Sixteen prospective cohorts from 12 countries (7 from the United States, 7 from Europe, 1 from Australia, 1 from Taiwan) performed new harmonised individual-level analysis for the prospective associations according to a standardised plan. In total, 63,682 participants with a broad range of baseline ages and BMIs and 15,180 incident cases of T2D over the average of 9 years of follow-up were evaluated.
The long-awaited result of the TRIGR Study, published in JAMA, shows that baby formula in which the cow’s milk proteins have been split does not prevent type 1 diabetes in children with genetic risk for type 1 diabetes.
Previous studies have indicated that early exposure to complex foreign proteins, such as cow’s milk proteins, increases the risk of type 1 diabetes in individuals with genetic risk for type 1 diabetes. “In 2002, we therefore embarked on a large-scale study on 2159 infants with a family member affected by type 1 diabetes and with genetic risk for type 1 diabetes to find an answer to the question whether delaying the exposure to complex foreign proteins will decrease the risk of diabetes”, says Professor Mikael Knip from the University of Helsinki, the leader of the international TRIGR Study.
The results show that in this large international randomized trial weaning to an extensively hydrolyzed casein formula during infancy did not result in a reduction in the incidence of type 1 diabetes compared to regular intact cow’s-milk-based formula after about 11.5 years of follow up. Accordingly there is no evidence to revise the current dietary recommendations for infants at high risk for type 1 diabetes.
Article: Effect of Hydrolyzed Infant Formula vs Conventional Formula on Risk of Type 1 Diabetes: The TRIGR Randomized Clinical Trial. JAMA 2018; 319: Jan 2, 2018. Writing Group for the TRIGR Study Group: Knip M, Åkerblom HK, Al Taji E, Becker D, Bruining J, Castano L, Danne T, de Beaufort C, Dosch H-M, Dupre J, Fraser WD, Howard N, Ilonen J, Konrad D, Kordonouri O, Krischer JP, Lawson ML, Ludvigsson J, Madacsy L, Mahon JL, Ormisson A, Palmer JP, Pozzilli P, Savilahti E, Serrano-Rios M, Songini M, Taback S, Vaarala O, White NH, Virtanen SM, Wasikowa R.
A report by seven researchers has concluded the milk may trigger type 1 diabetes. The researchers say:
“The evidence for milk and, particularly A1 β-casein, as a primary dietary trigger for type 1 diabetes is intriguing although causation remains unproven. The ecological evidence across populations is particularly strong. Exclusive breastfeeding is widely regarded as being protective against type 1 diabetes in early infancy, but its benefits may be lost if the mother supplements breast milk with cows’ milk formula, or if the duration of breastfeeding is too short. It is also conceivable that some dietary triggers might cross into breast milk. These factors might contribute to the inconsistencies in the reported associations between breastfeeding and type 1 diabetes.”