[PMID]: | 28687275 |
[Au] Autor: | Hyytinen M; Savilahti E; Virtanen SM; Härkönen T; Ilonen J; Luopajärvi K; Uibo R; Vaarala O; Åkerblom HK; Knip M; Finnish TRIGR Pilot Study Group |
[Ad] Endereço: | Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland. |
[Ti] Título: | Avoidance of Cow's Milk-Based Formula for At-Risk Infants Does Not Reduce Development of Celiac Disease: A Randomized Controlled Trial. |
[So] Source: | Gastroenterology;153(4):961-970.e3, 2017 Oct. |
[Is] ISSN: | 1528-0012 |
[Cp] País de publicação: | United States |
[La] Idioma: | eng |
[Ab] Resumo: | BACKGROUND & AIMS: Feeding during the first months of life might affect risk for celiac disease. Individuals with celiac disease or type 1 diabetes have been reported to have high titers of antibodies against cow's milk proteins. Avoidance of cow's milk-based formula for infants with genetic susceptibility for type 1 diabetes reduced the cumulative incidence of diabetes-associated autoantibodies. We performed a randomized controlled trial in the same population to study whether weaning to an extensively hydrolyzed formula reduced the risk of celiac disease autoimmunity or celiac disease. METHODS: We performed a double-blind controlled trial of 230 infants with HLA-defined predisposition to type 1 diabetes and at least 1 family member with type 1 diabetes. The infants were randomly assigned to groups fed a casein hydrolysate formula (n = 113) or a conventional formula (control, n = 117) whenever breast milk was not available during the first 6-8 months of life. Serum samples were collected over a median time period of 10 years and analyzed for antibodies to tissue transglutaminase (anti-TG2A) using a radiobinding assay, to endomysium using an immunofluorescence assay, and antibodies to a deamidated gliadine peptide using an immunofluorometry assay. Duodenal biopsies were collected if levels of anti-TG2A exceeded 20 relative units. Cow's milk antibodies were measured during the first 2 years of life. RESULTS: Of the 189 participants analyzed for anti-TG2A, 25 (13.2%) tested positive. Of the 230 study participants observed, 10 (4.3%) were diagnosed with celiac disease. We did not find any significant differences at the cumulative incidence of anti-TG2A positivity (hazard ratio, 1.14; 95% confidence interval, 0.51-2.54) or celiac disease (hazard ratio, 4.13; 95% confidence interval, 0.81-21.02) between the casein hydrolysate and cow's milk groups. Children who developed celiac disease had increased titers of cow's milk antibodies before the appearance of anti-TG2A or celiac disease. CONCLUSIONS: In a randomized controlled trial of 230 infants with genetic risk factors for celiac disease, we did not find evidence that weaning to a diet of extensively hydrolyzed formula compared with cow's milk-based formula would decrease the risk for celiac disease later in life. Increased titers of cow's milk antibody before anti-TG2A and celiac disease indicates that subjects with celiac disease might have increased intestinal permeability in early life. ClinicalTrials.gov Number: NCT00570102. |
[Mh] Termos MeSH primário: |
Autoanticorpos/sangue Autoimunidade Caseínas/uso terapêutico Doença Celíaca/prevenção & controle Diabetes Mellitus Tipo 1/imunologia Proteínas de Ligação ao GTP/imunologia Fórmulas Infantis/efeitos adversos Hipersensibilidade a Leite/prevenção & controle Proteínas do Leite/efeitos adversos Transglutaminases/imunologia
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[Mh] Termos MeSH secundário: |
Biópsia Caseínas/efeitos adversos Caseínas/imunologia Doença Celíaca/diagnóstico Doença Celíaca/imunologia Criança Pré-Escolar Diabetes Mellitus Tipo 1/sangue Diabetes Mellitus Tipo 1/diagnóstico Diabetes Mellitus Tipo 1/genética Método Duplo-Cego Duodeno/imunologia Duodeno/patologia Finlândia Gliadina/imunologia Seres Humanos Lactente Hipersensibilidade a Leite/diagnóstico Hipersensibilidade a Leite/imunologia Proteínas do Leite/imunologia Medição de Risco Fatores de Risco Testes Sorológicos Fatores de Tempo Resultado do Tratamento
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[Pt] Tipo de publicação: | JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL |
[Nm] Nome de substância:
| 0 (Autoantibodies); 0 (Caseins); 0 (Milk Proteins); 65072-00-6 (casein hydrolysate); 9007-90-3 (Gliadin); EC 2.3.2.- (transglutaminase 2); EC 2.3.2.13 (Transglutaminases); EC 3.6.1.- (GTP-Binding Proteins) |
[Em] Mês de entrada: | 1710 |
[Cu] Atualização por classe: | 171016 |
[Lr] Data última revisão:
| 171016 |
[Sb] Subgrupo de revista: | AIM; IM |
[Da] Data de entrada para processamento: | 170709 |
[St] Status: | MEDLINE |
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