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Yang L, Zhang X, Liu Q, Wen Y, Wang Q. Update on the ZNT8 epitope and its role in the pathogenesis of type 1 diabetes. Minerva Endocrinol (Torino) 2023; 48:447-458. [PMID: 38099391 DOI: 10.23736/s2724-6507.22.03723-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Type 1 diabetes (T1D) is an organ-specific chronic autoimmune disease mediated by autoreactive T cells. ZnT8 is a pancreatic islet-specific zinc transporter that is mainly located in β cells. It not only participates in the synthesis, storage and secretion of insulin but also maintains the structural integrity of insulin. ZnT8 is the main autoantigen recognized by autoreactive CD8+ T cells in children and adults with T1D. This article summarizes the latest research results on the T lymphocyte epitope and B lymphocyte epitope of ZnT8 in the current literature. The structure and expression of ZnT8, the role of ZnT8 in insulin synthesis and its role in autoimmunity are reviewed. ZnT8 is the primary autoantigen of T1D and is specifically expressed in pancreatic islets. Thus, it is one of biomarkers for the diagnosis of T1D. It has broad prospects for further research on immunomodulators for the treatment of T1D.
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Affiliation(s)
- Liu Yang
- Department of Endocrinology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xuejiao Zhang
- Department of Endocrinology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Qing Liu
- Department of Endocrinology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yan Wen
- Department of Endocrinology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Qing Wang
- Department of Endocrinology, China-Japan Union Hospital of Jilin University, Changchun, China -
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2
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Mameli C, Triolo TM, Chiarelli F, Rewers M, Zuccotti G, Simmons KM. Lessons and Gaps in the Prediction and Prevention of Type 1 Diabetes. Pharmacol Res 2023; 193:106792. [PMID: 37201589 DOI: 10.1016/j.phrs.2023.106792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 05/20/2023]
Abstract
Type 1 diabetes (T1D) is a serious chronic autoimmune condition. Even though the root cause of T1D development has yet to be determined, enough is known about the natural history of T1D pathogenesis to allow study of interventions that may delay or even prevent the onset of hyperglycemia and clinical T1D. Primary prevention aims to prevent the onset of beta cell autoimmunity in asymptomatic people at high genetic risk for T1D. Secondary prevention strategies aim to preserve functional beta cells once autoimmunity is present, and tertiary prevention aims to initiate and extend partial remission of beta cell destruction after the clinical onset of T1D. The approval of teplizumab in the United States to delay the onset of clinical T1D marks an impressive milestone in diabetes care. This treatment opens the door to a paradigm shift in T1D care. People with T1D risk need to be identified early by measuring T1D related islet autoantibodies. Identifying people with T1D before they have symptoms will facilitate better understanding of pre-symptomatic T1D progression and T1D prevention strategies that may be effective.
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Affiliation(s)
- Chiara Mameli
- Department of Pediatrics, V. Buzzi Children's Hospital, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
| | - Taylor M Triolo
- Barbara Davis Center for Diabetes, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045
| | | | - Marian Rewers
- Barbara Davis Center for Diabetes, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, V. Buzzi Children's Hospital, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Kimber M Simmons
- Barbara Davis Center for Diabetes, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045
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3
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Cadario F. Vitamin D and ω-3 Polyunsaturated Fatty Acids towards a Personalized Nutrition of Youth Diabetes: A Narrative Lecture. Nutrients 2022; 14:nu14224887. [PMID: 36432570 PMCID: PMC9699239 DOI: 10.3390/nu14224887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/09/2022] [Accepted: 11/12/2022] [Indexed: 11/22/2022] Open
Abstract
After the discovery of insulin, nutrition has become central in the management of diabetes in order to limit glycemic rise after meals, optimize metabolic control, and prevent complications. Over the past one hundred years, international scientific societies have consecutively refined nutritional needs and optimized food intake for the treatment of diabetes. In particular, over the past century, nutrition applied with pumps for the administration of insulin and continuous glucose monitoring have allowed substantial advancement in the treatment of type 1 diabetes mellitus. The role of some substances, such as vitamin D and n-3 polyunsaturated fatty acids, have been proposed without univocal conclusions, individually or in combination, or in the diet, to improve the nutrition of type 1 and type 2 diabetes. This second condition, which is highly associated with overweight, should be prevented from childhood onwards. Personalized nutrition could bypass the problem, reaching a scientific conclusion on the individual subject. This article focuses on childhood and adolescent diabetes, aims to provide a narrative summary of nutrition over the past century, and promotes the concept of personalized nutrition to pediatricians and pediatric diabetologists as a possible tool for the treatment of type 1 diabetes and the prevention of type 2 diabetes.
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Affiliation(s)
- Francesco Cadario
- Division of Pediatrics, University of Piemonte Orientale, 28100 Novara, Italy;
- Diabetes Research Institute Federation, Miami, FL 33163, USA
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4
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Abstract
PURPOSE OF REVIEW Epidemiological research on type 1 diabetes (T1D) has traditionally focussed on the paediatric age group, but recent data in adults has confirmed it to be a disease of all ages with a wide clinical spectrum. We review the epidemiology and clinical features of T1D across the lifespan. RECENT FINDINGS While the peak incidence of T1D is still in early adolescence, T1D is now diagnosed more commonly in adulthood than childhood due to increasing recognition of adult-onset T1D and the length of the adult lifespan. It still follows the known geographic variations in incidence, being highest in Northern Europe and lowest in Asia. The onset of T1D in adulthood is usually less acute than in childhood and confers a lower, although still substantial, risk of complications and early mortality. Interventions to delay T1D onset are emerging and screening for those at risk at birth is increasingly available. Type 1 diabetes can develop at any age and may not present with ketosis or an immediate insulin requirement in adults. Macro- and microvascular complications are the greatest cause of excess morbidity and mortality in this population.
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5
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Eun Pak M, Kim YJ, Jin Park Y, Go Y, Soo Shin C, Yoon JW, Jeon SM, Song YH, Kim K. Human milk oligosaccharide, 2′-Fucosyllactose, attenuates platelet activation in arterial thrombosis. J Funct Foods 2022. [DOI: 10.1016/j.jff.2022.105138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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6
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Çiçekli İ, Durusoy R. Breastfeeding, nutrition and type 1 diabetes: a case-control study in Izmir, Turkey. Int Breastfeed J 2022; 17:42. [PMID: 35624486 PMCID: PMC9145075 DOI: 10.1186/s13006-022-00470-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 03/27/2022] [Indexed: 01/11/2023] Open
Abstract
Background The relationship between infant breastfeeding and type 1 diabetes mellitus (DM) is unclear but it has been suggested that there may be a link between many environmental factors, including dietary antigens affecting diabetes epidemiology. The main objective of this study is to investigate nutritional risk factors, especially breastfeeding early in life that may be associated with the development of type 1 DM and to determine the relationship these factors have with the disease. Methods This research is a case-control study and was carried out in Ege University Children’s Hospital in İzmir, Turkey between 13 January 2020 and 5 March 2020. A total of 246 children aged between 4 and 14 years were included in the study. The case group consisted of patients diagnosed with type 1 DM followed-up by Ege University Children’s Hospital’s Endocrinology Unit and the control group included non-diabetic children attending the same hospital’s General Pediatric Outpatient Clinic. A structured questionnaire was created by the researchers after reviewing the literature related to nutritional and other risk factors for type 1 DM. The questionnaire was administered by interviewing the parents and it was related to the child, mother and family of the child. In this study, breastfeeding duration was defined as the total duration of breastfeeding and exclusive breastfeeding meant that the child received only breast milk from the mother. Results The mean age at diagnosis was 6.30 ± 4.03 years for cases and 7.48 ± 2.56 years for controls. We found that each monthly increase in exclusive breastfeeding duration provided a 0.83-fold (95% CI 0.72, 0.96) decrease in the risk of type 1 DM. Introduction of cereals in the diet at the sixth month or earlier was associated with a 2.58-fold (95% CI 1.29, 5.16) increased risk. Conclusions Determining the contribution of exclusive breastfeeding to the disease is important in establishing preventive policies. A longer duration of exclusive breastfeeding may be an important role in preventing the disease. This free intervention that truly works will be cost-effective. Future studies are needed to clarify the role of both exclusive and non-exclusive breastfeeding on the development of type 1 DM. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-022-00470-z.
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Affiliation(s)
- İpek Çiçekli
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Acibadem University, İstanbul, Turkey.
| | - Raika Durusoy
- Department of Public Health, Faculty of Medicine, Ege University, İzmir, Turkey
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7
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The Role of Exposomes in the Pathophysiology of Autoimmune Diseases I: Toxic Chemicals and Food. PATHOPHYSIOLOGY 2021; 28:513-543. [PMID: 35366249 PMCID: PMC8830458 DOI: 10.3390/pathophysiology28040034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/11/2021] [Accepted: 12/15/2021] [Indexed: 12/12/2022] Open
Abstract
Autoimmune diseases affect 5–9% of the world’s population. It is now known that genetics play a relatively small part in the pathophysiology of autoimmune disorders in general, and that environmental factors have a greater role. In this review, we examine the role of the exposome, an individual’s lifetime exposure to external and internal factors, in the pathophysiology of autoimmune diseases. The most common of these environmental factors are toxic chemicals, food/diet, and infections. Toxic chemicals are in our food, drink, common products, the air, and even the land we walk on. Toxic chemicals can directly damage self-tissue and cause the release of autoantigens, or can bind to human tissue antigens and form neoantigens, which can provoke autoimmune response leading to autoimmunity. Other types of autoimmune responses can also be induced by toxic chemicals through various effects at the cellular and biochemical levels. The food we eat every day commonly has colorants, preservatives, or packaging-related chemical contamination. The food itself may be antigenic for susceptible individuals. The most common mechanism for food-related autoimmunity is molecular mimicry, in which the food’s molecular structure bears a similarity with the structure of one or more self-tissues. The solution is to detect the trigger, remove it from the environment or diet, then repair the damage to the individual’s body and health.
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Virtanen SM, Cuthbertson D, Nucci AM, Hyytinen M, Ormisson A, Salonen M, Turrini T, Cummings EA, Bradley B, Tanner‐Blasiar M, Becker DJ, Åkerblom HK, Savilahti E, Krischer JP, Knip M. Dietary compliance in a randomized double-blind infant feeding trial during infancy aiming at prevention of type 1 diabetes. Food Sci Nutr 2021; 9:4221-4231. [PMID: 34401073 PMCID: PMC8358383 DOI: 10.1002/fsn3.2389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 11/20/2022] Open
Abstract
The international Trial to Reduce IDDM in the Genetically at Risk (TRIGR) tested the hypothesis whether extensively hydrolyzed casein-based versus regular cow's milk-based infant formula reduces the risk of type 1 diabetes. We describe dietary compliance in the trial in terms of study formula intake, feeding of nonrecommended foods, and serum cow's milk antibody concentration reflecting intake of cow's milk protein among 2,159 eligible newborn infants with a biological first-degree relative affected by type 1 diabetes and with HLA-conferred susceptibility to type 1 diabetes. The participating infants were introduced to the study formula feeding at the median age of 15 days with a median duration of study formula use of 63 days. During the intervention, 80% of the infants received study formula. Of these, 57% received study formula for at least 2 months. On average, 45.5 l of study formula were used per infant. Only 13% of the population had received a nonrecommended food by the age of 6 months. The dietary compliance was similar in the intervention and control arm. The reported cow's milk consumption by the families matched very well with measured serum casein IgA and IgG antibody concentration. To conclude, good compliance was observed in this randomized infant feeding trial. Compliance varied between the regions and those infants who were breastfed for a longer period of time had a shorter exposure to the study formula. High dietary compliance in infant feeding trial is necessary to allow accurate interpretation of study results.
