Omega-3 fatty-acid intake reduces the risk of islet autoimmunity in children at high risk for diabetes

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Omega-3 fatty-acid intake reduces the risk of islet autoimmunity in children at high risk for diabetes

September 25, 2007 Michael O'Riordan

Denver, CO - Could supplementing the diets of children at high risk for type 1 diabetes with polyunsaturated fatty acids help prevent the development of the autoimmune disease? A new study suggests this might indeed be possible, as researchers showed that the dietary intake of omega-3 fatty acids reduced the risk of pancreatic islet autoimmunity in children at increased risk for type 1 diabetes [1].

Type 1 diabetes mellitus is an autoimmune disease that is characterized by the destruction of insulin-producing beta cells in the pancreatic islets, but these new findings, say the researchers, "suggest that higher consumption of total omega-3 fatty acids . . . is associated with a lower risk of islet autoimmunity." Further study, write the researchers, is still needed to determine whether omega-3 fatty acids should become a dietary mainstay for pregnant women, infants, and young children.

The new findings, from a longitudinal, observational study performed by lead author Dr Jill Norris (University of Colorado, Denver) and colleagues, are published in the September 26, 2007 issue of the Journal of the American Medical Association.

The DAISY study

Norris and colleagues note that a recent case-control study from Norway showed that children with diabetes were less likely to have been given cod-liver oil during infancy than children without diabetes [2]. Cod liver contains vitamin D and the marine omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), so it is not entirely clear what factor—the vitamin D or the omega-3 fatty acids—provided the protection. The purpose of this study—known as Diabetes Autoimmunity Study in the Young (DAISY)—was to examine the whether the intake of omega-3 and omega-6 fatty acids was associated with the development of islet autoimmunity in children.

The DAISY investigators included two groups of young patients at risk for diabetes: one group consisted of unaffected first-degree relatives of individuals with type 1 diabetes, and the other consisted of children determined to be at genetic risk for diabetes by screening that identified diabetes-susceptibility alleles in the human leukocyte antigen (HLA) region. Recruiting children aged eight years and younger, including newborns, between 1994 and 2006, the group identified 1770 children at risk for type 1 diabetes mellitus.

With an average follow-up of 6.2 years, 58 children developed diabetes. After adjustment for HLA genotype, family history, caloric intake, and total omega-6 fatty-acid intake, omega-3 fatty acid intake was inversely associated with the risk of developing islet autoimmunity, a risk reduction of 55%. In a similar adjustment, the consumption of omega-6 fatty acids was not associated with a reduction in risk. When investigators tightened the analysis and measured the risk of developing multiple autoantibodies or type 1 diabetes by fatty-acid intake, the reduction in risk was 77% for the intake of omega-3 fatty acids. Again, omega-6 intake was not associated with a reduction in risk.

In further analysis, the researchers also performed a case-cohort study with 244 children to measure the fatty-acid content of erythrocyte membranes. In this small study, the omega-3 fatty-acid content of the erythrocyte membranes—shown to be a good marker of medium-term fatty-acid intake in children younger than two years—was associated with a 37% decrease in the risk of developing islet autoimmunity. Omega-6 fatty acid intake was not associated with any reduction in risk.

There is a trial currently under way—the Nutritional Intervention for the Prevention of Type 1 Diabetes—that will test the hypothesis that dietary supplementation with DHA in utero and in infancy will block early islet inflammatory events and thus prevent the development of islet autoimmunity in children at high genetic risk for the disease.

"If this trial confirms this hypothesis," write Norris and colleagues, "dietary supplementation with omega-3 fatty acids could become a mainstay for early intervention to safely prevent the development of type 1 diabetes."

The National Institutes of Health and the Diabetes Endocrine Research Center sponsored the study.



Sources

1. Norris JM, Yin X, Lamb MM, et al. Omega-3 polyunsaturated fatty acid intake and islet autoimmunity in children at increased risk for type 1 diabetes. JAMA 2007; 298: 1420-1428.
2. Stene LC, Joner G: the Norwegian Childhood Diabetes Study Group. Use of cod liver oil during the first year of life is associated with lower risk of childhood-onset type 1 diabetes: a large, population-based, case-control study. Am J Clin Nutr 2003; 78:1128-1134.




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