Intensive Dietary and Activity Counselling (IDAC)

Summary

The aim of this intervention study is to investigate if a intensive dietary and physical activity counselling during the first two years of life in children with increased (genetically) risk for Type 1 Diabetes (T1D) can promote a healthy beta-cell environment, in order to reduce increased weight gain and development of islet autoimmunity (beta-cell autoantibodies). The main hypotheses are: * Early lifestyle influences the susceptibility to islet autoimmunity (IA) by increasing beta-cell vulnerability. Introducing a "healthy beta-cell lifestyle" from infancy will reduce beta-cell vulnerability and the likelihood of IA. * Will promotion of a healthy beta-cell environment during early childhood in children with increased genetic risk of T1D reduce beta-cell stress, increased weight gain and development of islet autoantibodies? Primary outcome will be measured by development of IA and by the proinsulin/C-peptide ratio during an OGTT. Secondary outcomes are accelerated growth during infancy, overweight at the age of 36 months. Participants will be randomized (ratio 1:1) to control group and intervention group. Breastfeeding status at time of randomization will be taken into account. Participants will be enrolled by the age of four months and visit the research clinic ever third months up until the age of 24 months, and then yearly up until the age of 6 years. * Anthropometric measurements and blood draw will be taken at each visit. * Questionnaires focusing on breastfeeding and early infant feeding habits will be used at each visit. * 24hrs recalls will be done at the age of 6, 9, 12, 18 and 24 months of age. * Physical activity will be estimated using questionnaires (3, 6, 9 months) and accelerometer data (18 and 24 months). * Stool samples will be collected at 6, 12 and 18 months of age

Eligibility

Inclusion Criteria:

* The age of the infant at time of enrolment should be 3.0 months (13 - 17 weeks).
* An increased genetic risk (7-10%) to develop beta-cell autoantibodies by the age of 6 years.

Genetic inclusion criteria: Children without a T1D-FDR having HLA DR3/DR4-DQ8, DR4-DQ8/DR4-DQ8 or DR4-DQ8/DR4-DQ7 rs6901541 C/T genotype and:

* for males having a genetic risk score greater than or equal to 18.2 but excluding those who are eligible for AVANT1A.
* for females having a genetic risk score greater than or equal to 14.5 but excluding those who are eligible for AVANT1A.

Children with a T1D-FDR, all DR3/3, DR4-DQ8/DR4-DQ7 and DR4-DQ8/x where x is none of the following protective alleles: DRB1\*1501, DQB1\*0503, DRB1\*1303 will be included regardless of genetic risk score.

\- Written informed consent signed by the custodial parent(s).

Exclusion Criteria:

* Any medical condition, concomitant disease or treatment that may interfere with the assessments or may jeopardize the participant's safe participation in the study, as judged by the investigators.
* Preterm delivery \< 36 weeks of gestation.
* Any condition that could be associated with poor compliance.
* Diagnosis of diabetes prior to recruitment or randomization.
* Current use of any investigational drug.

Conditions3

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