The descriptive epidemiology of type 1 diabetes suggests an etiology involving genetic and environmental factors that vary across populations and environmental factors that vary over time. Exposures in the infant diet, specifically cereals and/or gluten, have been associated with development of diabetes autoimmunity in prospective studies of children at increased risk of type 1 diabetes. Similar exposures have also been associated with other childhood diseases such as celiac disease and wheat allergy, which while they may share some similarities with type 1 diabetes, essentially have different pathogeneses. The data published thus far suggest that there are specific times in infancy when exposure to cereals and/or gluten increases risk for a variety of diseases. They also suggest that intervention, i.e. removal of gluten, after becoming autoantibody positive does not lessen autoimmunity nor prevent the development of the disease itself. Additional research is needed to determine whether gluten is in fact the antigen driving the risk for three different disorders, whether gluten exposure is resulting in increased gut permeability leading to increased exposure to a variety of dietary antigens, each of which is disease specific, or whether there is yet another, undiscovered factor in the infant diet that results in disease.
Keywords: Type 1 diabetes, autoimmunity, allergy, celiac disease, cereal, gluten, infant diet, gut permeability
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