Early nutrition represents one of the first environmental determinants to which an infant is exposed. Accordingly one should search among early exposures for those exogenous factors that trigger and drive the disease process. Although no specific dietary factor or nutrient in infancy has so far been shown to unequivocally play a role in the development of T1D, there are data that indicate that dietary components may be risk factors that predispose to or protect against T1D.
Most notably, variations in the human leukocyte antigen (HLA) region located on chromosome 6 may account for more than 50% of familial aggregation in T1D. The two haplotypes DR4-DQ8 and DR3-DQ2 are of particular relevance, due to the very high frequency of these haplotypes in children with T1D. The greatest risk arises when both haplotypes are present in the same individual (Todd, 2005).
This study was conducted on 45 subjects with 21 control{group I} and 24 type 1 DM patients{group II} each of which was divided into two subgroups : Ia { control with exclusive breast feeding; n=11 }, Ib{ control with non exclusive breast feeding; n= 10}, IIa{ diabetic with exclusive breast feeding; n= 12} and group IIb{ diabetic with non exclusive breast feeding ; n= 12} .
They were subjected to detailed history taking especially dietetic history during the first year of life, clinical examination and investigation in the form of thyroid function (TSH, T4), liver function {SGPT}, kidney function {creatinine, and microalbumin in urine}, serum triglycerides, cholesterol and HLA typing for (HLADRB1 and HLADQB1).
This study was aiming to investigate children with type 1DM to evaluate the appearance of HLA –DRB1 and HLA –DQB1 as risk factors to T1D, and their relation to early feeding pattern (either milk or food) especially during first year of life.
The results found by this study are:
The early introduction of cow’s milk antigens could be a risk factor for T1D. While bottled cow’s milk, which is fortified with Vitamin D, could be associated with reduced risk of type 1 diabetes, similar to Vitamin D supplementation.
Vegetable intake, store brand formula, carbohydrate diet and soya based formula at 4–6 months of age was associated with increased risk of T1D, while steamed bread formula may be protective but after the first six months of age .
Both HLA-DRB1 0302 and HLA-DRB1 0401 were the most significant risk alleles of T1D in this study, while role of HLADRB1 0301, 0402, and HLADQB1*02 alleles needs further studies.
There was significant relation between HLADRB1 0302, and HLADQB1 *02 susceptibility risk and cow milk predisposing effect.
Exclusive breast feeding during the first six months of age delays onset of T1D among the susceptible children and decrease (not statistically significant) frequency of diabetic ketoacidosis (DKA).
In the exclusively breastfed the most commonly encountered allele was the HLADRB1*0302. Also with infants exposed to early raw cow's milk the most commonly occurring susceptible alleles were HLADRB1*0302 and HLADRB1*0301. In contrast, infants exposed to manufactured infant milk formula (IMF) feeds showed detection rates for all the susceptibility alleles studied HLADRB1 0301, HLADRB1 0302, HLADRB1 0401and HLADRB1 0402, although these were not detected in the controls who were formula fed.
This means that even if an infant has susceptible genes, exclusive breastfeeding will protect against development of the disease provided the protective genes are also present.
Regarding complications of T1D and relation to feeding pattern their was significant higher percentage of teeth decay and fundus changes both in the mixed feed and the artificially feed diabetic groups more than exclusively feed diabetic group , but no effect in both level of blood HBA1C and urine micro albumin levels .
In conclusion early infant feeding play an important role in the genetic and phenotypic expression of TID, Early exposure to cow’s milk and cereal manufactured and processed brands probably modulate gene expression amplifying their effect and increasing susceptibility to the disease. They may also cross react with other genes augment the presentation of the disease and worsening its course and hastening progress and complications. So exclusive breast feeding during the first 6th months of age protect siblings of children with type 1 diabetes how are genetically susceptible.
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