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Dinh NTT, Cox IA, de Graaff B, Campbell JA, Stokes B, Palmer AJ. A Comprehensive Systematic Review of Data Linkage Publications on Diabetes in Australia. Front Public Health 2022; 10:757987. [PMID: 35692316 PMCID: PMC9174992 DOI: 10.3389/fpubh.2022.757987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Aims Our study aimed to identify the common themes, knowledge gaps and to evaluate the quality of data linkage research on diabetes in Australia. Methods This systematic review was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (the PRISMA Statement). Six biomedical databases and the Australian Population Health Research Network (PHRN) website were searched. A narrative synthesis was conducted to comprehensively identify the common themes and knowledge gaps. The guidelines for studies involving data linkage were used to appraise methodological quality of included studies. Results After screening and hand-searching, 118 studies were included in the final analysis. Data linkage publications confirmed negative health outcomes in people with diabetes, reported risk factors for diabetes and its complications, and found an inverse association between primary care use and hospitalization. Linked data were used to validate data sources and diabetes instruments. There were limited publications investigating healthcare expenditure and adverse drug reactions (ADRs) in people with diabetes. Regarding methodological assessment, important information about the linkage performed was under-reported in included studies. Conclusions In the future, more up to date data linkage research addressing costs of diabetes and its complications in a contemporary Australian setting, as well as research assessing ADRs of recently approved antidiabetic medications, are required.
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Affiliation(s)
- Ngan T T Dinh
- Health Economics Research Group, Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.,Department of Pharmacology, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen University, Thai Nguyen, Vietnam
| | - Ingrid A Cox
- Health Economics Research Group, Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Barbara de Graaff
- Health Economics Research Group, Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Julie A Campbell
- Health Economics Research Group, Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Brian Stokes
- Tasmanian Data Linkage Unit, Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Andrew J Palmer
- Health Economics Research Group, Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.,Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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2
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Mattila M, Hakola L, Niinistö S, Tapanainen H, Takkinen HM, Ahonen S, Ilonen J, Toppari J, Veijola R, Knip M, Virtanen SM. Maternal Vitamin C and Iron Intake during Pregnancy and the Risk of Islet Autoimmunity and Type 1 Diabetes in Children: A Birth Cohort Study. Nutrients 2021; 13:nu13030928. [PMID: 33805588 PMCID: PMC8001228 DOI: 10.3390/nu13030928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 12/17/2022] Open
Abstract
Our aim was to study the associations between maternal vitamin C and iron intake during pregnancy and the offspring’s risk of developing islet autoimmunity and type 1 diabetes. The study was a part of the Finnish Type 1 Diabetes Prediction and Prevention (DIPP) prospective birth cohort including children genetically at risk of type 1 diabetes born between 1997–2004. The diets of 4879 mothers in late pregnancy were assessed with a validated food frequency questionnaire. The outcomes were islet autoimmunity and type 1 diabetes. Cox proportional hazards regression analysis adjusted for energy, family history of diabetes, human leukocyte antigen (HLA) genotype and sex was used for statistical analyses. Total intake of vitamin C or iron from food and supplements was not associated with the risk of islet autoimmunity (vitamin C: HR 0.91: 95% CI (0.80, 1.03), iron: 0.98 (0.87, 1.10)) or type 1 diabetes (vitamin C: 1.01 (0.87, 1.17), iron: 0.92 (0.78, 1.08)), neither was the use of vitamin C or iron supplements associated with the outcomes. In conclusion, no association was found between maternal vitamin C or iron intake during pregnancy and the risk of islet autoimmunity or type 1 diabetes in the offspring.
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Affiliation(s)
- Markus Mattila
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, FI-33014 Tampere, Finland; (L.H.); (H.-M.T.); (S.A.); (S.M.V.)
- Research, Development and Innovation Center, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland
- Health and Well-Being Promotion Unit, Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland;
- Correspondence:
| | - Leena Hakola
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, FI-33014 Tampere, Finland; (L.H.); (H.-M.T.); (S.A.); (S.M.V.)