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Affiliation(s)
- Suvi M. Virtanen
- Health and Well‐Being Promotion UnitFinnish Institute for Health and WelfareHelsinkiFinland
- Faculty of Social Sciences/Unit of Health SciencesTampere UniversityTampereFinland
- Center for Child Health ResearchTampere University HospitalTampere UniversityTampereFinland
- Research Development and Innovation CentreTampere University HospitalTampereFinland
| | | | - Anita M. Nucci
- Department of NutritionGeorgia State UniversityAtlantaGAUSA
| | | | - Anne Ormisson
- Department of PaediatricsUniversity of TartuTartuEstonia
| | | | | | | | - Brenda Bradley
- Children’s Hospital of Eastern OntarioUniversity of OttawaOttawaONCanada
| | | | - Dorothy J. Becker
- Children's Hospital of PittsburghPittsburghPAUSA
- University of PittsburghPittsburghPAUSA
| | | | | | | | - Mikael Knip
- University of HelsinkiHelsinkiFinland
- Children’s HospitalHelsinki University HospitalUniversity of HelsinkiHelsinkiFinland
- Folkhälsan Research CenterHelsinkiFinland
- Department of PediatricsTampere University HospitalTampereFinland
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9
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Mattila M, Niinistö S, Takkinen HM, Tapanainen H, Reinivuo H, Åkerlund M, Suomi J, Ahonen S, Ilonen J, Toppari J, Knip M, Veijola R, Virtanen SM. Maternal Nitrate and Nitrite Intakes during Pregnancy and Risk of Islet Autoimmunity and Type 1 Diabetes: The DIPP Cohort Study. J Nutr 2020; 150:2969-2976. [PMID: 32856042 DOI: 10.1093/jn/nxaa250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/26/2020] [Accepted: 07/27/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND High dietary intake of nitrate and nitrite might increase the risk of type 1 diabetes. To our knowledge, no earlier prospective study has explored whether maternal dietary intake of nitrate and nitrite during pregnancy is associated with the risk of type 1 diabetes in the offspring. OBJECTIVE Our aim was to study association between maternal intake of nitrate and nitrite during pregnancy and the risk of islet autoimmunity and type 1 diabetes in the offspring. DESIGN Children born between 1997 and 2004 at Oulu and Tampere University Hospitals in Finland and carrying increased human leukocyte antigen (HLA)-conferred risk for type 1 diabetes were followed in the Type 1 Diabetes Prediction and Prevention (DIPP) study from 3 mo of age. Islet autoantibodies were screened at 3- to 12-mo intervals from serum samples. Of 4879 children, 312 developed islet autoimmunity and 178 developed type 1 diabetes during a 15-y follow-up. Maternal intake of nitrate and nitrite during the eighth month of pregnancy was assessed after birth using a validated self-administered FFQ. Cox proportional hazards regression was used for the statistical analyses. RESULTS Maternal intake of nitrate and nitrite during pregnancy was not associated with the child's risk of islet autoimmunity [nitrate: HR 0.99 (95% CI: 0.88, 1.11); nitrite: HR 1.03 (95% CI: 0.92, 1.15)] or type 1 diabetes [nitrate: HR 1.02 (95% CI: 0.88, 1.17); nitrite: HR 0.97 (95% CI: 0.83, 1.12)] when adjusted for energy (residual method), sex, HLA risk group, and family history of diabetes. Further adjustment for dietary antioxidants (vitamin C, vitamin E, and selenium) did not change the results. CONCLUSION Maternal dietary intake of nitrate or nitrite during pregnancy is not associated with the risk of islet autoimmunity or type 1 diabetes in the offspring genetically at risk for type 1 diabetes.
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Affiliation(s)
- Markus Mattila
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland.,Research, Development and Innovation Centre, Tampere University Hospital, Tampere, Finland.,Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Sari Niinistö
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna-Mari Takkinen
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland.,Research, Development and Innovation Centre, Tampere University Hospital, Tampere, Finland.,Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Heli Tapanainen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Heli Reinivuo
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Mari Åkerlund
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland.,Research, Development and Innovation Centre, Tampere University Hospital, Tampere, Finland.,Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Johanna Suomi
- Risk Assessment Unit, Research and Laboratory Department, Finnish Food Authority, Helsinki, Finland
| | - Suvi Ahonen
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland.,Research, Development and Innovation Centre, Tampere University Hospital, Tampere, Finland.,Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jorma Ilonen
- Immunogenetics Laboratory, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Jorma Toppari
- Department of Pediatrics, Turku University Hospital, Turku, Finland.,Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Mikael Knip
- Pediatric Research Center, Children's Hospital, University of Helsinki, Helsinki, Finland.,Helsinki University Hospital, Helsinki, Finland.,The Clinical and Metabolic Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Riitta Veijola
- Department of Pediatrics, PEDEGO Research Unit, Medical Research Center, University of Oulu, Oulu, Finland.,Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Suvi M Virtanen
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland.,Research, Development and Innovation Centre, Tampere University Hospital, Tampere, Finland.,Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
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10
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Vojdani A, Gushgari LR, Vojdani E. Interaction between food antigens and the immune system: Association with autoimmune disorders. Autoimmun Rev 2020; 19:102459. [PMID: 31917265 DOI: 10.1016/j.autrev.2020.102459] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 08/19/2019] [Indexed: 02/08/2023]
Abstract
It has been shown that environmental factors such as infections, chemicals, and diet play a major role in autoimmune diseases; however, relatively little attention has been given to food components as the most prevalent modifiers of these afflictions. This review summarizes the current body of knowledge related to different mechanisms and associations between food proteins/peptides and autoimmune disorders. The primary factor controlling food-related immune reactions is the oral tolerance mechanism. The failure of oral tolerance triggers immune reactivity against dietary antigens, which may initiate or exacerbate autoimmune disease when the food antigen shares homology with human tissue antigens. Because the conformational fit between food antigens and a host's self-determinants has been determined for only a few food proteins, we examined evidence related to the reaction of affinity-purified disease-specific antibody with different food antigens. We also studied the reaction of monoclonal or polyclonal tissue-specific antibodies with various food antigens and the reaction of food-specific antibodies with human tissue antigens. Examining the assembled information, we postulated that chemical modification of food proteins by different toxicants in food may result in immune reaction against modified food proteins that cross-react with tissue antigens, resulting in autoimmune reactivity. Because we are what our microbiome eats, food can change the gut commensals, and toxins can breach the gut barrier, penetrating into different organs where they can initiate autoimmune response. Conversely, there are also foods and supplements that help maintain oral tolerance and microbiome homeostasis. Understanding the potential link between specific food consumption and autoimmunity in humans may lay the foundation for further research about the proper diet in the prevention of autoimmune diseases.
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Affiliation(s)
- Aristo Vojdani
- Immunosciences Lab, Inc., 822 S. Robertson Blvd, Ste. 312, Los Angeles, CA 90035, USA; Department of Preventive Medicine, Loma Linda University, Loma Linda, CA 92350, USA.
| | - Lydia R Gushgari
- Cyrex Laboratories, LLC. 2602 South 24(th) St., Phoenix, AZ 85034, USA.
| | - Elroy Vojdani
- Regenera Medical, 11860 Wilshire Blvd., Ste. 301, Los Angeles, CA 90025, USA.
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11
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Dedrick S, Sundaresh B, Huang Q, Brady C, Yoo T, Cronin C, Rudnicki C, Flood M, Momeni B, Ludvigsson J, Altindis E. The Role of Gut Microbiota and Environmental Factors in Type 1 Diabetes Pathogenesis. Front Endocrinol (Lausanne) 2020; 11:78. [PMID: 32174888 PMCID: PMC7057241 DOI: 10.3389/fendo.2020.00078] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 02/06/2020] [Indexed: 12/11/2022] Open
Abstract
Type 1 Diabetes (T1D) is regarded as an autoimmune disease characterized by insulin deficiency resulting from destruction of pancreatic β-cells. The incidence rates of T1D have increased worldwide. Over the past decades, progress has been made in understanding the complexity of the immune response and its role in T1D pathogenesis, however, the trigger of T1D autoimmunity remains unclear. The increasing incidence rates, immigrant studies, and twin studies suggest that environmental factors play an important role and the trigger cannot simply be explained by genetic predisposition. Several research initiatives have identified environmental factors that potentially contribute to the onset of T1D autoimmunity and the progression of disease in children/young adults. More recently, the interplay between gut microbiota and the immune system has been implicated as an important factor in T1D pathogenesis. Although results often vary between studies, broad compositional and diversity patterns have emerged from both longitudinal and cross-sectional human studies. T1D patients have a less diverse gut microbiota, an increased prevalence of Bacteriodetes taxa and an aberrant metabolomic profile compared to healthy controls. In this comprehensive review, we present the data obtained from both animal and human studies focusing on the large longitudinal human studies. These studies are particularly valuable in elucidating the environmental factors that lead to aberrant gut microbiota composition and potentially contribute to T1D. We also discuss how environmental factors, such as birth mode, diet, and antibiotic use modulate gut microbiota and how this potentially contributes to T1D. In the final section, we focus on existing recent literature on microbiota-produced metabolites, proteins, and gut virome function as potential protectants or triggers of T1D onset. Overall, current results indicate that higher levels of diversity along with the presence of beneficial microbes and the resulting microbial-produced metabolites can act as protectors against T1D onset. However, the specifics of the interplay between host and microbes are yet to be discovered.
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Affiliation(s)
- Sandra Dedrick
- Biology Department, Boston College, Chestnut Hill, MA, United States
| | | | - Qian Huang
- Biology Department, Boston College, Chestnut Hill, MA, United States
| | - Claudia Brady
- Biology Department, Boston College, Chestnut Hill, MA, United States
| | - Tessa Yoo
- Biology Department, Boston College, Chestnut Hill, MA, United States
| | - Catherine Cronin
- Biology Department, Boston College, Chestnut Hill, MA, United States
| | - Caitlin Rudnicki
- Biology Department, Boston College, Chestnut Hill, MA, United States
| | - Michael Flood
- Biology Department, Boston College, Chestnut Hill, MA, United States
| | - Babak Momeni
- Biology Department, Boston College, Chestnut Hill, MA, United States
| | - Johnny Ludvigsson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Emrah Altindis
- Biology Department, Boston College, Chestnut Hill, MA, United States
- *Correspondence: Emrah Altindis
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12
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Tremblay J, Hamet P. Environmental and genetic contributions to diabetes. Metabolism 2019; 100S:153952. [PMID: 31610851 DOI: 10.1016/j.metabol.2019.153952] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/18/2019] [Accepted: 07/18/2019] [Indexed: 01/18/2023]
Abstract
Diabetes mellitus (DM) is a heterogeneous group of disorders characterized by persistent hyperglycemia. Its two most common forms are type 1 diabetes (T1D) and type 2 diabetes (T2D), for which genetic and environmental risk factors act in synergy. Because it occurs in children and involves infectious, autoimmune or toxic destruction of the insulin-secreting pancreatic beta-cells, type 1 diabetes has been called juvenile or insulin-deficient diabetes. In type 2, patients can still secrete some insulin but its effectiveness may be attenuated by 'insulin resistance.' There is also a group of rare forms of diabetes in the young which are inherited as monogenetic diseases. Whether one calls the underlying process 'genes vs. environment' or 'nature vs nurture', diabetes occurs at the interface of the two domains. Together with our genetic background we are born tabula rasa-a blank slate upon which the story of life, with all its environmental inputs will be written. There is one proviso: the influence of epigenetic inheritance must also be considered. Thus, in the creation of databases that include "big data" originating from genomic as well as exposome (defined as: the totality of environmental exposure from conception to death), a broad perspective is crucial as these factors act in concert in such chronic illnesses as diabetes that, for example, are likely to require adoption of an appropriate lifestyle change. Also, it is becoming increasingly evident that epigenetic factors can modulate the interplay between genes and environment. Consequently, throughout the life of an individual nature and nurture interact in a complex manner in the development of diabetes. This review addresses the question of the contribution of gene and environment and their interactions in the development of diabetes.
