Public Health Nutrition

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Infant feeding patterns in families with a diabetes history – observations from The Environmental Determinants of Diabetes in the Young (TEDDY) birth cohort study

Sandra Hummela1a2 c1, Kendra Vehika3, Ulla Uusitaloa3, Wendy McLeoda3, Carin Andrén Aronssona4, Nicole Franka5, Patricia Gesualdoa5, Jimin Yanga3, Jill M Norrisa6 and Suvi M Virtanena7a8a9a10 the TEDDY Study Group


a1 Institute of Diabetes Research, Helmholtz Zentrum München and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstaedter Landstrasse 1, D-85764 Neuherberg, Germany

a2 Forschergruppe Diabetes eV, Neuherberg, Germany

a3 Morsani College of Medicine, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, USA

a4 Department of Clinical Sciences, Lund University, Malmo, Sweden

a5 The Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO, USA

a6 Colorado School of Public Health, University of Colorado, Aurora, CO, USA

a7 Unit of Nutrition, National Institute for Health and Welfare, Helsinki, Finland

a8 School of Health Sciences, University of Tampere, Tampere, Finland

a9 Science Center of Pirkanmaa Hospital District, Tampere, Finland

a10 Research Center for Child Health, Tampere University and University Hospital, Tampere, Finland


Objective To assess the association between diabetes family history and infant feeding patterns.

Design Data on breast-feeding duration and age at first introduction of cow's milk and gluten-containing cereals were collected in 3-month intervals during the first 24 months of life.

Setting Data from the multicentre TEDDY (The Environmental Determinants of Diabetes in the Young) study, including centres in the USA, Sweden, Finland and Germany.

Subjects A total of 7026 children, including children with a mother with type 1 diabetes (T1D; n 292), gestational diabetes mellitus (GDM; n 404) or without diabetes but with a father and/or sibling with T1D (n 464) and children without diabetes family history (n 5866).

Results While exclusive breast-feeding ended earlier and cow's milk was introduced earlier in offspring of mothers with T1D and GDM, offspring of non-diabetic mothers but a father and/or sibling with T1D were exclusively breast-fed longer and introduced to cow's milk later compared with infants without diabetes family history. The association between maternal diabetes and shorter exclusive breast-feeding duration was attenuated after adjusting for clinical variables (delivery mode, gestational age, Apgar score and birth weight). Country-specific analyses revealed differences in these associations, with Sweden showing the strongest and Finland showing no association between maternal diabetes and breast-feeding duration.

Conclusions Family history of diabetes is associated with infant feeding patterns; however, the associations clearly differ by country, indicating that cultural differences are important determinants of infant feeding behaviour. These findings need to be considered when developing strategies to improve feeding patterns in infants with a diabetes family history.

(Received December 26 2012)

(Revised September 13 2013)

(Accepted October 15 2013)

(Online publication November 27 2013)


  • Type 1 diabetes;
  • Gestational diabetes;
  • Infant diet;
  • Breast-feeding


c1 Corresponding author: Email


  Members of the TEDDY Study Group are listed in the Appendix