There are many options when weaning an infant from breast milk. The story discusses a recently published NEJM study which compared extensively hydrolyzed formula with regular infant formula in infants from 6-8 months, and followed these children for 10 years. The more expensive hydrolyzed forumula was associated with fewer cases of Type 1 diabetes antibodies in children who were at risk of developing the autoimmune disease. However, the story notes that there is not definitive evidence that choosing regular cow’s milk infant formula will increase the risk of developing Type 1 diabetes, compared to other types of formula.
Particularly important is the statement from the co-director of the Diabetes Center of Excellence at the University of Massachusetts, that there are quite a few steps between preventing one of two diabetes-causing antibodies in at-risk children via a special formula, and how Type 1 diabetes manifests as an autoimmune disease. Recommendations for infant formula have not changed as a result of this study and more evidence is needed to change clinical practice.
The story notes that the extensively hydrolyzed formula is more expensive than standard formula; however, the authors should have indicated how much more expensive hydrolyzed formula is compared to regular formula. Monthly cost comparison of two formulas would have been appropriate as this may be a deciding factor for many families who choose not to breastfeed, or who are weaning.
We’ve already penalized the story in “evidence” above for not giving the absolute risk reduction, so we won’t do it again here. The story reports on a study which showed about 50% fewer diabetes antibodies in at-risk children who were fed special hydrogized infant formula. But 50% of what? This may or may not translate into fewer cases of childhood diabetes. If there are other side effects or harms associated with using hydrolyzed versus standard formula, they are not described.
There are no real “harms” with using formula, either cow’s milk formula or extensively hydrolyzed formula. It appears the latter may be a better choice because there are fewer proteins broken down for digestion.
What is missing here for the reader is a clear estimate of the absolute increase in risk of developing these antibodies. For example, if the risk for infants exposed to hydrolyzed is 1% and the risk for standard formula is 2% this may not be worth the cost. Whereas if the risk for those exposed to hydrolyzed is 5% and for those exposed to standard formula is 10% this may be worth it. Both of these represent a 50% increase in risk, but the absolute differences would have substantially different clinical implications
The story does not engage in disease mongering. The story carefully explains the results of the study and is conservative about the role a formula may play in the prevention of Type 1 diabetes in susceptible children. it would have been helpful to indicate the prevalence of type 1 diabetes and how much the risk is increased if you have a first degree relative with type 1, which would have provided some perspective on the meaning of the relative increased risk for developing these auto-antibodies if an infant is exposed to standard formula.
The story quotes several clinical experts who provide explanation of the results and put these into context with current formula recommendations. Study authors are cited as well as clinical experts who feel the research is noteworthy, but should not change recommendations for a hydrolyzed formula to prevent Type 1 diabetes. Affliations of all sources are listed in the story postscript.
There are many options when weaning an infant from breast milk. The story discusses the NEJM study which compared extensively hydrolyzed formula with regular infant formula. While the more expensive hydrolyzed forumula was associated with fewer cases of Type 1 diabetes antibodies in at-risk children, the story notes that there is not definitive evidence that cow’s milk formula will increase the risk of Type 1 Diabetes compared to other types of formular or breast feeding.
Various infant formulas are available when weaning infants from breast milk, or when breastfeeding is not an option. The story discusses research that compared regular infant formula with a type of extensively hydrolyzed formula that helps break down proteins during digestion.
This formula may not be available to some parents due to greater expense.
It is known that breast feeding is preferable to formula, and that it may offer some protection against the development of Type 1 diabetes. Formula is an option, particularly when breast milk is not available, and using formula will not harm an infant. However, formula may somehow trigger the development of autoantibodies as these proteins are broken down for digestion. More research is needed, but this new information from a well-designed double-blinded RCT trial may guide recommendations and parents decisions in choosing a specialized infant formula that does not require breakdown of so many proteins during digestion.
There is some thoughtful independent reporting and the story does not appear to rely on a news release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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