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Affiliation(s)
- Johanne Tremblay
- CRCHUM Research Center, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Pavel Hamet
- CRCHUM Research Center, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
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13
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Ali MT, Al Suwaidi J. Racial and ethnic differences in cardiovascular disease and outcome in type 1 diabetes patients. Expert Rev Endocrinol Metab 2019; 14:225-231. [PMID: 31081398 DOI: 10.1080/17446651.2019.1613887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Type 1 diabetes mellitus (T1DM) has increased dramatically over the last two decades with global variation greater than 350-fold difference reflecting the ethnic, racial, and geographical variation. Diabetic patients remain at a higher risk of cardiovascular mortality than those without diabetes. Therefore, it is vital for clinicians to have in-depth knowledge of T1DM statistics and their impact on people health and health resources. AREAS COVERED This review will cover the epidemiologic characteristics of T1DM and the influence of race, ethnicity, and geographical variation on the incidence and the outcome. The minority populations health disparities in the clinical presentation and outcomes among youth with T1DM, the long-term glycemic control patterns in racially and ethnically diverse youth, and the long-term influence of these factors on cardiovascular outcomes will be elucidated. The PubMed database was searched using the terms: T1DM ± incidence, Race, ethnicity, and Genetic. EXPERT OPINION Understanding the epidemiological characteristics of T1DM including race, ethnicity and the genetic predisposition will help to develop guidelines target these higher risk patients of an unfavorable outcome. Further research and interventional strategies to identify infants at genetic risk of T1DM may help to prevent, stop or retard the destructive autoimmune process leading to T1DM.
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Affiliation(s)
- Mohammed T Ali
- a Heart Hospital , Hamad Medical Corporation , Doha , Qatar
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14
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Gershteyn IM, Ferreira LMR. Immunodietica: A data-driven approach to investigate interactions between diet and autoimmune disorders. J Transl Autoimmun 2019; 1:100003. [PMID: 32743493 PMCID: PMC7388395 DOI: 10.1016/j.jtauto.2019.100003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 05/17/2019] [Accepted: 05/19/2019] [Indexed: 12/30/2022] Open
Abstract
Autoimmunity is on the rise around the globe. Diet has been proposed as a risk factor for autoimmunity and shown to modulate the severity of several autoimmune disorders. Yet, the interaction between diet and autoimmunity in humans remains largely unstudied. Here, we systematically interrogated commonly consumed animals and plants for peptide epitopes previously implicated in human autoimmune disease. A total of fourteen species investigated could be divided into three broad categories regarding their content in human autoimmune epitopes, which we represented using a new metric, the Gershteyn-Ferreira index (GF index). Strikingly, pig contains a disproportionately high number of unique autoimmune epitopes compared to all other species analyzed. This work uncovers a potential new link between pork consumption and autoimmunity in humans and lays the foundation for future studies on the impact of diet on the pathogenesis and progression of autoimmune disorders.
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Affiliation(s)
- Iosif M Gershteyn
- Ajax Biomedical Foundation, Newton, MA, United States.,ImmuVia LLC, Waltham, MA, United States
| | - Leonardo M R Ferreira
- Ajax Biomedical Foundation, Newton, MA, United States.,Department of Surgery, Transplantation Research Laboratory, University of California San Francisco, San Francisco, CA, United States.,Diabetes Center, Sean N. Parker Autoimmunity Research Laboratory, University of California San Francisco, San Francisco, CA, United States
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15
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Immunomodulatory Effect of Vitamin D and Its Potential Role in the Prevention and Treatment of Type 1 Diabetes Mellitus-A Narrative Review. Molecules 2018; 24:molecules24010053. [PMID: 30586887 PMCID: PMC6337255 DOI: 10.3390/molecules24010053] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 12/14/2018] [Accepted: 12/21/2018] [Indexed: 12/16/2022] Open
Abstract
Type 1 diabetes mellitus is a chronic autoimmune disease associated with degeneration of pancreatic β-cells that results in an inability to produce insulin and the need for exogenous insulin administration. It is a significant global health problem as the incidence of this disorder is increasing worldwide. The causes are still poorly understood, although it certainly has genetic and environmental origins. Vitamin D formed profusely in the skin upon exposure to sunlight, as well as from dietary sources, exhibits an immunomodulatory effect based on gene transcription control. Indeed, vitamin D can downregulate mechanisms connected with adaptive immunity, induce immunological tolerance and decrease auto-aggression-related inflammation. These properties provide the basis for a preventive and therapeutic role of vitamin D. As many studies have demonstrated, appropriate supplementation with vitamin D reduces the risk of autoimmune diseases, including type 1 diabetes mellitus, and alleviates disease symptoms in patients. The aim of this narrative review is to present the molecular mechanisms for the vitamin D immunomodulatory effect as well as review human clinical studies on the use of vitamin D as adjuvant therapy in type 1 diabetes mellitus.
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16
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Borg DJ, Yap FYT, Keshvari S, Simmons DG, Gallo LA, Fotheringham AK, Zhuang A, Slattery RM, Hasnain SZ, Coughlan MT, Kantharidis P, Forbes JM. Perinatal exposure to high dietary advanced glycation end products in transgenic NOD8.3 mice leads to pancreatic beta cell dysfunction. Islets 2018; 10:10-24. [PMID: 29157116 PMCID: PMC5796486 DOI: 10.1080/19382014.2017.1405189] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 07/17/2017] [Accepted: 11/03/2017] [Indexed: 01/11/2023] Open
Abstract
The contribution of environmental factors to pancreatic islet damage in type 1 diabetes remains poorly understood. In this study, we crossed mice susceptible to type 1 diabetes, where parental male (CD8+ T cells specific for IGRP206-214; NOD8.3) and female (NOD/ShiLt) mice were randomized to a diet either low or high in AGE content and maintained on this diet throughout pregnancy and lactation. After weaning, NOD8.3+ female offspring were identified and maintained on the same parental feeding regimen for until day 28 of life. A low AGE diet, from conception to early postnatal life, decreased circulating AGE concentrations in the female offspring when compared to a high AGE diet. Insulin, proinsulin and glucagon secretion were greater in islets isolated from offspring in the low AGE diet group, which was akin to age matched non-diabetic C57BL/6 mice. Pancreatic islet expression of Ins2 gene was also higher in offspring from the low AGE diet group. Islet expression of glucagon, AGEs and the AGE receptor RAGE, were each reduced in low AGE fed offspring. Islet immune cell infiltration was also decreased in offspring exposed to a low AGE diet. Within pancreatic lymph nodes and spleen, the proportions of CD4+ and CD8+ T cells did not differ between groups. There were no significant changes in body weight, fasting glucose or glycemic hormones. This study demonstrates that reducing exposure to dietary AGEs throughout gestation, lactation and early postnatal life may benefit pancreatic islet secretion and immune infiltration in the type 1 diabetic susceptible mouse strain, NOD8.3.
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Affiliation(s)
- Danielle J. Borg
- Glycation and Diabetes, Mater Research Institute, The University of Queensland, Translational Research Institute, Brisbane, Australia
- Inflammatory Diseases Biology and Therapeutics, Mater Research Institute- The University of Queensland, Translational Research Institute, Brisbane, Australia
| | - Felicia Y. T. Yap
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- Department of Immunology, Central and Eastern Clinical School, AMREP Precinct, Monash University, Melbourne, Australia
| | - Sahar Keshvari
- Inflammatory Diseases Biology and Therapeutics, Mater Research Institute- The University of Queensland, Translational Research Institute, Brisbane, Australia
| | - David G. Simmons
- School of Biomedical Sciences, The University of Queensland, St Lucia, Australia
| | - Linda A. Gallo
- Glycation and Diabetes, Mater Research Institute, The University of Queensland, Translational Research Institute, Brisbane, Australia
- School of Biomedical Sciences, The University of Queensland, St Lucia, Australia
| | - Amelia K. Fotheringham
- Glycation and Diabetes, Mater Research Institute, The University of Queensland, Translational Research Institute, Brisbane, Australia
- School of Biomedical Sciences, The University of Queensland, St Lucia, Australia
| | - Aowen Zhuang
- Glycation and Diabetes, Mater Research Institute, The University of Queensland, Translational Research Institute, Brisbane, Australia
| | - Robyn M. Slattery
- Department of Immunology, Central and Eastern Clinical School, AMREP Precinct, Monash University, Melbourne, Australia
| | - Sumaira Z. Hasnain
- Inflammatory Diseases Biology and Therapeutics, Mater Research Institute- The University of Queensland, Translational Research Institute, Brisbane, Australia
| | - Melinda T. Coughlan
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- Diabetes Department, Central Clinical School, Monash University, Clayton, Vic, Australia
| | - Phillip Kantharidis
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- Diabetes Department, Central Clinical School, Monash University, Clayton, Vic, Australia
| | - Josephine M. Forbes
- Glycation and Diabetes, Mater Research Institute, The University of Queensland, Translational Research Institute, Brisbane, Australia
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- Diabetes Department, Central Clinical School, Monash University, Clayton, Vic, Australia
- Mater Clinical School, School of Medicine, The University of Queensland, St Lucia, Australia
- Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, Australia
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17
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Lee M, Kim MJ, Oh J, Piao C, Park YW, Lee DY. Gene delivery to pancreatic islets for effective transplantation in diabetic animal. J IND ENG CHEM 2017. [DOI: 10.1016/j.jiec.2017.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Shaltout AA, Wake D, Thanaraj TA, Omar DM, Al-AbdulRazzaq D, Channanath A, AlKandari H, Abdulrasoul M, Miller S, Conway N, Tuomilehto J, Davidsson L. Incidence of type 1 diabetes has doubled in Kuwaiti children 0-14 years over the last 20 years. Pediatr Diabetes 2017; 18:761-766. [PMID: 27981709 DOI: 10.1111/pedi.12480] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 10/24/2016] [Accepted: 11/03/2016] [Indexed: 12/22/2022] Open
Abstract
AIMS This study had 2 aims: to report data on the incidence of childhood-onset type 1 diabetes in Kuwaiti children aged 0-14 years during 2011 to 2013 and to compare the recent data with those collected during 1992 to 1997. METHODS All newly diagnosed patients were registered through the Childhood-Onset Diabetes eRegistry (CODeR) in 2011-2013, based on the DiaMond protocol used in 1992-1997. RESULTS A total of 515 Kuwaiti children (247 boys and 268 girls) aged 0-14 years newly diagnosed with type 1 diabetes were registered from 1 January 2011 to 31 December 2013. Data ascertainment were 96.7%. The mean age ± SD at diagnosis was 8.7 ± 3.4 years in boys and 7.9 ± 3.1 years in girls. The crude incidence rate (95% CI) was 40.9 (37.4-44.6) and the age standardized rate 41.7 (95% 38.1-45.4) per 100,000 per year, 39.3 (34.6-44.4) among boys and 44.1 (39.0-49.7) among girls. A statistically significant increasing trend in incidence was observed as the overall crude incidence rose from 17.7 in 1992-1994 to 40.9 per 100,000 per year in 2011-2013. The Poisson regression model depicting the trend in incidence revealed that, the incidence rates adjusted for age and sex in 2011 to 2013 was 2.3 (95% CI 1.9-2.7) times higher than 1992-1997. CONCLUSIONS The incidence of type 1 diabetes in Kuwaiti children 0-14 years has doubled in the last 2 decades. The reasons for this increase requires further investigation.
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Affiliation(s)
- Azza A Shaltout
- Research Division, Dasman Diabetes Institute, Kuwait, Kuwait
| | - Deborah Wake
- Medical Research Unit, University of Dundee, Ninewells Hospital, Dundee, United Kingdom of Great Britain and Northern Ireland
| | | | - Dina M Omar
- Research Division, Dasman Diabetes Institute, Kuwait, Kuwait
| | | | | | | | - Majedah Abdulrasoul
- Department of Pediatrics, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | | | - Nicholas Conway
- Medical Research Unit, University of Dundee, Ninewells Hospital, Dundee, United Kingdom of Great Britain and Northern Ireland
| | | | - Lena Davidsson
- Research Division, Dasman Diabetes Institute, Kuwait, Kuwait
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19
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Abstract
Type 1 diabetes (T1D) is perceived as a chronic immune-mediated disease with a subclinical prodromal period characterized by selective loss of insulin-producing beta cells in the pancreatic islets in genetically susceptible subjects. The incidence of T1D has increased manifold in most developed countries after World War II in parallel with a series of other immune-mediated diseases. T1D results from gene-environmental interactions. The appearance of disease-associated autoantibodies into the peripheral circulation is the first detectable sign of the initiation of the disease process leading to clinical T1D. The first autoantibodies may appear already before the age of 6 months and the seroconversion rate peaks during the second year of life. This implies that exogenous factors involved in the pathogenesis of T1D must be operative in early life, some of them most likely already during pregnancy. Here, we discuss putative endogenous factors that may contribute to the development of T1D during fetal and early postnatal life. Many environmental factors operative in early life have been implicated in the pathogenesis of T1D, but relatively few have been firmly confirmed.
