ENVIRONMENTAL-FACTORS IN CHILDHOOD IDDM - A POPULATION-BASED, CASE-CONTROL STUDY

OBJECTIVE - To identify environmental factors involved in the etiology of insulin-dependent diabetes mellitus (IDDM). RESEARCH DESIGN AND ME THODS - An estimated 90% of all incident cases of IDDM in patients 0-1 4 years of age in New South Wales, Australia, were ascertained over 18 months. For each IDDM patient, two age- and sex-matched control subje cts were randomly selected from the population. Past environmental exp osures were determined with a questionnaire completed by the parents. Response rates were 92% for the IDDM patients (217 of 235) and 55% for the control subjects (258 of 470). The relative risk associated with each exposure was estimated with the odds ratio (OR) adjusted for conf ounding factors using multiple logistic regression. RESULTS - The intr oduction of cow's milk-based infant formula into the diet before 3 mon ths of age was associated with an increased risk (OR 1.52, 95% confide nce interval [CI] 1.04-2.24). Exclusive breast-feeding for greater tha n or equal to 3 months was associated with a protective effect (OR 0.6 6, 95% CI 0.45-0.97). High dietary intake of cow's milk protein in the 12 months before the onset of diabetic symptoms was also associated w ith an increased risk (OR 1.84, 95% CI 1.12-3.00). A recent infection (during the 3 months before onset of diabetic symptoms) was more commo n in the patients than the control subjects (OR 2.92, 95% CI 1.96-4.35 ), as was day care attendance before the age of 3 (OR 1.73, 95% CI 1.0 0-3.00). When two age-groups, defined by the median age at onset of di abetes, were compared, the associations with early infant-feeding were stronger among the younger group (<9.2 years), and associations with recent diet and recent infection were stronger among the older group ( <9.2 years). CONCLUSIONS - These results indicate an increased risk of IDDM associated with early dietary exposure to cow's milk-containing formula, short duration of exclusive breast-feeding, high intake of co w's milk protein in the recent diet, recent infection, and early atten dance at day care.