Fish consumption and the risk of islet autoimmunity: The Environmental Determinants of Diabetes in the Young (TEDDY) Study

Background

In TEDDY fish-derived fatty acid status during childhood was inversely associated with the risk of islet autoimmunity (IA). The current study aimed to examine the association of fish consumption with the risk of IA as well as IAA only and GADA only as the first appearing autoantibody during the first 5 years of life.

Methods

TEDDY is a longitudinal cohort study of children at high genetic risk for T1DM (n=8 676) born between 2004-2010 in Germany, Finland, Sweden and the US. Food consumption was studied by 3-day food records at the age of 6, 9 and 12 months and thereafter biannually. We included 8474 subjects in the analysis, after exclusions for HLA ineligibility (n=120), indeterminate autoantibody (n=55) and missing food records (n=27). During the first 5 years of life, 542 (6.4%) children developed persistent confirmed IA, with 240 (2.8%) having IAA only and 199 (2.3%) GADA only as the first appearing autoantibody. The median (IQR) age at clinical onset was 24 (13-39) months for persistent confirmed IA, 18 (10-31) months for IAA only and 31 (18-46) months for GADA only. Time-dependent Cox proportional hazard regression was used to analyze the association with adjustment for HLA-genotype, FDR status, sex, and country (as strata).

Results

The proportion of children reported to consume fish during the 3 recording days increased from 0% at 3 months to 32% at 12 months, remaining about 40% from the age of 18 months. Fish consumption was associated with lower risk of IA (HR 0.75, 95% CI 0.61-0.93, p=0.010). In smaller subsets, fish consumption tended to reduce the risk of IAA only (HR 0.73, 95% CI 0.54-1.00, p=0.052) but not GADA only (HR 0.77, 95% CI 0.54-1.10, p=0.150) as the first appearing autoantibody.

Conclusion

Fish consumption might protect against IA in children genetically susceptible to T1DM.