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20
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Awadalla NJ, Hegazy AA, Abd El-Salam M, Elhady M. Environmental Factors Associated with Type 1 Diabetes Development: A Case Control Study in Egypt. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E615. [PMID: 28590451 PMCID: PMC5486301 DOI: 10.3390/ijerph14060615] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 06/01/2017] [Accepted: 06/03/2017] [Indexed: 01/14/2023]
Abstract
Uncertainty still exists regarding the role of some environmental risk in the development of type 1 diabetes mellitus (T1DM) both globally and in Egypt. The objective here was to explore the potential environmental risk factors associated with the development of T1DM among children in Egypt. A case-controlled study of 204 T1DM children and an equal number of age and sex-matched controls was conducted in Assiut, Egypt. Data regarding the parental, gestational, neonatal, and childhood possible risk factors for T1DM were evaluated. The final sex adjusted multivariable logistic regression model revealed that the risk for T1DM was significantly higher among rural residents (aOR = 2.03, 95% CI: 1.30-4.25), those with parental history of T1DM (aOR = 9.03, 95% CI: 1.02-83.32), birth through cesarean section (aOR = 2.13, 95% CI: 1.09-5.03), and having history of early introduction of cow milk in the first year of life (aOR = 19.49, 95% CI: 8.73-45.53). On the other hand, a protective effect was observed between at least six months' breastfeeding, vitamin D supplementation in the first year of life, high physical activity, and the development of T1DM. Educational programs should be adopted to improve awareness and knowledge of the parents to avoid the increased risk factors and encourage protective practices.
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Affiliation(s)
- Nabil J Awadalla
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia.
- Department of Community Medicine, Faculty of Medicine, Mansoura University, Mansoura 3551, Egypt.
| | - Amal A Hegazy
- Department of Family and Community Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia.
- Department of Community and Occupational Medicine, Faculty of Medicine (for girls), Al-Azhar University, Cairo 11651, Egypt.
| | - Manal Abd El-Salam
- Department of Pediatrics, Faculty of Medicine (for girls), Al-Azhar University, Cairo 11651, Egypt.
| | - Marwa Elhady
- Department of Pediatrics, Faculty of Medicine (for girls), Al-Azhar University, Cairo 11651, Egypt.
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21
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Nucci AM, Virtanen SM, Sorkio S, Bärlund S, Cuthbertson D, Uusitalo U, Lawson ML, Salonen M, Berseth CL, Ormisson A, Lehtonen E, Savilahti E, Becker DJ, Dupré J, Krischer JP, Knip M, Åkerblom HK. Regional differences in milk and complementary feeding patterns in infants participating in an international nutritional type 1 diabetes prevention trial. MATERNAL AND CHILD NUTRITION 2016; 13. [PMID: 27714970 DOI: 10.1111/mcn.12354] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 06/02/2016] [Accepted: 06/07/2016] [Indexed: 01/24/2023]
Abstract
Differences in breastfeeding, other milk feeding and complementary feeding patterns were evaluated in infants at increased genetic risk with and without maternal type 1 diabetes (T1D). The Trial to Reduce IDDM in the Genetically at Risk is an international nutritional primary prevention double-blinded randomized trial to test whether weaning to extensively hydrolyzed vs. intact cow's milk protein formula will decrease the development of T1D-associated autoantibodies and T1D. Infant diet was prospectively assessed at two visits and seven telephone interviews between birth and 8 months. Countries were grouped into seven regions: Australia, Canada, Northern Europe, Southern Europe, Central Europe I, Central Europe II and the United States. Newborn infants with a first-degree relative with T1D and increased human leukocyte antigen-conferred susceptibility to T1D were recruited. A lower proportion of infants born to mothers with than without T1D were breastfed until 6 months of age in all regions (range, 51% to 60% vs. 70% to 80%). Complementary feeding patterns differed more by region than by maternal T1D. In Northern Europe, a higher proportion of infants consumed vegetables and fruits daily compared with other regions. Consumption of meat was more frequent in all European regions, whereas cereal consumption was most frequent in Southern Europe, Canada and the United States. Maternal T1D status was associated with breastfeeding and other milk feeding patterns similarly across regions but was unrelated to the introduction of complementary foods. Infant feeding patterns differed significantly among regions and were largely inconsistent with current recommended guidelines.
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Affiliation(s)
- Anita M Nucci
- Department of Nutrition, Georgia State University, Atlanta, Georgia, USA
| | - Suvi M Virtanen
- Nutrition Unit, National Institute for Health and Welfare, Helsinki, Finland.,School of Health Sciences, University of Tampere, Tampere, Finland.,Center for Child Health Research, Tampere University Hospital, University of Tampere, Tampere, Finland.,The Science Center of Pirkanmaa Hospital District, Tampere, Finland
| | - Susa Sorkio
- Nutrition Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Sonja Bärlund
- Nutrition Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - David Cuthbertson
- Pediatrics Epidemiology Center, University of South Florida, Tampa, Florida, USA
| | - Ulla Uusitalo
- Pediatrics Epidemiology Center, University of South Florida, Tampa, Florida, USA
| | - Margaret L Lawson
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Marja Salonen
- Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - Anne Ormisson
- Department of Paediatrics, University of Tartu, Tartu, Estonia
| | - Eveliina Lehtonen
- Nutrition Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Erkki Savilahti
- Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Dorothy J Becker
- Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,University of Pittsburgh, Pittsburgh, PA
| | - John Dupré
- Robarts Research Institute, London, Ontario, Canada
| | - Jeffrey P Krischer
- Pediatrics Epidemiology Center, University of South Florida, Tampa, Florida, USA
| | - Mikael Knip
- Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.,Folkhälsan Research Center, Helsinki, Finland.,Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | - Hans K Åkerblom
- Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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22
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Virtanen SM. Dietary factors in the development of type 1 diabetes. Pediatr Diabetes 2016; 17 Suppl 22:49-55. [PMID: 27411437 DOI: 10.1111/pedi.12341] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/02/2015] [Accepted: 11/06/2015] [Indexed: 12/13/2022] Open
Abstract
There are several indicators concerning the putative importance of dietary factors during the fetal period lactation, infancy and childhood in the etiology of type 1 diabetes. Among foods, cow's milk consumption has been associated with an increased risk of preclinical and/or clinical type 1 diabetes and sugars with a progression from preclinical to clinical disease. Breast milk, on the other hand, may be protective. Processed foods may be related to a greater risk of type 1 diabetes because they contain higher amounts of advanced glycation end-products. Nitrites or N-nitroso compounds in processed meat products could increase the risk of this disease. Among nutrients, n-3 fatty acids, vitamins D and E, and zinc may protect from preclinical and/or clinical type 1 diabetes. The microbial composition of foods or food's other effects on gut microbiota are receiving increasing attention, also due to their putative role in the development of type 1 diabetes. Still the number of prospective studies in this research field is limited and most of the findings remain to be replicated.
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Affiliation(s)
- Suvi M Virtanen
- Unit of Nutrition, Department of Health, National Institute for Health and Welfare, Helsinki, Finland.,School of Health Sciences, University of Tampere, Tampere, Finland.,Science Center of Pirkanmaa Hospital District, Tampere, Finland.,Center for Child Health Research, University of Tampere and University Hospital of Tampere, Tampere, Finland
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23
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Szendroedi J, Saxena A, Weber KS, Strassburger K, Herder C, Burkart V, Nowotny B, Icks A, Kuss O, Ziegler D, Al-Hasani H, Müssig K, Roden M. Cohort profile: the German Diabetes Study (GDS). Cardiovasc Diabetol 2016; 15:59. [PMID: 27053136 PMCID: PMC4823856 DOI: 10.1186/s12933-016-0374-9] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/24/2016] [Indexed: 12/16/2022] Open
Abstract
Background The German Diabetes Study (GDS) is a prospective longitudinal cohort study describing the impact of subphenotypes on the course of the disease. GDS aims at identifying prognostic factors and mechanisms underlying the development of related comorbidities. Study design and methods The study comprises intensive phenotyping within 12 months after clinical diagnosis, at 5-year intervals for 20 years and annual telephone interviews in between. Dynamic tests, including glucagon, mixed meal, intravenous glucose tolerance and hyperinsulinemic clamp tests, serve to assess beta-cell function and tissue-specific insulin sensitivity. Magnetic resonance imaging and multinuclei spectroscopy allow quantifying whole-body fat distribution, tissue-specific lipid deposition and energy metabolism. Comprehensive analyses of microvascular (nerve, eye, kidney) and macrovascular (endothelial, cardiorespiratory) morphology and function enable identification and monitoring of comorbidities. The GDS biobank stores specimens from blood, stool, skeletal muscle, subcutaneous adipose tissue and skin for future analyses including multiomics, expression profiles and histology. Repeated questionnaires on socioeconomic conditions, patient-reported outcomes as quality of life, health-related behavior as physical activity and nutritional habits are a specific asset of GDS. This study will recruit 3000 patients and a group of humans without familiy history of diabetes. 237 type 1 and 456 type 2 diabetes patients have been already included. Electronic supplementary material The online version of this article (doi:10.1186/s12933-016-0374-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julia Szendroedi
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Aaruni Saxena
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Katharina S Weber
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Klaus Strassburger
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Institute for Biometrics and Epidemiology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany
| | - Christian Herder
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Volker Burkart
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Bettina Nowotny
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Andrea Icks
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Institute for Biometrics and Epidemiology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,Public Health Unit, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Oliver Kuss
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Institute for Biometrics and Epidemiology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany
| | - Dan Ziegler
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Hadi Al-Hasani
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Institute for Clinical Biochemistry and Pathobiochemistry German Diabetes Center, Leibniz Institute for Diabetes Research, Düsseldorf, Germany
| | - Karsten Müssig
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany. .,German Center for Diabetes Research (DZD), München-Neuherberg, Germany. .,Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.
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24
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Oral supplementation of 2'-fucosyllactose during lactation improves memory and learning in rats. J Nutr Biochem 2016; 31:20-7. [PMID: 27133420 DOI: 10.1016/j.jnutbio.2015.12.014] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 12/02/2015] [Accepted: 12/21/2015] [Indexed: 12/21/2022]
Abstract
Human milk oligosaccharides have been proposed to exert beneficial effects on brain development. During the last decades, most of the studies have focused on the evaluation of sialylated structures but recent experiments have also tested fucosylated oligosaccharides, i.e. 2'-fucosyllactose (2'-FL). The present study aimed to determine whether oral 2'-FL has an effect on the development of newborn brain, contributing to enhance cognitive skills later in life. Rat pups received an oral supplementation of 2'-FL (2'-FL group) or water (control group) during the lactation period. Thereafter, animals were maintained on a rodent standard diet. Rats (n=12 rats/group) were evaluated twice, at age 4-6weeks and again at age 1year, using classical behavioral tests. In vivo long-term potentiation (LTP) was also performed at the same ages (n=10 rats/group). Both groups showed similar behavior when the animals were assessed just after weaning (age 4-6weeks), although the 2'-FL group seemed to perform slightly better in Morris Water Maze. At age 1year, 2'-FL rats performed significantly better in the Novel Object Recognition and Y maze paradigms, when compared to controls. In addition, LTP was more intense and longer lasting in the rats supplemented with 2'-FL than in control animals, both in young and adult animals. Oral administration of 2'-FL exclusively during lactation enhanced cognitive abilities, not only in childhood but also in adulthood.
