Maternal dietary supplement use and development of islet autoimmunity in the offspring: TEDDY study

Abstract

Objective We investigated the association between maternal use of vitamin D and omega‐3 fatty acids (n‐3 FAs) supplements during pregnancy and risk of islet autoimmunity (IA) in the offspring. Methods The Environmental Determinants of Diabetes in the Young (TEDDY) Study is prospectively following 8676 children with increased genetic risk for type 1 diabetes in Finland, Germany, Sweden, and the United States. Blood samples were collected every 3 months between 3 and 48 months of age then every 6 months thereafter to determine persistent IA. Duration, frequency, and supplement dose during pregnancy were recalled by mothers at 3 to 4 months postpartum. Cumulative intakes of supplemental vitamin D and n‐3 FAs were analyzed as continuous or binary variables. We applied time‐to‐event analysis to study the association between maternal supplement use and IA, adjusting for country, human leukocyte antigen‐DR‐DQ genotype, family history of type 1 diabetes and sex. Secondary outcomes included insulin autoantibodies (IAA) or glutamic acid decarboxylase (GADA) as the first appearing autoantibody. Results As of February 2018, there were 747 (9.0%) children with IA. Vitamin D supplement intake during pregnancy (any vs none) was not associated with risk for IA (hazard ratio [HR] 1.11; 95% confidence interval [CI] 0.94, 1.31); neither was cumulative vitamin D supplement intake. Supplemental n‐3 FA intake was similarly not associated with IA risk (HR: 1.19, 95% CI 0.98, 1.45). Similar lack of association was observed for either IAA or GADA as the first appearing autoantibody. Conclusions The TEDDY cohort showed no evidence of benefit regarding IA risk for vitamin D or n‐3 FA supplementation during pregnancy.

Type 1 diabetes—early life origins and changing epidemiology

“…Vitamin D intake during pregnancy was not associated with risk of islet autoimmunity in the offspring, and childhood vitamin D intake was not associated with risk of islet autoimmunity or progression to type 1 diabetes. [60][61][62] A more relevant measure of vitamin D exposure could be circulating 25-hydroxyvitamin D (25(OH)D), which is determined by dietary intake and sun exposure of the skin, and reflects a person's vitamin D status. Numerous prospective studies have shown that there is no major association between serum 25(OH)D concentration in pregnancy [63][64][65][66] and at birth, [65][66][67][68][69] and the development of islet autoimmunity or type 1 diabetes in the child.…”

Autoimmune thyroid disease and type 1 diabetes mellitus: same pathogenesis; new perspective?

“… 200 These results are in agreement with a Swedish study, 201 and the recently published Environmental Determinants of Diabetes in the Young (TEDDY) study. 202 However, it may be difficult to control the factors that have led to different results, such as diet and additional environmental determinants. 203 – 206 …”

Vitamin D Deficiency and Diabetes Mellitus

“…However, some other studies have not demonstrated a beneficial effect of VD supplementation in preventing/improving the course of T1D or its complications. The prospective Environmental Determinants of Diabetes in the Young (TEDDY) Study demonstrated no benefit of maternal VD supplementation during pregnancy on the risk of islet autoimmunity in the offspring [49]. According to the review [32], there was no beneficial impact of VD supplementation on β-cell function, HbA1c levels, or insulin requirement.…”