erythrocyte membranes (as a percentage of total lipids) was examined. Main Outcome Measure Risk of IA, defined as being positive for insulin, glutamic acid decarboxylase, or insulinoma-associated antigen-2 autoantibodies on 2 consecutive visits and still autoantibody positive or having diabetes at last follow-up visit. Results Fifty-eight children developed IA. Adjusting for HLA genotype, family history of type 1 diabetes, caloric intake, and omega-6 fatty acid intake, omega-3 fatty acid intake was inversely associated with risk of IA (hazard ratio [HR], 0.45; 95% confidence interval [CI], 0.21-0.96; P=.04). The association was strengthened when the definition of the outcome was limited to those positive for 2 or more autoantibodies (HR, 0.23; 95% CI, 0.09-0.58; P=.002). In the case-cohort study, omega-3 fatty acid content of erythrocyte membranes was also inversely associated with IA risk (HR, 0.63; 95% CI, 0.41-0.96; P=.03). Conclusion Dietary intake of omega-3 fatty acids is associated with reduced risk of IA in children at increased genetic risk for type 1 diabetes.

Delaying initial exposure to cereal grains until after 6 months may increase the risk of developing wheat allergy. These results do not support delaying introduction of cereal grains for the protection of food allergy.

OBJECTIVE -The objective of this study was to determine whether earlier diagnosis of diabetes in prospectively followed autoantibody-positive children lowered onset morbidity and improved the clinical course after diagnosis. RESEARCH DESIGN AND METHODS -The Diabetes Autoimmunity Study in theYoung (DAISY) follows genetically at-risk children for the development of diabetes. Increased genetic risk is identified by family history of type 1 diabetes or expression of diabetes-associated HLA genotypes. Of the 2,140 prospectively followed children, 112 have developed islet autoantibodies and 30 have progressed to diabetes. Diabetes onset characteristics and early clinical course of these 30 children followed to diabetes were compared with those of 101 age-and sex-matched children concurrently diagnosed with diabetes in the community.RESULTS -Pre-diabetic children followed to diabetes were less often hospitalized than the community cases (3.3 vs. 44%; P Ͻ 0.0001). They had a lower mean HbA 1c at onset (7.2 vs. 10.9%; P Ͻ 0.0001) and 1 month after diagnosis (6.9 vs. 8.6%; P Ͻ 0.0001) but not after 6 months of diabetes. The mean insulin dose was lower in the DAISY group at 1 (0.30 vs. 0.51 U ⅐ kg Ϫ1 ⅐ day Ϫ1; P ϭ 0.003), 6 (0.37 vs. 0.58; P ϭ 0.001), and 12 months (0.57 vs. 0.72; P ϭ 0.03). There was no difference in growth parameters between the two groups. Comparisons limited to children with a family history of type 1 diabetes in both groups showed a similar pattern.CONCLUSIONS -Childhood type 1 diabetes diagnosed through a screening and follow-up program has a less severe onset and a milder clinical course in the first year after diagnosis. Diabetes Care 27:1399 -1404, 2004T ype 1 diabetes affects ϳ15-30 million people globally and 1.4 million in the U.S. (1,2). The incidence is increasing by 3-5% per year (3,4), especially among young children (5-9). Type 1 diabetes is responsible for significant morbidity, premature mortality (10), and financial burden (11). The disease usually is preceded by a preclinical period lasting months to years. Pre-diabetes can often be detected by the presence of autoantibodies to islet antigens such as GAD65, insulin, and IA-2 that are highly predictive of type 1 diabetes risk in children with (12) and without (13) a first-degree type 1 diabetic relative.In the absence of effective prevention, screening for pre-diabetes is currently not recommended outside of research studies. To date, interventions applied after the development of islet autoantibodies have been unsuccessful in slowing progression to diabetes (14,15). Several ongoing cohort studies (16 -19) follow high-risk children from birth to determine environmental triggers of type 1 diabetes. Interventions based on avoidance of these triggers before the onset of autoimmunity could be effective in preventing type 1 diabetes.One of these projects, Diabetes Autoimmunity Study in the Young (DAISY) (16,19), intensively follows two groups of children at increased risk for the development of diabetes: young first-degree relatives and infa...

OBJECTIVE -The goal of this study was to examine whether maternal dietary intake of vitamin D, -3 fatty acids, and -6 fatty acids during pregnancy is associated with the appearance of islet autoimmunity (IA) in offspring. RESEARCH DESIGN AND METHODS -The Diabetes Autoimmunity Study in theYoung (DAISY) is recruiting at birth and following children at increased risk for type 1 diabetes, as determined by HLA-DR genotype or by family history of type 1 diabetes. A total of 233 mothers of newly recruited DAISY subjects were asked to recall their intake of food and nutritional supplements during the third trimester of pregnancy using the Willett food frequency questionnaire. Children were followed for an average of 4 years (range 0.8 -7.3 years) for the appearance of insulin, GAD 65 , and IA-2 autoantibodies. Sixteen children developed at least one autoantibody during this period. Unadjusted and adjusted hazard ratios (HRs) for the development of IA were estimated with survival analysis using a Weibull distribution.RESULTS -Maternal intake of vitamin D via food was significantly associated with a decreased risk of IA appearance in offspring, independent of HLA genotype, family history of type 1 diabetes, presence of gestational diabetes mellitus, and ethnicity (adjusted HR ϭ 0.37; 95% CI 0.17-0.78). Vitamin D intake via supplements, -3 fatty acids, and -6 fatty acids intake during pregnancy were not associated with appearance of IA in offspring.CONCLUSIONS -Our findings suggest that maternal intake of vitamin D through food during pregnancy may have a protective effect on the appearance of IA in offspring. Diabetes Care 26:3237-3242, 2003T ype 1 diabetes is a T-cell-mediated autoimmune disease characterized by the destruction of insulinproducing ␤-cells of the pancreas. The causes of type 1 diabetes are unknown, yet low concordance rates among monozygotic twins (1), a 10% progression rate among those genetically susceptible (2), migratory studies (3), and increasing worldwide incidence rates (4) suggest that genetic factors interact with environmental factors in the development of type 1 diabetes. These environmental factors have not been clearly identified.Type 1 diabetes is preceded by a preclinical stage termed islet autoimmunity (IA) that signals the beginning of ␤-cell destruction with the presence of autoantibodies against islet autoantigens. IA appears typically by 2 years of age and sometimes as early as 3 months of age in individuals with type 1 diabetic firstdegree relatives (5-7). Autoantibodies can be persistent for months or years, often predicting clinical diagnosis, or can be transient. Transient autoantibody positivity has not been associated with genetic risk factors (7,8), suggesting that environmental factors may be involved in suppressing persistent ␤-cell destruction.Increased expression of proinflammatory cytokines may be associated with the appearance and persistence of IA (9). Vitamin D and the -3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have been shown to modify th...