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25
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Uusitalo U, Liu X, Yang J, Aronsson CA, Hummel S, Butterworth M, Lernmark Å, Rewers M, Hagopian W, She JX, Simell O, Toppari J, Ziegler AG, Akolkar B, Krischer J, Norris JM, Virtanen SM. Association of Early Exposure of Probiotics and Islet Autoimmunity in the TEDDY Study. JAMA Pediatr 2016; 170:20-8. [PMID: 26552054 PMCID: PMC4803028 DOI: 10.1001/jamapediatrics.2015.2757] [Citation(s) in RCA: 170] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE Probiotics have been hypothesized to affect immunologic responses to environmental exposures by supporting healthy gut microbiota and could therefore theoretically be used to prevent the development of type 1 diabetes mellitus (T1DM)-associated islet autoimmunity. OBJECTIVE To examine the association between supplemental probiotic use during the first year of life and islet autoimmunity among children at increased genetic risk of T1DM. DESIGN, SETTING, AND PARTICIPANTS In this ongoing prospective cohort study that started September 1, 2004, children from 6 clinical centers, 3 in the United States (Colorado, Georgia/Florida, and Washington) and 3 in Europe (Finland, Germany, and Sweden), were followed up for T1DM-related autoantibodies. Blood samples were collected every 3 months between 3 and 48 months of age and every 6 months thereafter to determine persistent islet autoimmunity. Details of infant feeding, including probiotic supplementation and infant formula use, were monitored from birth using questionnaires and diaries. We applied time-to-event analysis to study the association between probiotic use and islet autoimmunity, stratifying by country and adjusting for family history of type 1 diabetes, HLA-DR-DQ genotypes, sex, birth order, mode of delivery, exclusive breastfeeding, birth year, child's antibiotic use, and diarrheal history, as well as maternal age, probiotic use, and smoking. Altogether 8676 infants with an eligible genotype were enrolled in the follow-up study before the age of 4 months. The final sample consisted of 7473 children with the age range of 4 to 10 years (as of October 31, 2014). EXPOSURES Early intake of probiotics. MAIN OUTCOMES AND MEASURES Islet autoimmunity revealed by specific islet autoantibodies. RESULTS Early probiotic supplementation (at the age of 0-27 days) was associated with a decreased risk of islet autoimmunity when compared with probiotic supplementation after 27 days or no probiotic supplementation (hazard ratio [HR], 0.66; 95% CI, 0.46-0.94). The association was accounted for by children with the DR3/4 genotype (HR, 0.40; 95% CI, 0.21-0.74) and was absent among other genotypes (HR, 0.97; 95% CI, 0.62-1.54). CONCLUSIONS AND RELEVANCE Early probiotic supplementation may reduce the risk of islet autoimmunity in children at the highest genetic risk of T1DM. The result needs to be confirmed in further studies before any recommendation of probiotics use is made.
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Affiliation(s)
- Ulla Uusitalo
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa
| | - Xiang Liu
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa
| | - Jimin Yang
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa
| | | | - Sandra Hummel
- Institute of Diabetes Research, Helmholtz Zentrum München and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München and Forschergruppe Diabetes e.V., Munich, Germany
| | - Martha Butterworth
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Marian Rewers
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora
| | - William Hagopian
- Pacific Northwest Diabetes Research Institute, Seattle, Washington
| | - Jin-Xiong She
- Medical College of Georgia, Georgia Regents University, Augusta
| | - Olli Simell
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Jorma Toppari
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland8Department of Physiology, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Anette G Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München and Forschergruppe Diabetes e.V., Munich, Germany
| | - Beena Akolkar
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Jeffrey Krischer
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa
| | - Jill M Norris
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora
| | - Suvi M Virtanen
- National Institute for Health and Welfare, Nutrition Unit, Helsinki, Finland12School of Health Sciences and Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland 13The Science Center of Pirkanmaa Hospita
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Khashan AS, Kenny LC, Lundholm C, Kearney PM, Gong T, McNamee R, Almqvist C. Gestational Age and Birth Weight and the Risk of Childhood Type 1 Diabetes: A Population-Based Cohort and Sibling Design Study. Diabetes Care 2015; 38:2308-15. [PMID: 26519334 DOI: 10.2337/dc15-0897] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 08/30/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We investigated the effects of gestational age, birth weight, small for gestational age (SGA), and large for gestational age (LGA) on risk of childhood type 1 diabetes. RESEARCH DESIGN AND METHODS We conducted a population-based cohort study of all singleton live births in Sweden between 1973 and 2009 and a sibling control study. Perinatal data were extracted from the Swedish Medical Birth Register. Children with type 1 diabetes diagnosis were identified from the Swedish National Patient Register. Log-linear Poisson regression and conditional logistic regression were used for data analysis. RESULTS The study cohort consisted of 3,624,675 singleton live births (42,411,054 person-years). There were 13,944 type 1 diabetes cases during the study period. The sibling control study consisted of 11,403 children with type 1 diabetes and 17,920 siblings. Gestational age between 33 and 36 weeks (relative risk [RR] 1.18 [95% CI 1.09, 1.28) and 37 and 38 weeks (RR 1.12 [95% CI 1.07, 1.17]) was associated with type 1 diabetes in the cohort study and remained significant in the sibling control study. SGA (RR 0.83 [95% CI 0.75, 0.93]) and LGA (RR 1.14 [95% CI 1.04, 1.24]) were associated with type 1 diabetes in the cohort study. The SGA association remained unchanged in the sibling study, while the LGA association disappeared. Very low birth weight was associated with a reduced risk of type 1 diabetes. CONCLUSIONS The findings suggest a small association between gestational age and type 1 diabetes that is not likely due to familial confounding factors. Gestational age and type 1 diabetes may be related to insulin resistance due to early life growth restriction or altered gut microbiota in preterm babies.
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Affiliation(s)
- Ali S Khashan
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland The Irish Centre for Fetal and Neonatal Translational Research, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Louise C Kenny
- The Irish Centre for Fetal and Neonatal Translational Research, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Cecilia Lundholm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Patricia M Kearney
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Tong Gong
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Roseanne McNamee
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, U.K
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Astrid Lindgren Children's Hospital, Lung and Allergy Unit, Karolinska University Hospital, Stockholm, Sweden
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Abstract
Type 1 diabetes (T1D) is an autoimmune disease that results from the destruction of the β cells of the pancreas in genetically at-risk individuals. The autoimmune process that precedes the development of T1D is believed to be triggered by environmental factors, including nutrition. Early introduction of complementary foods has been implicated in the etiology of T1D as a possible explanation of the increasing incidence of the disease, particularly in children younger than 5 years of age. Infant feeding recommendations have been designed to promote adequate growth, provide essential nutrients, and reduce the risk of developing chronic illnesses. The World Health Organization and the American Academy of Pediatrics recommend exclusive breastfeeding to 6 months of age followed by continued breastfeeding as complementary foods are introduced. A lack of compliance with these recommendations has been observed in the general population as well as in infants at high risk for T1D. Dietary factors such as the provision of breast milk and duration of breastfeeding, the age at introduction of cow's milk and gluten-containing foods, as well as other complementary feeding have been investigated. However, the evidence that early infant feeding patterns are linked with T1D currently remains inconclusive.
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Affiliation(s)
- Anita M. Nucci
- Department of Nutrition, Georgia State University, P.O. Box 3995, Atlanta, GA 30303-3995, USA
| | - Suvi M. Virtanen
- Nutrition Unit, National Institute for Health and Welfare, Helsinki, Finland
- School of Health Sciences, University of Tampere, Tampere, Finland
- Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
- The Science Center of Pirkanmaa Hospital District, Tampere, Finland
| | - Dorothy J. Becker
- Division of Endocrinology and Diabetes, University of Pittsburgh and Children's Hospital of Pittsburgh of UPMC, 4401 Penn Ave, Pittsburgh, PA 15224, USA
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Periodontal Diseases and Dental Caries in Children with Type 1 Diabetes Mellitus. Mediators Inflamm 2015; 2015:379626. [PMID: 26347009 PMCID: PMC4539482 DOI: 10.1155/2015/379626] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 05/15/2015] [Accepted: 05/18/2015] [Indexed: 11/17/2022] Open
Abstract
Type 1 diabetes mellitus is a chronic metabolic disease of an autoimmune origin with early manifestation predominantly in the childhood. Its incidence has been rising in most European countries. Diabetes has been intensively studied by all branches of medicine. There were a number of studies investigating oral consequences of diabetes; however, unambiguous conclusions were drawn only for the relationship between diabetes and periodontal impairment. Many studies confirmed higher plaque levels and higher incidence of chronic gingivitis both in adults and in children with diabetes. Juvenile periodontitis is rare both in healthy subjects and in those with type 1 diabetes. Yet certain findings from well-conducted studies, for example, differences in oral microflora or the impact of metabolic control of diabetes on periodontal health, indicate a higher risk of periodontitis in children with type 1 diabetes. As for the association of diabetes and dental caries, the results of the studies are inconsistent. However, it was found that some risk factors for dental caries are either more or less prevalent in the diabetic population. Despite an extensive research in this area we have to acknowledge that many questions have remained unanswered. There is a need for continued, thorough research in this area.
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Viator RJ, Khader H, Hingorani N, Long S, Solodushko V, Fouty B. Hypoxia-induced increases in glucose uptake do not cause oxidative injury or advanced glycation end-product (AGE) formation in vascular endothelial cells. Physiol Rep 2015; 3:3/7/e12460. [PMID: 26177960 PMCID: PMC4552536 DOI: 10.14814/phy2.12460] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
An increase in glucose uptake by endothelial cells exposed to hyperglycemia is the presumed initiating event that causes systemic vascular disease in individuals with diabetes. Diabetics do not develop clinically significant pulmonary vascular disease, however, despite the pulmonary circulation’s exposure to the same level of glucose. We hypothesized that pulmonary artery endothelial cells are protected from the detrimental effects of hyperglycemia because they take up less glucose than endothelial cells in the systemic circulation, either because of intrinsic differences between the two cell types or because the lower oxygen tension in the pulmonary arterial blood depresses glucose uptake. To test this hypothesis, we exposed normoglycemic and hyperglycemic bovine pulmonary artery (PAECs) and aortic endothelial cells (AECs) from the same animal to progressively lower oxygen tensions and determined glucose uptake. In contrast with our initial hypothesis, we detected no significant difference in glucose uptake between the two cell types. Furthermore, glucose uptake in both PAECs and AECs increased, not decreased, as the oxygen tension dropped; this oxygen-dependent increase in glucose uptake in endothelial cells predominated over the hyperglycemia-mediated decrease in glucose uptake that has been reported by others. Despite the increase in glucose uptake at lower oxygen tensions, we detected no corresponding increase in protein carbonylation or advanced glycation endproducts. These results demonstrate that small physiologically relevant changes in oxygen tension can have an important impact on glucose uptake in endothelial cells. These results also demonstrate that an increase in glucose uptake, by itself, is not sufficient to generate ROS-mediated protein carbonylation or increase intracellular advanced glycation endproducts in vascular endothelial cells.
