Background: Prior research found that children at risk for type 1 diabetes (T1D) with increased dietary intake of sugar and higher glycemic index foods had quicker progression from islet autoimmunity (IA) to T1D diagnosis. However, this has not yet been studied in another population.

Objective: To investigate the role of macronutrients in the progression to T1D in TrialNet’s cohort of individuals with IA, including older children and adults.

Methods: Baseline dietary data derived from a food frequency questionnaire (FFQ) estimating intake over the past year, and longitudinal clinical data until development of T1D were obtained for individuals with IA from TrialNet’s Pathway to Prevention Study. Proportional hazard regression analysis stratified by age group (1-4 yrs, 5-12 yrs, 13-22 yrs, and 23+ yrs old) was used to evaluate the time from IA detection to T1D diagnosis, with regard to average daily dietary intake of carbohydrates, protein, fat, sugar, fiber, glycemic index, and glycemic load, after adjusting for confounders.

Results: A total of 881 individuals age 1-51 years with at least one autoantibody were included, among whom 73/138 toddlers, 160/388 children, 48/166 adolescent/young adults (AYA), and 27/189 adults developed T1D. Given multiple comparisons, there was no significant association between rate of progression from IA to T1D and daily dietary intake of any macronutrients analyzed, after adjusting for baseline age, BMI, and number of autoantibodies, high risk HLA, and time from IA detection to FFQ completion. Borderline association with higher protein intake among AYA (HR 1.04, 95% CI 1.00-1.08) persisted after sensitivity analysis restricted to those with 2+ autoantibodies (HR 1.05, 95% CI 1.01-1.09).

Conclusions: Baseline dietary macronutrient intake does not appear to influence rate of T1D diagnosis in children, adolescents, or adults with IA. Further study of dietary factors’ complex role in T1D progression is warranted, including effects of a change in diet over time.


E. L. Lundgrin: None. A. Viswanathan: None. S. B. Johnson: None. J. M. Norris: None. H. M. Ismail: None. J. R. Wood: Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Insulet Corporation, Speaker’s Bureau; Self; Xeris Pharmaceuticals, Inc. A. J. Thomas: None. D. J. Becker: None.


Rainbow Babies & Children’s Foundation; National Institute of Diabetes and Digestive and Kidney Diseases; National Institute of Allergy and Infectious Diseases; Eunice Kennedy Shriver National Institute of Child Health and Human Development; JDRF

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at