{
 "id": "061d870f-1d33-45e1-9a4c-f7f888e336b0",
 "disease": {
  "id": "H00408",
  "names": [
   "Type 1 diabetes mellitus"
  ],
  "dbLinks": {
   "icd10": [
    "E10"
   ],
   "mesh": [
    "D003922"
   ]
  },
  "category": "Metabolic disease; Immune system disease; Endocrine disease"
 },
 "article": {
  "id": "14519705",
  "text": "CONTEXT:\nDietary exposures in infancy have been implicated, albeit inconsistently, in the etiology of type 1 diabetes mellitus (DM).\n\nOBJECTIVE:\nTo examine the association between cereal exposures in the infant diet and appearance of islet autoimmunity (IA).\n\nDESIGN:\nBirth cohort study conducted from 1994 to 2002 with a mean follow-up of 4 years.\n\nSETTING:\nNewborn screening for HLA was done at St Joseph's Hospital in Denver, Colo. First-degree relatives of type 1 DM individuals were recruited from the Denver metropolitan area.\n\nPARTICIPANTS:\nWe enrolled 1183 children at increased type 1 DM risk, defined as either HLA genotype or having a first-degree relative with type 1 DM, at birth and followed them prospectively. We obtained exposure and outcome measures for 76% of enrolled children. Participants had variable lengths of follow-up (9 months to 9 years).\n\nMAIN OUTCOME MEASURES:\nBlood draws for the detection of insulin autoantibody, glutamic acid decarboxylase autoantibody, or IA-2 autoantibody were performed at 9, 15, and 24 months and annually thereafter. Children with IA (n = 34) were defined as those testing positive for at least 1 of the autoantibodies on 2 or more consecutive visits and who tested positive or had diabetes on their most recent visit.\n\nRESULTS:\nChildren initially exposed to cereals between ages 0 and 3 months (hazard ratio [HR], 4.32; 95% confidence interval [CI], 2.0-9.35) and those who were exposed at 7 months or older (HR, 5.36; 95% CI, 2.08-13.8) had increased hazard of IA compared with those who were exposed during the fourth through sixth month, after adjustment for HLA genotype, family history of type 1 DM, ethnicity, and maternal age. In children who were positive for the HLA-DRB1*03/04,DQB8 genotype, adjusted HRs were 5.55 (95% CI, 1.92-16.03) and 12.53 (95% CI, 3.19-49.23) for initial cereal exposure between ages 0 to 3 months and at 7 months or older, respectively.\n\nCONCLUSION:\nThere may be a window of exposure to cereals in infancy outside which initial exposure increases IA risk in susceptible children."
 },
 "questions": [
  {
   "id": "c54996c9-73e7-4025-b6b1-dde8c060d4d1",
   "text": "What are the risk factors of Type 1 diabetes mellitus?",
   "answers": [
    {
     "answer_start": 1286,
     "text": "Children initially exposed to cereals between ages 0 and 3 months"
    },
    {
     "answer_start": 1422,
     "text": "those who were exposed at 7 months or older"
    },
    {
     "answer_start": 1695,
     "text": "children who were positive for the HLA-DRB1*03/04,DQB8 genotype"
    },
    {
     "answer_start": 1968,
     "text": "exposure to cereals in infancy"
    }
   ]
  }
 ]
}