Retinol, Carotenoid, and Tocopherol Intake and Status, and the Risk of Islet Autoimmunity and Type 1 Diabetes: The Environmental Determinants of Diabetes in the Young Study

The TEDDY Study Group.; Leena Hakola; Joanna L. Clasen; Ulla Uusitalo; Carin Andrén Aronsson; Sandra Hummel; Markus Mattila; Sari Niinistö; Jorma Toppari; Anette G. Ziegler; William A. Hagopian; Beena Akolkar; Marian J. Rewers; Richard A. McIndoe; Åke Lernmark; Jeffrey P. Krischer; Jill M. Norris; Iris Erlund; Suvi M. Virtanen

doi:10.1002/dmrr.70196

Retinol, Carotenoid, and Tocopherol Intake and Status, and the Risk of Islet Autoimmunity and Type 1 Diabetes: The Environmental Determinants of Diabetes in the Young Study

The TEDDY Study Group.
, Leena Hakola^*
, Joanna L. Clasen
, Ulla Uusitalo
, Carin Andrén Aronsson
, Sandra Hummel
, Markus Mattila
, Sari Niinistö
, Jorma Toppari
, Anette G. Ziegler
, William A. Hagopian
, Beena Akolkar
, Marian J. Rewers
, Richard A. McIndoe
, Åke Lernmark
, Jeffrey P. Krischer
, Jill M. Norris
, Iris Erlund
, Suvi M. Virtanen

^*Corresponding author for this work

Research output: Contribution to journal › Article › Scientific › peer-review

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Abstract

Aims: To study the associations of dietary intake of A and E vitamins, as well as plasma retinols, carotenoids, and tocopherols in relation to development of islet autoimmunity and progression to T1D. Materials and Methods: The Environmental Determinants of Diabetes in the Young (TEDDY) Study followed 7659 newborns with genetic susceptibility to T1D for 6 years in the USA, Finland, Germany, and Sweden. Dietary vitamin intake was assessed repeatedly with 3-day food-records in full cohort at ages 6 months to 6 years. Plasma retinols, carotenoids, and tocopherols were analysed in a nested case-control setting with 359 children with islet autoimmunity and 1033 matched controls. Results: In the full cohort analyses, dietary intake of retinol, β-carotene, and vitamin E was not associated with the risk of islet autoimmunity or progression to T1D. Further, none of the plasma retinol, carotenoid, and tocopherol biomarkers were associated with islet autoimmunity or T1D in the full nested case-control analyses. We observed effect modification by country, breastfeeding, sex, and follow-up time for both intake and biomarkers of vitamins on the risk of islet autoimmunity or T1D, and some subgroup associations. Finally, a plasma carotenoid metabolite (likely zeinoxanthin) (OR 0.61, 95% CI 0.39, 0.95, p = 0.03) and γ-carotene at 6 months (OR 0.65, 95% CI 0.45, 0.94, p = 0.02) were inversely associated with the odds of developing GADA-first. Conclusions: Retinol, carotenoids and tocopherols were not consistently associated with islet autoimmunity. This study adds to the understanding of factors and their interactions related to T1D development.

Original language	English
Article number	e70196
Journal	Diabetes/Metabolism Research and Reviews
Volume	42
Issue number	5
DOIs	https://doi.org/10.1002/dmrr.70196
Publication status	Published - Jul 2026
Publication type	A1 Journal article-refereed

Funding

The TEDDY Study is funded by U01 DK63829, U01 DK63861, U01 DK63821, U01 DK63865, U01 DK63863, U01 DK63836, U01 DK63790, UC4 DK63829, UC4 DK63861, UC4 DK63821, UC4 DK63865, UC4 DK63863, UC4 DK63836, UC4 DK95300, UC4 DK100238, UC4 DK106955, UC4 DK112243, UC4 DK117483, U01 DK124166, U01 DK128847, and Contract No. HHSN267200700014C from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institute of Allergy and Infectious Diseases (NIAID), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institute of Environmental Health Sciences (NIEHS), Centres for Disease Control and Prevention (CDC), and Breakthrough T1D (formerly JDRF). This work is supported in part by the NIH/NCATS Clinical and Translational Science Awards to the University of Florida (UL1 TR000064) and the University of Colorado (UL1 TR002535). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. In addition, writing this paper was supported by Research Council of Finland (339922) and State funding for university-level health research, Tampere University Hospital, Wellbeing services county of Pirkanmaa. During the preparation of this work, no AI-assisted technologies were used. Open access publishing facilitated by Tampereen yliopisto ja Tampereen ammattikorkeakoulu, as part of the Wiley - FinELib agreement.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

birth cohort
carotenoids
diabetes mellitus, type 1
retinol
tocopherols
vitamin A
vitamin E

Publication forum classification

Publication forum level 1

ASJC Scopus subject areas

Internal Medicine
Endocrinology, Diabetes and Metabolism
Endocrinology

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Retinol Carotenoid and Tocopherol Intake and Status and the Risk of IsletFinal published version, 1.13 MBLicence: CC BY

