To The Editor:

I am familiar with the work of Dr Shehadeh et al. There may indeed be a place for insulin in infant formula. However, before such a step is taken, I believe that it is imperative that appropriate prospective studies be done, including safety monitoring. Although our human pilot study and animal studies suggest there may be a benefical effect of oral insulin, much more work needs to be done and recommending its use now is, to my mind, not appropriate. [1]

Reference

(1) RJ Shulman. Effect of enteral administration of insulin on intestinal development and feeding tolerance in preterm infants: a pilot study. Arch Dis Child Fetal Neonatal Ed. 2002;86:F131-3.

Dear Editor

I read with great interest the article by Shulman.[1] Indeed, orally administered insulin may have a positive effect on gut maturation and mucosal enzyme expression in preterm infants. We have recently demonstrated that human milk is rich in insulin (mean = 60.2 micro U/ml), and that insulin is barely detected in infant formulas.[2] Moreover, we have hypothesized that insulin content of human milk may have an important role in the primary prevention of type 1 diabetes, by inducing active cellular machanisms that suppress the development of autoimmune diabetes, and by reducing intestinal transmission of 'triggering' dietary peptides.[3] We suggest to add human insulin to infant formulas in a concentration similar to insulin concentration present in human milk. This addition may lead to the following beneficial effects: It will make infant formula similar to human milk; it may fasten gut maturation; and it may protect from the development of type 1 diabetes.

References

(1) Shulman RJ. Effect of interal administration of insulin on itestinal development and feeding tolerance in preterm infants: a pilot study. Arch Dis Child Fetal Neonatal Ed 2002;86:F131-3.

(2) Shehadeh N, Gelertner L, Blazer S, Perlman R, Solovachik L, Etzioni A. Importance of insulin content in infant diet: suggestion for a new infant formula. Acta Pediatr 2001;90:93-5.

(3) Shehadeh N, Shamir R, Berant M, Etzioni A. Insulin in human milk and the prevention of type 1 diabetes. Pediatric Diabetes 2001;2:175-7.