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Cow’s milk consumption, disease‐associated autoantibodies and Type 1 diabetes mellitus: a follow‐up study in siblings of diabetic children

Evidence from case–control studies for the diabetogenicity of introduction of cow’s milk‐based formulas at early age in infancy is inconclusive. We followed siblings of children with Type 1 diabetes mellitus (Type 1 DM) to investigate a possible relationship between cow’s milk consumption during infancy or later in childhood and the emergence of diabetes‐associated autoantibodies and progression to clinical Type 1 DM. A cohort of 725 initially unaffected 0 to 25‐year‐old siblings of 801 index children with Type 1 DM diagnosed in 1986–1989 participated in the study (82 % of those invited). The siblings were observed for Type 1 DM associated autoantibodies at intervals of 3–12 months for 4 years, starting from the diagnosis of Type 1 DM in the index child. The follow‐up for Type 1 DM started at the same time and ended on 31 October 1995. The combined prevalence of Type 1 DM associated autoantibodies (islet cell antibodies (ICA), insulin autoantibodies (IAA), GAD autoantibodies (GADA), and/or antibodies to the insulinoma associated cDNA2 protein (IA‐2A)) was 13.6 % (95/697) at the beginning of the study. Of the initially seronegative siblings, 7.5 % (45/602) converted to antibody positivity during 4 years, and of all siblings 4.6 % (33/725) developed Type 1 DM during the total follow‐up time. The age at introduction of supplementary milk feeding was not significantly related to seroconversion to positivity for Type 1 DM associated autoantibodies or to the development of Type 1 DM in the siblings. When adjusted for age, sex, infant feeding patterns, and maternal age and education, high milk consumption in childhood (≥3 glasses daily) was associated with more frequent emergence of Type 1 DM‐associated autoantibodies than low consumption (<3 glasses daily) (adjusted odds ratio 3.97, 95 % confidence interval 1.3–11.7, p = 0.01). There was a non‐significant association between high milk consumption and progression to clinical Type 1 DM (adjusted hazard ratio 2.75, 95 % confidence interval 0.9–8.4, p = 0.07). To conclude, this study suggests that high consumption of cow’s milk during childhood may be associated both with seroconversion to positivity for diabetes‐associated autoantibodies and progression to clinical Type 1 DM among siblings of children with diabetes. © 1998 John Wiley & Sons, Ltd.