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Cite this

The TEDDY Study Group., Hakola, L., Clasen, J. L., Uusitalo, U., Andrén Aronsson, C., Hummel, S., Mattila, M., Niinistö, S., Toppari, J., Ziegler, A. G., Hagopian, W. A., Akolkar, B., Rewers, M. J., McIndoe, R. A., Lernmark, Å., Krischer, J. P., Norris, J. M., Erlund, I., & Virtanen, S. M. (2026). Retinol, Carotenoid, and Tocopherol Intake and Status, and the Risk of Islet Autoimmunity and Type 1 Diabetes: The Environmental Determinants of Diabetes in the Young Study. Diabetes/Metabolism Research and Reviews, 42(5), Article e70196. https://doi.org/10.1002/dmrr.70196

@article{c57ab90303b54d59b08f23130708dfc7,

title = "Retinol, Carotenoid, and Tocopherol Intake and Status, and the Risk of Islet Autoimmunity and Type 1 Diabetes: The Environmental Determinants of Diabetes in the Young Study",

abstract = "Aims: To study the associations of dietary intake of A and E vitamins, as well as plasma retinols, carotenoids, and tocopherols in relation to development of islet autoimmunity and progression to T1D. Materials and Methods: The Environmental Determinants of Diabetes in the Young (TEDDY) Study followed 7659 newborns with genetic susceptibility to T1D for 6 years in the USA, Finland, Germany, and Sweden. Dietary vitamin intake was assessed repeatedly with 3-day food-records in full cohort at ages 6 months to 6 years. Plasma retinols, carotenoids, and tocopherols were analysed in a nested case-control setting with 359 children with islet autoimmunity and 1033 matched controls. Results: In the full cohort analyses, dietary intake of retinol, β-carotene, and vitamin E was not associated with the risk of islet autoimmunity or progression to T1D. Further, none of the plasma retinol, carotenoid, and tocopherol biomarkers were associated with islet autoimmunity or T1D in the full nested case-control analyses. We observed effect modification by country, breastfeeding, sex, and follow-up time for both intake and biomarkers of vitamins on the risk of islet autoimmunity or T1D, and some subgroup associations. Finally, a plasma carotenoid metabolite (likely zeinoxanthin) (OR 0.61, 95\% CI 0.39, 0.95, p = 0.03) and γ-carotene at 6 months (OR 0.65, 95\% CI 0.45, 0.94, p = 0.02) were inversely associated with the odds of developing GADA-first. Conclusions: Retinol, carotenoids and tocopherols were not consistently associated with islet autoimmunity. This study adds to the understanding of factors and their interactions related to T1D development.",

keywords = "birth cohort, carotenoids, diabetes mellitus, type 1, retinol, tocopherols, vitamin A, vitamin E",

author = "\{The TEDDY Study Group.\} and Leena Hakola and Clasen, \{Joanna L.\} and Ulla Uusitalo and \{Andr{\'e}n Aronsson\}, Carin and Sandra Hummel and Markus Mattila and Sari Niinist{\"o} and Jorma Toppari and Ziegler, \{Anette G.\} and Hagopian, \{William A.\} and Beena Akolkar and Rewers, \{Marian J.\} and McIndoe, \{Richard A.\} and {\AA}ke Lernmark and Krischer, \{Jeffrey P.\} and Norris, \{Jill M.\} and Iris Erlund and Virtanen, \{Suvi M.\}",

note = "Publisher Copyright: {\textcopyright} 2026 The Author(s). Diabetes/Metabolism Research and Reviews published by John Wiley \& Sons Ltd. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.",

year = "2026",

month = jul,

doi = "10.1002/dmrr.70196",

language = "English",

volume = "42",

journal = "Diabetes/Metabolism Research and Reviews",

issn = "1520-7552",

publisher = "John Wiley \& Sons",

number = "5",

}

The TEDDY Study Group., Hakola, L, Clasen, JL, Uusitalo, U, Andrén Aronsson, C, Hummel, S, Mattila, M, Niinistö, S, Toppari, J, Ziegler, AG, Hagopian, WA, Akolkar, B, Rewers, MJ, McIndoe, RA, Lernmark, Å, Krischer, JP, Norris, JM, Erlund, I & Virtanen, SM 2026, 'Retinol, Carotenoid, and Tocopherol Intake and Status, and the Risk of Islet Autoimmunity and Type 1 Diabetes: The Environmental Determinants of Diabetes in the Young Study', Diabetes/Metabolism Research and Reviews, vol. 42, no. 5, e70196. https://doi.org/10.1002/dmrr.70196

Retinol, Carotenoid, and Tocopherol Intake and Status, and the Risk of Islet Autoimmunity and Type 1 Diabetes: The Environmental Determinants of Diabetes in the Young Study. / The TEDDY Study Group. ; Hakola, Leena; Clasen, Joanna L. et al.
In: Diabetes/Metabolism Research and Reviews, Vol. 42, No. 5, e70196, 07.2026.

