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El momento de la exposición inicial a los cereales en la infancia y el riesgo de autoinmunidad insular
Jill M Norris1, Katherine Barriga, Georgeanna Klingensmith
1Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver 80262, USA. jill.norris@uchsc.edu
JAMA
|October 2, 2003
Resumen
La introducción temprana o tardía de cereales en la infancia aumenta el riesgo de autoinmunidad de islotes (IA) en niños genéticamente predispuestos a la diabetes tipo 1. El momento óptimo para la introducción de cereales puede ser entre 4-6 meses para mitigar este riesgo.
Área de la Ciencia:
- Endocrinología Pediátrica Endocrinología pediátrica.
- Inmunología Inmunología.
- Ciencias de la Nutrición Ciencias de la Nutrición
Sus antecedentes:
- Las exposiciones dietéticas infantiles están inconsistentemente vinculadas con el desarrollo de diabetes mellitus tipo 1 (DM).
- Comprender los factores dietéticos tempranos es crucial para prevenir las enfermedades autoinmunes en niños susceptibles.
Objetivo del estudio:
- Investigar la asociación entre el momento de la introducción de cereales para bebés y el inicio de la autoinmunidad de islotes (IA).
- Identificar ventanas críticas potenciales para las exposiciones dietéticas en relación con el riesgo de diabetes tipo 1.
Principales métodos:
- Estudio de cohorte de nacimiento prospectivo de 1183 bebés de alto riesgo (definido por genotipo de HLA o antecedentes familiares) de 1994-2002.
- Cribado de autoanticuerpos (insulina, GAD, IA-2) realizado a intervalos regulares hasta los 9 años de edad.
- Autoinmunidad de islotes (IA) definida por la positividad persistente de autoanticuerpos o el diagnóstico de diabetes.
Principales resultados:
- La exposición inicial a cereales entre los 0-3 meses (HR, 4.32) y a los 7+ meses (HR, 5.36) aumentó significativamente el riesgo de IA en comparación con los 4-6 meses.
- En niños positivos a HLA-DRB1*03/04, DQB8, la exposición temprana (0-3 meses) y tardía (7+ meses) a los cereales mostró riesgos de IA sustancialmente más altos (HRs 5.55 y 12.53, respectivamente).
Conclusiones:
- Puede existir una "ventana de oportunidad" específica para la introducción de cereales en la infancia.
- La introducción de cereales fuera de esta ventana aumenta el riesgo de IA en niños genéticamente susceptibles, lo que sugiere un período crítico para la intervención dietética.
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