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Affiliation(s)
- Ryan J Viator
- The Center for Lung Biology, University of South Alabama School of Medicine, Mobile, Alabama, USA The Department of Pharmacology, University of South Alabama School of Medicine, Mobile, Alabama, USA
| | - Heba Khader
- The Center for Lung Biology, University of South Alabama School of Medicine, Mobile, Alabama, USA The Department of Pharmacology, University of South Alabama School of Medicine, Mobile, Alabama, USA Department of Pharmacology, Zarqa University, Zarqa, Jordan
| | - Neha Hingorani
- The Center for Lung Biology, University of South Alabama School of Medicine, Mobile, Alabama, USA
| | - Sara Long
- The Center for Lung Biology, University of South Alabama School of Medicine, Mobile, Alabama, USA
| | - Victor Solodushko
- The Center for Lung Biology, University of South Alabama School of Medicine, Mobile, Alabama, USA The Department of Pharmacology, University of South Alabama School of Medicine, Mobile, Alabama, USA
| | - Brian Fouty
- The Center for Lung Biology, University of South Alabama School of Medicine, Mobile, Alabama, USA The Department of Pharmacology, University of South Alabama School of Medicine, Mobile, Alabama, USA The Department of Internal Medicine/Division of Pulmonary and Critical Care Medicine, University of South Alabama School of Medicine, Mobile, Alabama, USA
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Lamichhane AP, Crandell JL, Jaacks LM, Couch SC, Lawrence JM, Mayer-Davis EJ. Longitudinal associations of nutritional factors with glycated hemoglobin in youth with type 1 diabetes: the SEARCH Nutrition Ancillary Study. Am J Clin Nutr 2015; 101:1278-85. [PMID: 25948670 PMCID: PMC4441810 DOI: 10.3945/ajcn.114.103747] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 04/02/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Improved glycated hemoglobin (Hb A1c) delays the progression of microvascular and macrovascular complications in individuals with type 1 diabetes (T1D). We previously showed that higher baseline intakes of n-3 (ω-3) fatty acids and leucine are associated with preserved β cell function 2 y later in youth with T1D. OBJECTIVE In the current study, we extend this work to explore the longitudinal associations of nutritional factors with Hb A1c in youth with T1D. DESIGN We included 908 T1D youth with baseline and follow-up Hb A1c measurements. Nutritional factors assessed at baseline were as follows: breastfeeding status and timing of complimentary food introduction; intakes of leucine, carbohydrates, protein, fat, and fiber estimated from a food-frequency questionnaire (FFQ); and plasma biomarkers for vitamins D and E, eicosapentaenoic acid (EPA), and docosahexaenoic acid. We fit linear regression models adjusted for baseline Hb A1c, sociodemographic variables, diabetes-related variables, time between baseline and follow-up visits, saturated fat, physical activity, and for FFQ-derived nutrients, total calories. The vitamin D model was further adjusted for season and body mass index z score. RESULTS The mean ± SD age and diabetes duration at baseline was 10.8 ± 3.9 y and 10.1 ± 5.8 mo, respectively. A total of 9.3% of participants had poor Hb A1c (value ≥9.5%) at baseline, which increased to 18.3% during follow-up (P < 0.0001). Intakes of EPA (β = -0.045, P = 0.046), leucine (β = -0.031, P = 0.0004), and protein (β = -0.003, P = 0.0002) were significantly negatively associated with follow-up Hb A1c after adjustment for confounders. Intake of carbohydrates was significantly positively (β = 0.001, P = 0.003) associated with follow-up Hb A1c after adjustment for confounders. CONCLUSIONS Several nutritional factors may be associated with Hb A1c during early stages of disease progression in youth recently diagnosed with T1D. In addition to the overall role of major macronutrients such as carbohydrates and protein, leucine and n-3 fatty acid intakes, such as of EPA, may be important for long-term glycemic control.
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Affiliation(s)
- Archana P Lamichhane
- From the Department of Nutrition, Gillings School of Global Public Health (APL), the Department of Nutrition, Gillings School of Global Public Health and School of Medicine (EJM-D), and the Departments of Nursing and Biostatistics (JLC), University of North Carolina, Chapel Hill, NC; the Department of Nutritional Sciences, University of Cincinnati Medical Center, Cincinnati, OH (SCC); the Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA (JML), and the Hubert Department of Global Health, Emory University, Atlanta, GA (LMJ).
| | - Jamie L Crandell
- From the Department of Nutrition, Gillings School of Global Public Health (APL), the Department of Nutrition, Gillings School of Global Public Health and School of Medicine (EJM-D), and the Departments of Nursing and Biostatistics (JLC), University of North Carolina, Chapel Hill, NC; the Department of Nutritional Sciences, University of Cincinnati Medical Center, Cincinnati, OH (SCC); the Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA (JML), and the Hubert Department of Global Health, Emory University, Atlanta, GA (LMJ)
| | - Lindsay M Jaacks
- From the Department of Nutrition, Gillings School of Global Public Health (APL), the Department of Nutrition, Gillings School of Global Public Health and School of Medicine (EJM-D), and the Departments of Nursing and Biostatistics (JLC), University of North Carolina, Chapel Hill, NC; the Department of Nutritional Sciences, University of Cincinnati Medical Center, Cincinnati, OH (SCC); the Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA (JML), and the Hubert Department of Global Health, Emory University, Atlanta, GA (LMJ)
| | - Sarah C Couch
- From the Department of Nutrition, Gillings School of Global Public Health (APL), the Department of Nutrition, Gillings School of Global Public Health and School of Medicine (EJM-D), and the Departments of Nursing and Biostatistics (JLC), University of North Carolina, Chapel Hill, NC; the Department of Nutritional Sciences, University of Cincinnati Medical Center, Cincinnati, OH (SCC); the Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA (JML), and the Hubert Department of Global Health, Emory University, Atlanta, GA (LMJ)
| | - Jean M Lawrence
- From the Department of Nutrition, Gillings School of Global Public Health (APL), the Department of Nutrition, Gillings School of Global Public Health and School of Medicine (EJM-D), and the Departments of Nursing and Biostatistics (JLC), University of North Carolina, Chapel Hill, NC; the Department of Nutritional Sciences, University of Cincinnati Medical Center, Cincinnati, OH (SCC); the Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA (JML), and the Hubert Department of Global Health, Emory University, Atlanta, GA (LMJ)
| | - Elizabeth J Mayer-Davis
- From the Department of Nutrition, Gillings School of Global Public Health (APL), the Department of Nutrition, Gillings School of Global Public Health and School of Medicine (EJM-D), and the Departments of Nursing and Biostatistics (JLC), University of North Carolina, Chapel Hill, NC; the Department of Nutritional Sciences, University of Cincinnati Medical Center, Cincinnati, OH (SCC); the Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA (JML), and the Hubert Department of Global Health, Emory University, Atlanta, GA (LMJ)
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Berná G, Oliveras-López MJ, Jurado-Ruíz E, Tejedo J, Bedoya F, Soria B, Martín F. Nutrigenetics and nutrigenomics insights into diabetes etiopathogenesis. Nutrients 2014; 6:5338-69. [PMID: 25421534 PMCID: PMC4245593 DOI: 10.3390/nu6115338] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 10/17/2014] [Accepted: 11/04/2014] [Indexed: 01/17/2023] Open
Abstract
Diabetes mellitus (DM) is considered a global pandemic, and the incidence of DM continues to grow worldwide. Nutrients and dietary patterns are central issues in the prevention, development and treatment of this disease. The pathogenesis of DM is not completely understood, but nutrient-gene interactions at different levels, genetic predisposition and dietary factors appear to be involved. Nutritional genomics studies generally focus on dietary patterns according to genetic variations, the role of gene-nutrient interactions, gene-diet-phenotype interactions and epigenetic modifications caused by nutrients; these studies will facilitate an understanding of the early molecular events that occur in DM and will contribute to the identification of better biomarkers and diagnostics tools. In particular, this approach will help to develop tailored diets that maximize the use of nutrients and other functional ingredients present in food, which will aid in the prevention and delay of DM and its complications. This review discusses the current state of nutrigenetics, nutrigenomics and epigenomics research on DM. Here, we provide an overview of the role of gene variants and nutrient interactions, the importance of nutrients and dietary patterns on gene expression, how epigenetic changes and micro RNAs (miRNAs) can alter cellular signaling in response to nutrients and the dietary interventions that may help to prevent the onset of DM.
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Affiliation(s)
- Genoveva Berná
- Department of Stem Cells, Andalusian Center of Molecular Biology and Regenerative Medicine, University Pablo Olavide (CABIMER-UPO), Seville 41091, Spain.
| | - María Jesús Oliveras-López
- Department of Stem Cells, Andalusian Center of Molecular Biology and Regenerative Medicine, University Pablo Olavide (CABIMER-UPO), Seville 41091, Spain.
| | - Enrique Jurado-Ruíz
- Department of Stem Cells, Andalusian Center of Molecular Biology and Regenerative Medicine, University Pablo Olavide (CABIMER-UPO), Seville 41091, Spain.
| | - Juan Tejedo
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), CIBER of Diabetes and Associated Metabolic Diseases, Instituto de Salud Carlos III, Madrid 28029, Spain.
| | - Francisco Bedoya
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), CIBER of Diabetes and Associated Metabolic Diseases, Instituto de Salud Carlos III, Madrid 28029, Spain.
| | - Bernat Soria
- Department of Stem Cells, Andalusian Center of Molecular Biology and Regenerative Medicine, University Pablo Olavide (CABIMER-UPO), Seville 41091, Spain.
| | - Franz Martín
- Department of Stem Cells, Andalusian Center of Molecular Biology and Regenerative Medicine, University Pablo Olavide (CABIMER-UPO), Seville 41091, Spain.
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Crume TL, Crandell J, Norris JM, Dabelea D, Fangman MT, Pettitt DJ, Dolan L, Rodriguez BL, O'Connor R, Mayer-Davis EJ. Timing of complementary food introduction and age at diagnosis of type 1 diabetes: the SEARCH nutrition ancillary study (SNAS). Eur J Clin Nutr 2014; 68:1258-60. [PMID: 25117987 PMCID: PMC4414319 DOI: 10.1038/ejcn.2014.159] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 05/02/2014] [Accepted: 05/26/2014] [Indexed: 11/08/2022]
Abstract
The association between timing of complementary food introduction and age at diagnosis of type 1 diabetes was investigated among 1077 children in the SEARCH for Diabetes in Youth study. Age at diagnosis was 5 months earlier for children introduced to sugar-sweetened beverages (SSB) in the first 12 months of life compared with those who were not (9.0±0.2 vs 9.5±0.1; P=0.02) independent of human leukocyte antigen (HLA) risk status. Analyses stratified by HLA risk status found that children with a high-risk HLA genotype had an earlier age at diagnosis if they were introduced to fruit juice in the first year of life (mean age at diagnosis=9.3±0.1, 9.1±0.1 and 9.6±0.2 for introduction at ⩽6 months, between 7 and 11 months and ⩾12 months, respectively; P=0.04). Introduction of SSB in the first year of life may accelerate the onset of type 1 diabetes independent of HLA risk status.
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Affiliation(s)
- T L Crume
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
| | - J Crandell
- Department of Nutrition, University of North Carolina at Chapel Hill School of Public Health and School of Medicine, Chapel Hill, NC, USA
| | - J M Norris
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
| | - D Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
| | - M T Fangman
- Department of Nutrition, University of North Carolina at Chapel Hill School of Public Health and School of Medicine, Chapel Hill, NC, USA
| | - D J Pettitt
- Sansum Diabetes Research Institute, Santa Barbara, CA, USA
| | - L Dolan
- Cincinnati Children's Hospital, The University of Cincinnati, Cincinnati, OH, USA
| | - B L Rodriguez
- John A Burns School of Medicine, University of Hawaii, Kaukini Medical Center, Honolulu, HI, USA
| | - R O'Connor
- Center for Clinical and Translational Research, Division of Endocrinology, Seattle Children's Research Institute and University of Washington School of Nursing, Seattle, WA, USA
| | - E J Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill School of Public Health and School of Medicine, Chapel Hill, NC, USA
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Abstract
Type 1 diabetes (T1D) and celiac disease (CD) are autoimmune diseases with clinical and pathogenic overlap. The mean prevalence of CD in patients with T1D is about 8 %. Classic intestinal symptoms of CD may not be present in T1D leading to the recommendation for active case finding in this higher risk group. Screening is done with sensitive and specific serologies including tissue transglutaminase (tTG) IgA and deaminated gliadin peptide (DGP) IgA and IgG. Positive serologies are confirmed by the presence of villous atrophy and increased intraepithelial lymphocytes on duodenal biopsy. A strict gluten free diet is recommended, although this can pose challenges for T1D patients who already have dietary restrictions. In aggregate, it appears as if the gluten free diet may help T1D management. T1D and CD have overlapping genetic and environmental risk factors. Among these, non-HLA genetic factors and the gut microbiome are among recent developments that will be discussed in this review.
