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14 September 1996

Follow-Up to Cow's Milk Not Linked to Type 1 Diabetes Report

We received an e-mail from a reader expressing concern about the report regarding cow's milk not being linked to Type 1 diabetes. The reader felt that the report was only one of 90 related to cow's milk and diabetes risk, and that the other reports showed a link. Further, the reader felt that parents should not base a decision on whether or not to feed infants milk-based formula on this report alone.

Reply by Dr. Jill Norris

We appreciate the comments and concerns raised regarding the Cow's Milk Not Linked to Type 1 Diabetes report of our study on cow's milk and beta-cell autoimmunity.

There was a concern that our study is only "one study out of 90." We assume that this number came from the American Academy of Pediatrics Work Group on Cow's Milk Protein and Diabetes Mellitus Report (Pediatrics 1994;94:752-754), that had reviewed 90 articles. Firstly, as stated in the work group report, the 90 articles (not studies) reviewed were mixed in their support of the "cow's milk hypothesis." Furthermore, there are actually very few studies that specifically looked at whether cow's milk protein exposure increased risk of diabetes in children. For example, the American Academy of Pediatrics Work Group Report drew heavily from the Gerstein meta-analysis (Diabetes Care 1994;17:13-19), which based its conclusions on 2 studies (published in 3 articles) about cow's milk protein exposure and diabetes in children.

Another concern was that all sides of the story were not presented in the Cow's Milk Not Linked to Type 1 Diabetes report. Neither the report, nor the JAMA article, was meant to be a review of the existing literature. There are several excellent and balanced reviews concerning this topic. Our purpose was to report the results of one study.

The report was a copy of a statement made to the press when the study was published. We apologize that the report did not offer all of the information contained in the journal article. As stated in the JAMA article, 3 of the 18 cases of beta-cell autoimmunity (17%) had been exposed to cow's milk protein by the age of 3 months. This was compared to the children without beta-cell autoimmunity, of whom 36% had been exposed to cow's milk protein by 3 months of age. We hope this is helpful.

Finally, neither the report nor the JAMA article was meant to offer recommendations about infant feeding practices. Any recommendations should be discussed with one's pediatrician. We fully agree with the concerns about people changing their behavior based on one report. It would be unwise for couples to make decisions about infant feeding practices without first discussing them with their pediatrician, who can assimilate the current research, and discuss options with the couple in a fully informed manner. Therefore, it is just as important to report the results of a study showing that there is no association between cow's milk and beta-cell autoimmunity as it was for the previous investigators to report the results of their studies showing that there was an association between cow's milk and diabetes. Only this way can pediatricians make fully-informed recommendations to their patients.

Dr. Jill M. Norris
Assistant Professor, Department of Preventive Medicine and Biometrics
University of Colorado Health Sciences Center

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