Prenatal and infant nutrition in the pathogenesis of type 1 diabetes implications for diagnosis and therapy

The concept of type 1 diabetes as a disease of childhood and adolescence is being challenged by studies that relate islet autoimmunity to prenatal and infantile determinants (1-5). Recent discoveries that increased maternal age (6,7), ABO incompatibility (8), and rapid postnatal growth (9-11) are all diabetes risk factors suggest that the pathogenic process starts very early in life. Interactions among protective and predisposing genes, environmental exposures, and immunological responses all appear necessary for the initiation and propagation of autoimmune T-lymphocyte responses that destroy the insulin-producing pancreatic beta cells. This chapter will review the current understanding of the pathogenesis of type 1 diabetes and highlight the contribution of infant nutrition to the initiation of progression of autoimmunity.