Colleagues... I just sent this to my residents and students for their monthly newletter. I sort of paraphrased the committee's report. I thought you might find it interesting. twh Cow's Milk and IDDM in Children ? Insulin dependent diabetes mellitus(IDDM) is a common and serious genetic disorder with a prevalence of 2.6 per 1000 persons. Current statistics vary but in general suggest that an adolescent peak occurs in most populations, with approximately equal numbers developing IDDM before and after 19 years of age. The etiology of beta cell damage appears to involve a link between genetic predisposition and an environmental insult. IDDM is not inherited. Although the diabetic gene has been located on chromosome 6, it appears that less than 5% of those possessing the "diabetic gene" actually become diabetic. In the past, there have been many attempts to link various diseases with the expression of the disease, particularly mumps. In 1984 the first study was published that linked the early introduction of cow's milk to the infant's diet to the incidence of IDDM. Since that time, over 90 articles have variously supported or disputed these findings. But the general concensus is that a significant risk is associated with the early introduction of cow's milk in the first year of life. For some years, it has been known that children with IDDM have an increased presence of antibodies to a variety of cow's milk proteins(particularly a 17-amino acid fragment of bovine serum albumin). In one group of recent studies, investigators found that 100% of a large group of Finnish children with IDDM had antibodies to specific cow's milk proteins. This same antibody was found in but few of the controls. Animal studies are even more convincing. The addition of cow's milk proteins to routine rat chow increased the frequency of diabetes in a susceptible strain up to nearly 100%, compared to zero percent in controls. Therefore, the Work Group on Cow's Milk Protein and Diabetes Mellitus from the American Academy of Pediatrics* recommends the following(partial): 1) Breast-feeding is strongly endorsed as the primary source of nutrition during the first year of life for all infants. 2) In families with a strong history of IDDM, breast-feeding and avoidance of products containing cow's milk are strongly encouraged. 3) Because many artificial infant formulations contain cow's milk proteins, there is no current evidence to date to suggest that artificial formulations containing cow's milk proteins will induce IDDM. 4) The substitution of soy-based formulas for milk-based formulas is not advised, because of numerous studies linking the ingestion of soy based products with the development of diabetes. *Drash, AL, Kramer, M, et.al. American Academy of Pediatrics: Infant feeding practices and their possible relationship to the etiology of diabetes mellitus. Pediatrics 94:752-754, 1994. *********************************** T.W. Hale, Ph.D. Associate Professor of Pediatrics Texas Tech University School of Medicine ***********************************