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REVIEW ARTICLE |
1 From the Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki (SMV); the Tampere School of Public Health, Tampere University, Tampere, Finland (SMV); the Department of Pediatrics, Tampere University Hospital, Tampere, Finland (SMV and MK); and the Hospital for Children and Adolescents, University of Helsinki (MK).
Type 1 diabetes is an immune-mediated disease characterized by a preclinical prodrome during which ß cell autoimmunity proceeds at a variable rate. Large geographic differences and a conspicuous increase in incidence, especially among young children since the 1950s, and the relatively low concordance in identical twins are factors that favor a critical role of environmental factors in the etiology of this disease. Only 
5% or fewer subjects with HLA-conferred genetic susceptibility to type 1 diabetes actually develop the clinical disease. Breastfeeding, nicotinamide, zinc, and vitamins C, D, and E have been reported as possibly protecting against type 1 diabetes, whereas N-nitroso compounds, cow milk, increased linear growth, and obesity may increase the risk. Thus far, only the significance of infant feeding, cow milk, and vitamin D have been studied in both case-control and cohort settings. The major shortcoming of most studies done so far is that only single dietary exposures have been assessed at single time points. Putative nutritional and other confounding factors have received little attention as have the limitations of the dietary methods used. There is little firm evidence of the significance of nutritional factors in the etiology of type 1 diabetes. The availability of good markers of preclinical type 1 diabetes and of genetic risk have decreased the sample sizes needed and made longitudinal cohort studies of the assessment of children’s diets feasible.
Key Words: Type 1 diabetes • preclinical diabetes • autoimmunity • ß cell function • etiology • nutrition • growth
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