A Meta-Analysis of Infant Diet and Insulin-Dependent Diabetes Mellitus: Do Biases Play a Role?

We evaluated the relation between early infant diet and insulin-dependent diabetes risk with a meta-analysis of 17 case-control studies. A summary of all studies indicated a moderate effect for exposure to breast-milk substitutes [odds ratio (OR) = 1.38; 95% confidence interval (CI) = 1.18-1.61] and...

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Bibliographic Details
Published in:Epidemiology (Cambridge, Mass.) Mass.), 1996-01, Vol.7 (1), p.87-92
Main Authors: Norris, Jill M., Scott, Fraser W.
Format: Article
Language:English
Subjects:
Australia
Bias
Biological and medical sciences
Breast Feeding
Breastfeeding
Case control studies
Childhood
Cows milk
Diabetes mellitus
Diabetes Mellitus, Type 1 - epidemiology
Diabetes. Impaired glucose tolerance
Diet
Diet records
Endocrine pancreas. Apud cells (diseases)
Endocrinopathies
Epidemiology
Etiopathogenesis. Screening. Investigations. Target tissue resistance
Europe
Humans
Infant
Infant Food
Infant, Newborn
Medical sciences
Mental Recall
North America
Odds Ratio
Response rates
Review
Time Factors
Type 1 diabetes mellitus
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Summary:We evaluated the relation between early infant diet and insulin-dependent diabetes risk with a meta-analysis of 17 case-control studies. A summary of all studies indicated a moderate effect for exposure to breast-milk substitutes [odds ratio (OR) = 1.38; 95% confidence interval (CI) = 1.18-1.61] and cow's milk-based substitutes (OR = 1.61; 95% CI = 1.31-1.98) before 3 months of age. Fourteen studies relied on retrospectively collected infant diet data based on long-term maternal recall, which may be biased or inaccurate; three studies used existing infant diet records to assess exposure, thus lessening the possibility of recall bias or inaccurate data. The studies using existing records demonstrated little association compared with the studies relying on long-term recall. Studies in which the controls had a participation rate that was more than 20% lower than that of the cases showed a stronger diabetogenic effect of never being breast-fed (OR = 1.58) than studies whose cases and controls had similar participation rates (OR = 1.06). Thus, differences in the participation rates of cases and controls may have biased the results of these studies. This meta-analysis indicates that the weak association between infant diet and risk of diabetes mellitus may have methodologic explanations.
ISSN:1044-3983
1531-5487
DOI:10.1097/00001648-199601000-00015