Research output: Contribution to journal › Article › Scientific › peer-review

TY - JOUR

T1 - Retinol, Carotenoid, and Tocopherol Intake and Status, and the Risk of Islet Autoimmunity and Type 1 Diabetes

T2 - The Environmental Determinants of Diabetes in the Young Study

AU - The TEDDY Study Group.

AU - Hakola, Leena

AU - Clasen, Joanna L.

AU - Uusitalo, Ulla

AU - Andrén Aronsson, Carin

AU - Hummel, Sandra

AU - Mattila, Markus

AU - Niinistö, Sari

AU - Toppari, Jorma

AU - Ziegler, Anette G.

AU - Hagopian, William A.

AU - Akolkar, Beena

AU - Rewers, Marian J.

AU - McIndoe, Richard A.

AU - Lernmark, Åke

AU - Krischer, Jeffrey P.

AU - Norris, Jill M.

AU - Erlund, Iris

AU - Virtanen, Suvi M.

N1 - Publisher Copyright: © 2026 The Author(s). Diabetes/Metabolism Research and Reviews published by John Wiley & Sons Ltd. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.

PY - 2026/7

Y1 - 2026/7

N2 - Aims: To study the associations of dietary intake of A and E vitamins, as well as plasma retinols, carotenoids, and tocopherols in relation to development of islet autoimmunity and progression to T1D. Materials and Methods: The Environmental Determinants of Diabetes in the Young (TEDDY) Study followed 7659 newborns with genetic susceptibility to T1D for 6 years in the USA, Finland, Germany, and Sweden. Dietary vitamin intake was assessed repeatedly with 3-day food-records in full cohort at ages 6 months to 6 years. Plasma retinols, carotenoids, and tocopherols were analysed in a nested case-control setting with 359 children with islet autoimmunity and 1033 matched controls. Results: In the full cohort analyses, dietary intake of retinol, β-carotene, and vitamin E was not associated with the risk of islet autoimmunity or progression to T1D. Further, none of the plasma retinol, carotenoid, and tocopherol biomarkers were associated with islet autoimmunity or T1D in the full nested case-control analyses. We observed effect modification by country, breastfeeding, sex, and follow-up time for both intake and biomarkers of vitamins on the risk of islet autoimmunity or T1D, and some subgroup associations. Finally, a plasma carotenoid metabolite (likely zeinoxanthin) (OR 0.61, 95% CI 0.39, 0.95, p = 0.03) and γ-carotene at 6 months (OR 0.65, 95% CI 0.45, 0.94, p = 0.02) were inversely associated with the odds of developing GADA-first. Conclusions: Retinol, carotenoids and tocopherols were not consistently associated with islet autoimmunity. This study adds to the understanding of factors and their interactions related to T1D development.

AB - Aims: To study the associations of dietary intake of A and E vitamins, as well as plasma retinols, carotenoids, and tocopherols in relation to development of islet autoimmunity and progression to T1D. Materials and Methods: The Environmental Determinants of Diabetes in the Young (TEDDY) Study followed 7659 newborns with genetic susceptibility to T1D for 6 years in the USA, Finland, Germany, and Sweden. Dietary vitamin intake was assessed repeatedly with 3-day food-records in full cohort at ages 6 months to 6 years. Plasma retinols, carotenoids, and tocopherols were analysed in a nested case-control setting with 359 children with islet autoimmunity and 1033 matched controls. Results: In the full cohort analyses, dietary intake of retinol, β-carotene, and vitamin E was not associated with the risk of islet autoimmunity or progression to T1D. Further, none of the plasma retinol, carotenoid, and tocopherol biomarkers were associated with islet autoimmunity or T1D in the full nested case-control analyses. We observed effect modification by country, breastfeeding, sex, and follow-up time for both intake and biomarkers of vitamins on the risk of islet autoimmunity or T1D, and some subgroup associations. Finally, a plasma carotenoid metabolite (likely zeinoxanthin) (OR 0.61, 95% CI 0.39, 0.95, p = 0.03) and γ-carotene at 6 months (OR 0.65, 95% CI 0.45, 0.94, p = 0.02) were inversely associated with the odds of developing GADA-first. Conclusions: Retinol, carotenoids and tocopherols were not consistently associated with islet autoimmunity. This study adds to the understanding of factors and their interactions related to T1D development.

KW - birth cohort

KW - carotenoids

KW - diabetes mellitus, type 1

KW - retinol

KW - tocopherols

KW - vitamin A

KW - vitamin E

UR - https://www.scopus.com/pages/publications/105043453844

U2 - 10.1002/dmrr.70196

DO - 10.1002/dmrr.70196

M3 - Article

AN - SCOPUS:105043453844

SN - 1520-7552

VL - 42

JO - Diabetes/Metabolism Research and Reviews

JF - Diabetes/Metabolism Research and Reviews

IS - 5

M1 - e70196

ER -

Retinol, Carotenoid, and Tocopherol Intake and Status, and the Risk of Islet Autoimmunity and Type 1 Diabetes: The Environmental Determinants of Diabetes in the Young Study

Abstract

Funding

UN SDGs

Keywords

Publication forum classification

ASJC Scopus subject areas

Access to Document

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