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.

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T.W. Hale, Ph.D.
Associate Professor of Pediatrics
Texas Tech University School of Medicine

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