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Affiliation(s)
- Aaron Cohn
- Department of Medicine, University of Chicago, 900 East 57th Street, MB#9, Chicago, IL, 60637, USA
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Xie Z, Chang C, Zhou Z. Molecular Mechanisms in Autoimmune Type 1 Diabetes: a Critical Review. Clin Rev Allergy Immunol 2014; 47:174-92. [DOI: 10.1007/s12016-014-8422-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Nielsen DS, Krych Ł, Buschard K, Hansen CHF, Hansen AK. Beyond genetics. Influence of dietary factors and gut microbiota on type 1 diabetes. FEBS Lett 2014; 588:4234-43. [PMID: 24746688 DOI: 10.1016/j.febslet.2014.04.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/04/2014] [Accepted: 04/07/2014] [Indexed: 12/31/2022]
Abstract
Type 1 diabetes (T1D) is an autoimmune disease ultimately leading to destruction of insulin secreting β-cells in the pancreas. Genetic susceptibility plays an important role in T1D etiology, but even mono-zygotic twins only have a concordance rate of around 50%, underlining that other factors than purely genetic are involved in disease development. Here we review the influence of dietary and environmental factors on T1D development in humans as well as animal models. Even though data are still inconclusive, there are strong indications that gut microbiota dysbiosis plays an important role in T1D development and evidence from animal models suggests that gut microbiota manipulation might prove valuable in future prevention of T1D in genetically susceptible individuals.
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Affiliation(s)
- Dennis S Nielsen
- Department of Food Science, Faculty of Science, University of Copenhagen, 1958 Frederiksberg C, Denmark.
| | - Łukasz Krych
- Department of Food Science, Faculty of Science, University of Copenhagen, 1958 Frederiksberg C, Denmark
| | | | - Camilla H F Hansen
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, 1871 Frederiksberg C, Denmark
| | - Axel K Hansen
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, 1871 Frederiksberg C, Denmark
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Franciscus M, Nucci A, Bradley B, Suomalainen H, Greenberg E, Laforte D, Kleemola P, Hyytinen M, Salonen M, Martin MJ, Catte D, Catteau J. Recruitment and retention of participants for an international type 1 diabetes prevention trial: a coordinators' perspective. Clin Trials 2014; 11:150-8. [PMID: 24216218 PMCID: PMC3972359 DOI: 10.1177/1740774513510070] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Trial to Reduce Insulin Dependent Diabetes Mellitus in the Genetically at Risk (TRIGR) is the first multicenter international type 1 diabetes (T1D) prevention trial to be undertaken. A unique feature of TRIGR has been recruitment of eligible pregnant women and enrollment of newborns for long-term follow-up assessments. PURPOSE Our purpose is to summarize the recruitment and retention strategies used to conduct TRIGR from the perspective of the study coordinators. METHODS TRIGR was designed to test whether weaning to formula containing hydrolyzed versus intact cow's milk protein would be efficacious in decreasing risk for development of T1D-associated autoantibodies and T1D among infants identified to be at increased risk for T1D based on their human leukocyte antigen (HLA) profile and family history. Multiple strategies tailored to local issues were required to enroll and follow the target number of infants. RESULTS This study was conducted in the United States, Canada, Australia, and 12 countries in Europe. Of the 5606 mothers registered worldwide, 5000 of their infants were randomized. Of these, 2159 were HLA eligible and enrolled in the 8-month intervention and 10-year follow-up phases of this study. The TRIGR study met the accrual goal after 4.7 years of recruitment, 2.7 years longer than projected initially. Challenges included difficulty in finding fathers with T1D, a higher than expected rate of premature delivery among T1D mothers, and implementation of new privacy regulations mid-trial. The majority of participants were recruited from primary care antenatal clinics located near the study centers and from a general hospital or pediatric center that was affiliated with a TRIGR Study center. Internet and magazine advertisements were found to be useful for recruitment of families. Alternative follow-up strategies are offered to families who wish to reduce or discontinue participation. LIMITATIONS Our experience is limited to a single international multicenter trial. CONCLUSIONS TRIGR coordinators played key roles in the recruitment and intervention periods and continue to be instrumental in retaining families and children during the 10-year follow-up period for each child.
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Affiliation(s)
- Margaret Franciscus
- aDepartment of Pediatric Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Evaluating the diet of children at increased risk for type 1 diabetes: first results from the TEENDIAB study. Public Health Nutr 2014; 18:50-8. [DOI: 10.1017/s1368980013003406] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveThe development of type 1 diabetes (T1D) is potentially influenced by nutrition. The aim of our study was to assess food and nutrient intakes of children at increased risk of T1D.DesignDietary intake of the last 4 weeks was assessed using a diet history interview. The daily nutrient and food intakes were compared with the German Dietary Reference Intakes, the Optimized Mixed Diet recommendations and those of a representative sample of children from the EsKiMo study.SettingChildren included in the analysis participated in the prospective TEENDIAB study.SubjectsFirst-degree relatives of people with T1D (n 268), aged 8–12 years.ResultsThe TEENDIAB children consumed 52·0 % of their total energy from carbohydrates, 32·6 % from fat and 14·3 % from protein. Compared with the reference values, their intake was lowest for folate at 61·3 % of the reference, for iodine at 58·1 % and for vitamin D at 8·9 %, and exceeded the reference for vitamin K about 5-fold, for Na about 3·5-fold and for protein about 1·5-fold. Their nutrient intakes were similar to those of a control cohort without increased T1D risk. The consumption of non-desirable food groups (meat products, sweets/snacks) was above the recommendations and the consumption of desirable food groups (fruits, vegetables, carbohydrate-rich foods) was below the recommendations.ConclusionsThe TEENDIAB children had intakes considerably below the recommendations for vitamin D, iodine, folate and plant-based foods, and intakes above for vitamin K, Na, protein, meat products and sweets/snacks. They showed similar dietary patterns to non-risk children.
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Lacroix IME, Li-Chan ECY. Investigation of the Putative Associations Between Dairy Consumption and Incidence of Type 1 and Type 2 Diabetes. Crit Rev Food Sci Nutr 2013; 54:411-32. [DOI: 10.1080/10408398.2011.587039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Muntoni S, Mereu R, Atzori L, Mereu A, Galassi S, Corda S, Frongia P, Angius E, Pusceddu P, Contu P, Cucca F, Congia M, Muntoni S. High meat consumption is associated with type 1 diabetes mellitus in a Sardinian case-control study. Acta Diabetol 2013; 50:713-9. [PMID: 22391937 DOI: 10.1007/s00592-012-0385-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 02/21/2012] [Indexed: 01/29/2023]
Abstract
The large worldwide variation in type 1 diabetes incidence and increasing incidence over time points toward important environmental risk factors. Among them, nutrition plays an important role. The objective was to investigate the relationship between type 1 diabetes and nutritional factors in pregnancy and early in life. We carried out, using semi-quantitative food frequency questionnaires, a retrospective case-control study in 298 children of 0-15 years old, 145 of which were affected by type 1 diabetes. The diet of all children and of their mothers during pregnancy and lactation was assessed. In children, a statistically significant dose-response association between type 1 diabetes and the amount of meat consumption was found while no other nutritional factors were associated with the disease. High meat consumption seems to be an important early in life cofactor for type 1 diabetes development, although these findings need to be confirmed in wider prospective follow-up studies.
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Affiliation(s)
- Sandro Muntoni
- Unit of Oncology and Molecular Pathology, Department of Toxicology, University of Cagliari, Via Porcell 4, 09124, Cagliari, Italy,
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Frederiksen B, Kroehl M, Lamb MM, Seifert J, Barriga K, Eisenbarth GS, Rewers M, Norris JM. Infant exposures and development of type 1 diabetes mellitus: The Diabetes Autoimmunity Study in the Young (DAISY). JAMA Pediatr 2013; 167:808-15. [PMID: 23836309 PMCID: PMC4038357 DOI: 10.1001/jamapediatrics.2013.317] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE The incidence of type 1 diabetes mellitus (T1DM) is increasing worldwide, with the most rapid increase among children younger than 5 years of age. OBJECTIVE To examine the associations between perinatal and infant exposures, especially early infant diet, and the development of T1DM. DESIGN The Diabetes Autoimmunity Study in the Young (DAISY) is a longitudinal, observational study. SETTING Newborn screening for human leukocyte antigen (HLA) was done at St. Joseph's Hospital in Denver, Colorado. First-degree relatives of individuals with T1DM were recruited from the Denver metropolitan area. PARTICIPANTS A total of 1835 children at increased genetic risk for T1DM followed up from birth with complete prospective assessment of infant diet. Fifty-three children developed T1DM. EXPOSURES Early (<4 months of age) and late (≥6 months of age) first exposure to solid foods compared with first exposures at 4 to 5 months of age (referent). MAIN OUTCOME AND MEASURE Risk for T1DM diagnosed by a physician. RESULTS Both early and late first exposure to any solid food predicted development of T1DM (hazard ratio [HR], 1.91; 95% CI, 1.04-3.51, and HR, 3.02; 95% CI, 1.26-7.24, respectively), adjusting for the HLA-DR genotype, first-degree relative with T1DM, maternal education, and delivery type. Specifically, early exposure to fruit and late exposure to rice/oat predicted T1DM (HR, 2.23; 95% CI, 1.14-4.39, and HR, 2.88; 95% CI, 1.36-6.11, respectively), while breastfeeding at the time of introduction to wheat/barley conferred protection (HR, 0.47; 95% CI, 0.26-0.86). Complicated vaginal delivery was also a predictor of T1DM (HR, 1.93; 95% CI, 1.03-3.61). CONCLUSIONS AND RELEVANCE These results suggest the safest age to introduce solid foods in children at increased genetic risk for T1DM is between 4 and 5 months of age. Breastfeeding while introducing new foods may reduce T1DM risk.
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Afonso G, Mallone R. Infectious triggers in type 1 diabetes: is there a case for epitope mimicry? Diabetes Obes Metab 2013; 15 Suppl 3:82-8. [PMID: 24003924 DOI: 10.1111/dom.12166] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 05/22/2013] [Indexed: 12/13/2022]
Abstract
Environmental factors are the main contributors to type 1 diabetes (T1D) pathogenesis, yet they remain unidentified. Enteroviruses are proposed candidate triggers due to temporal correlations between infection and T1D autoimmunity and to detection of viral proteins in diseased islets. However, such correlations are not universal and may be relatively uncommon. Furthermore, evidence of a cause-effect relationship is lacking, as infection of non-obese diabetic mice with Coxsackie enteroviruses can either trigger or blunt disease. The proposed mechanisms are either non-antigen-specific (i.e. β-cell destruction and release of sequestered antigens, islet inflammation) or antigen-specific (i.e. epitope mimicry, by which immune responses to enteroviruses may be diverted against homologous β-cell antigens). The case for the latter mechanisms is even less stringent, as there is little evidence of promiscuous antigen recognition at the single T-cell level. Other infectious agents may thus be implicated. Demonstration of their role will require fulfilling the Koch's postulates, namely isolation of the agent preferentially in T1D patients, including before disease onset; and T1D induction when the agent is inoculated into mice. The same is needed for cross-reactive T cells to support epitope mimicry mechanisms. Generation of alternative (humanized) mouse models that could be challenged with candidate microbes is needed.
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Affiliation(s)
- G Afonso
- Cochin Institute, INSERM U1016, DeAR Lab Avenir, Paris, France
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Penno MAS, Couper JJ, Craig ME, Colman PG, Rawlinson WD, Cotterill AM, Jones TW, Harrison LC. Environmental determinants of islet autoimmunity (ENDIA): a pregnancy to early life cohort study in children at-risk of type 1 diabetes. BMC Pediatr 2013; 13:124. [PMID: 23941366 PMCID: PMC3751791 DOI: 10.1186/1471-2431-13-124] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 08/12/2013] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The incidence of type 1 diabetes has increased worldwide, particularly in younger children and those with lower genetic susceptibility. These observations suggest factors in the modern environment promote pancreatic islet autoimmunity and destruction of insulin-producing beta cells. The Environmental Determinants of Islet Autoimmunity (ENDIA) Study is investigating candidate environmental exposures and gene-environment interactions that may contribute to the development of islet autoimmunity and type 1 diabetes. METHODS/DESIGN ENDIA is the only prospective pregnancy/birth cohort study in the Southern Hemisphere investigating the determinants of type 1 diabetes in at-risk children. The study will recruit 1,400 unborn infants or infants less than six months of age with a first-degree relative (i.e. mother, father or sibling) with type 1 diabetes, across five Australian states. Pregnant mothers/infants will be followed prospectively from early pregnancy through childhood to investigate relationships between genotype, the development of islet autoimmunity (and subsequently type 1 diabetes), and prenatal and postnatal environmental factors. ENDIA will evaluate the microbiome, nutrition, bodyweight/composition, metabolome-lipidome, insulin resistance, innate and adaptive immune function and viral infections. A systems biology approach will be used to integrate these data. Investigation will be by 3-monthly assessments of the mother during pregnancy, then 3-monthly assessments of the child until 24 months of age and 6-monthly thereafter. The primary outcome measure is persistent islet autoimmunity, defined as the presence of autoantibodies to one or more islet autoantigens on consecutive tests. DISCUSSION Defining gene-environment interactions that initiate and/or promote destruction of the insulin-producing beta cells in early life will inform approaches to primary prevention of type 1 diabetes. The strength of ENDIA is the prospective, comprehensive and frequent systems-wide profiling from early pregnancy through to early childhood, to capture dynamic environmental exposures that may shape the development of islet autoimmunity. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry ACTRN12613000794707.
