INFANTS DIETS AND INSULIN-DEPENDENT DIABETES - EVALUATING THE COWS MILK HYPOTHESIS AND A ROLE FOR ANTI-BOVINE SERUM-ALBUMIN IMMUNITY

Insulin-Dependent Diabetes (IDD) results from an autoimmune destructio n of the insulin secreting pancreatic beta cells. The immunological me chanisms underlying the development of IDD as well as the role of envi ronmental agents (e.g., diet, viruses, stress) in the pathogenesis of the disease are the subject of considerable research efforts. Signific ant attention has recently been directed to a hypothesis that consumpt ion of cows' milk in infancy may trigger the autoimmune process underl ying IDD. Early evidence supporting this ''cows' milk hypothesis'' inc luded case-control studies surveying infant nutrition practices (i.e., breast feeding versus consumption of infant formula) and the subseque nt development of IDD. However, intense media interest surrounding a r eport indicating anti-bovine serum albumin (BSA) immunity as the cause of IDD has lead to heightened public awareness of the issue and, toge ther with the epidemiological data, prompted The American Academy of P ediatrics to modify its guidelines for infant feeding practices. Howev er, less public and scientific attention has been given toward the obs ervations that many of these case-control studies were retrospective i n design and subject to recall bias, narrow in scope in terms of colle cting dietary information, and that similar results have not been dupl icated in other more recent (and better designed) investigations. Furt hermore, the immunological report implicating anti-BSA immunity with t he disease has become controversial due to difficulties in confirming the findings, and experiments in animal models closely resembling huma n IDD have not uniformly supported a role for anti-BSA immunity in the pathogenesis of TDD. Given the significant morbidity and mortality as sociated with TTD, an improved understanding of the cause of this diso rder as well as identifying possible methods for its prevention are es sential. However, without additional supporting information, modificat ion of the cows' milk/BSA composition of diets in order to avoid the d isease may be premature. Further studies are needed to clearly establi sh a role for diet in the pathogenesis of DDD.