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Abstract
Type 1 diabetes (T1D) is perceived as a progressive immune-mediated disease, the clinical diagnosis of which is preceded by an asymptomatic preclinical period of highly variable duration. It has long been postulated that the disease process leading to overt T1D is triggered by an infectious agent, the strongest candidate being a diabetogenic enterovirus. The initiation and progression of the disorder likely requires, in addition to genetic T1D susceptibility, a trigger, an exogenous antigen capable of driving the development of this disease. This may be a dietary antigen similar to gluten in celiac disease. Recent data further suggests that the initiation of autoimmunity is preceded by inflammation reflected by a proinflammatory metabolic serum profile. The cause of the inflammation remains open, but given that the intestinal microbiome appears to differ between individuals who progress to clinical T1D and nonprogressors, one may speculate that changes in the gut microflora might contribute to the inflammatory process.
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Affiliation(s)
- Mikael Knip
- Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Folkhälsan Research Center, FI-00290 Helsinki, Finland.
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Mayer-Davis EJ, Dabelea D, Crandell JL, Crume T, D'Agostino RB, Dolan L, King IB, Lawrence JM, Norris JM, Pihoker C, The N. Nutritional factors and preservation of C-peptide in youth with recently diagnosed type 1 diabetes: SEARCH Nutrition Ancillary Study. Diabetes Care 2013; 36:1842-50. [PMID: 23801797 PMCID: PMC3687285 DOI: 10.2337/dc12-2084] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 02/06/2013] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To test the novel hypothesis that nutritional factors previously associated with type 1 diabetes etiology or with insulin secretion are prospectively associated with fasting C-peptide (FCP) concentration among youth recently diagnosed with type 1 diabetes. RESEARCH DESIGN AND METHODS Included were 1,316 youth with autoantibody-positive type 1 diabetes who participated in the SEARCH for Diabetes in Youth study (baseline disease duration, 9.9 months; SD, 6.3). Nutritional exposures included breastfeeding and age at introduction of complementary foods, baseline plasma long-chain omega-3 fatty acids including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), vitamin D, vitamin E, and, from a baseline food frequency questionnaire, estimated intake of the branched-chain amino acid leucine and total carbohydrate. Multiple linear regression models were conducted to relate each nutritional factor to baseline FCP adjusted for demographics, disease-related factors, and other confounders. Prospective analyses included the subset of participants with preserved β-cell function at baseline (baseline FCP ≥0.23 ng/mL) with additional adjustment for baseline FCP and time (mean follow-up, 24.3 months; SD, 8.2; n = 656). FCP concentration was analyzed as log(FCP). RESULTS In adjusted prospective analyses, baseline EPA (P = 0.02), EPA plus DHA (P = 0.03), and leucine (P = 0.03) were each associated positively and significantly with FCP at follow-up. Vitamin D was unexpectedly inversely associated with FCP (P = 0.002). CONCLUSIONS Increased intake of branched-chain amino acids and long-chain omega-3 fatty acids may support preservation of β-cell function. This represents a new direction for research to improve prognosis for type 1 diabetes.
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Affiliation(s)
- Elizabeth J Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
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Gage H, Von Rosen-Von Hoewel J, Laitinen K, Jakobik V, Martin-Bautista E, Schmid M, Egan B, Morgan J, Williams P, Decsi T, Campoy C, Koletzko B, Raats M. Health effects of infant feeding: Information for parents in leaflets and magazines in five European countries. PUBLIC UNDERSTANDING OF SCIENCE (BRISTOL, ENGLAND) 2013; 22:365-379. [PMID: 23833060 DOI: 10.1177/0963662511435452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Parents' decisions about whether to breastfeed their infant, and when to introduce complementary foods, are important public health issues. Breastfeeding has beneficial health effects and is widely promoted. Leaflets and magazine articles on infant feeding were collected in 2005, in five European countries (England, Finland, Germany, Hungary, Spain), and screened for statements that link feeding behaviours to infant health outcomes. A total of 127 leaflets contained 512 statements (0.38 / published page). Magazines contained approximately 1 article / month. Health outcomes were more intensively covered in England and Germany. Most statements referred to short term health implications. Lack of scientific agreement may underlie lack of cover of longer term health effects. Scope may exist to promote improved infant feeding practices by increasing the quantity and specificity of messages about health effects. Further research is required to evaluate the impact of alternative means of providing information on infant feeding practices.
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Eringsmark Regnéll S, Lernmark A. The environment and the origins of islet autoimmunity and Type 1 diabetes. Diabet Med 2013; 30:155-60. [PMID: 23252770 PMCID: PMC3552102 DOI: 10.1111/dme.12099] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 11/29/2012] [Accepted: 12/06/2012] [Indexed: 12/22/2022]
Abstract
Type 1 diabetes involves the specific destruction of the pancreatic islet β-cells, eventually resulting in a complete dependency of exogenous insulin. The clinical onset of diabetes is preceded by the appearance of autoantibodies against β-cell antigens. The human leukocyte antigen (HLA) region is the single most important genetic determinant of Type 1 diabetes susceptibility, yet variability in the HLA region has been estimated to explain only approximately 60% of the genetic influence of the disease. Over 50 identified non-HLA genetic polymorphisms support the notion that genetics alone cannot explain Type 1 diabetes. Several lines of evidence indicate that environmental triggers may be integral in inducing the onset of islet autoimmunity in genetically susceptible individuals. The association between environmental factors and the clinical onset is complicated by observation that the rate of progression to clinical onset may be affected by environmental determinants. Hence, the environment may be aetiological as well as pathogenic. Putative inductive mechanisms include viral, microbial, diet-related, anthropometric and psychosocial factors. Ongoing observational cohort studies such as The Environmental Determinants of Diabetes in the Young (TEDDY) study aim to ascertain environmental determinants that may trigger islet autoimmunity and either speed up or slow down the progression to clinical onset in subjects with persistent islet autoimmunity.
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Affiliation(s)
- S Eringsmark Regnéll
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden
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Virtanen SM, Uusitalo L, Knip M. Early introduction of complementary foods: is there a link with Type 1 diabetes? ACTA ACUST UNITED AC 2013. [DOI: 10.2217/dmt.12.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Patelarou E, Girvalaki C, Brokalaki H, Patelarou A, Androulaki Z, Vardavas C. Current evidence on the associations of breastfeeding, infant formula, and cow's milk introduction with type 1 diabetes mellitus: a systematic review. Nutr Rev 2012; 70:509-19. [PMID: 22946851 DOI: 10.1111/j.1753-4887.2012.00513.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Current evidence provides contradictory results in regards to the associations of breastfeeding or early introduction of cow's milk and formula with the development of type 1 diabetes (T1D). The aim of this systematic review was to evaluate the type of feeding, duration of breastfeeding, time of introduction of formula or cow's milk, and the potential impact on developing T1D. The literature search was conducted based on the standards outlined in the MOOSE Guidelines for Meta-Analyses and Systematic Reviews of Observational Studies and yielded a total of 161 studies, 28 of which were included in this review. Twenty seven of the included studies were case-control and one was a prospective cohort study. Eight of the studies indicated breastfeeding has a protective role against the development of T1D. Seven additional studies emphasized that a short period or absence of breastfeeding could be a risk factor for T1D development. The results of this systematic review indicate a short duration and/or a lack of breastfeeding may constitute a risk factor for the development of T1D later in life.
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Affiliation(s)
- Evridiki Patelarou
- University Hospital of Heraklion, Department of Social Medicine, University of Crete, Greece.
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Nucci AM, Becker DJ, Virtanen SM, Cuthbertson D, Softness B, Huot C, Wasikowa R, Dosch HM, Åkerblom HK, Knip M. Growth differences between North American and European children at risk for type 1 diabetes. Pediatr Diabetes 2012; 13:425-31. [PMID: 22251851 PMCID: PMC3335929 DOI: 10.1111/j.1399-5448.2011.00840.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Accepted: 11/17/2011] [Indexed: 11/28/2022] Open
Abstract
AIM To evaluate the relationships between early growth and regional variations in type 1 diabetes (T1D) incidence in an international cohort of children with familial and genetic risk for T1D. METHODS Anthropometric indices between birth to 5 yr of age were compared among regions and T1D proband in 2160 children participating in the Trial to Reduce Insulin-dependent diabetes mellitus in the Genetically at Risk study. RESULTS Children in Northern Europe had the highest weight z-score between birth to 12 months of age, while those in Southern Europe and U.S.A. had the lowest weight and length/height z-scores at most time points (p < 0.005 to p < 0.001). Few differences in z-score values for weight, height, and body mass index were found by maternal T1D status. Using International Obesity Task Force criteria, the obesity rates generally increased with age and at 5 yr were highest in males in Northern Europe (6.0%) and in females in Canada (12.8%). However, no statistically significance difference was found by geographic region. In Canada, the obesity rate for female children of mothers with and without T1D differed significantly at 4 and 5 yr (6.0 vs. 0.0% and 21.3 vs. 1.9%, respectively; p < 0.0125) but no differences by maternal T1D status were found in other regions. CONCLUSIONS There are regional differences in early childhood growth that are consistent with the higher incidence of T1D in Northern Europe and Canada as compared to Southern Europe. Our prospective study from birth will allow evaluation of relationships between growth and the emerging development of autoimmunity and progression to T1D by region in this at-risk population of children.
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Affiliation(s)
- Anita M Nucci
- Division of Nutrition, Georgia State University, Atlanta, GA 30302, USA.
| | - Dorothy J Becker
- Division of Endocrinology, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, 15224
| | - Suvi M Virtanen
- Nutrition Unit, National Institute for Health and Welfare, Helsinki, Finland, 00300; Tampere School of Public Health, University of Tampere, Finland and Research Unit, Tampere University Hospital, Tampere, Finland, 33014
| | - David Cuthbertson
- University of South Florida, Pediatrics Epidemiology Center, Tampa, FL, 33612
| | - Barney Softness
- Columbia University College of Physicians and Surgeons, Naomi Berrie Diabetes Center, New York, NY, 10032
| | - Celine Huot
- CHU Ste. Justine, Montreal, Quebec, Canada, H3T 1C5
| | | | | | - Hans K Åkerblom
- Children’s Hospital and Biomedicum Helsinki Institute, University of Helsinki, Helsinki, Finland, 00014
| | - Mikael Knip
- Department of Pediatrics, Tampere University Hospital, Tampere Finland, 33014, Children’s Hospital, University of Helsinki and Helsinki University Central Hospital and Folkhälsan Research Center, Helsinki, Finland, 00014
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Abstract
Type 1 diabetes is an autoimmune disease that gradually destructs insulin-producing beta cells. Over the years, clinicians' knowledge regarding the immunopathogenesis of this disease has greatly increased. Immunotherapies that can change the course of immune-mediated destruction and preserve and possibly regenerate the pancreatic beta cells seem to be promising in preclinical trials but so far have been unsuccessful in human studies. This article reviews the important immune interventions for type 1 diabetes that have been tried so far targeting the different stages of disease development and provides an insight into what the future might hold.
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Affiliation(s)
- Smita Gupta
- Diabetes and Endocrinology Consultants, 8435 Clearvista Place, Suite 101 Indianapolis, IN 46256, USA.
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