- Research, Development and Innovation Center, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland
| | - Sari Niinistö
- Health and Well-Being Promotion Unit, Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland;
| | - Heli Tapanainen
- Population Health Unit, Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland;
| | - Hanna-Mari Takkinen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, FI-33014 Tampere, Finland; (L.H.); (H.-M.T.); (S.A.); (S.M.V.)
- Research, Development and Innovation Center, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland
- Health and Well-Being Promotion Unit, Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland;
| | - Suvi Ahonen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, FI-33014 Tampere, Finland; (L.H.); (H.-M.T.); (S.A.); (S.M.V.)
- Research, Development and Innovation Center, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland
- Health and Well-Being Promotion Unit, Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland;
| | - Jorma Ilonen
- Immunogenetics Laboratory, Institute of Biomedicine, University of Turku, FI-20014 Turku, Finland;
| | - Jorma Toppari
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, FI-20520 Turku, Finland;
- Department of Pediatrics, Turku University Hospital, FI-20520 Turku, Finland
| | - Riitta Veijola
- PEDEGO Research Unit, Department of Pediatrics, Medical Research Center, University of Oulu, P.O. Box 8000, FI-90014 Oulu, Finland;
- Department of Children and Adolescents, Oulu University Hospital, P.O. Box 10, FI-90029 Oulu, Finland
| | - Mikael Knip
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, FI-00029 Helsinki, Finland;
- Folkhälsan Research Center, FI-00251 Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, FI-00014 Helsinki, Finland
- Department of Pediatrics, Tampere University Hospital, FI-33521 Tampere, Finland
| | - Suvi M. Virtanen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, FI-33014 Tampere, Finland; (L.H.); (H.-M.T.); (S.A.); (S.M.V.)
- Research, Development and Innovation Center, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland
- Health and Well-Being Promotion Unit, Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland;
- Center for Child Health Research, Tampere University and Tampere University Hospital, FI-33014 Tampere, Finland
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3
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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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4
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Mattila M, Erlund I, Lee HS, Niinistö S, Uusitalo U, Andrén Aronsson C, Hummel S, Parikh H, Rich SS, Hagopian W, Toppari J, Lernmark Å, Ziegler AG, Rewers M, Krischer JP, Norris JM, Virtanen SM. Plasma ascorbic acid and the risk of islet autoimmunity and type 1 diabetes: the TEDDY study. Diabetologia 2020; 63:278-286. [PMID: 31728565 PMCID: PMC6946743 DOI: 10.1007/s00125-019-05028-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/03/2019] [Indexed: 02/06/2023]
Abstract
AIMS/HYPOTHESIS We studied the association of plasma ascorbic acid with the risk of developing islet autoimmunity and type 1 diabetes and examined whether SNPs in vitamin C transport genes modify these associations. Furthermore, we aimed to determine whether the SNPs themselves are associated with the risk of islet autoimmunity or type 1 diabetes. METHODS We used a risk set sampled nested case-control design within an ongoing international multicentre observational study: The Environmental Determinants of Diabetes in the Young (TEDDY). The TEDDY study followed children with increased genetic risk from birth to endpoints of islet autoantibodies (350 cases, 974 controls) and type 1 diabetes (102 cases, 282 controls) in six clinical centres. Control participants were matched for family history of type 1 diabetes, clinical centre and sex. Plasma ascorbic acid concentration was measured at ages 6 and 12 months and then annually up to age 6 years. SNPs in vitamin C transport genes were genotyped using the ImmunoChip custom microarray. Comparisons were adjusted for HLA genotypes and for background population stratification. RESULTS Childhood plasma ascorbic acid (mean ± SD 10.76 ± 3.54 mg/l in controls) was inversely associated with islet autoimmunity risk (adjusted OR 0.96 [95% CI 0.92, 0.99] per +1 mg/l), particularly islet autoimmunity, starting with insulin autoantibodies (OR 0.94 [95% CI 0.88, 0.99]), but not with type 1 diabetes risk (OR 0.93 [95% Cl 0.86, 1.02]). The SLC2A2 rs5400 SNP was associated with increased risk of type 1 diabetes (OR 1.77 [95% CI 1.12, 2.80]), independent of plasma ascorbic acid (OR 0.92 [95% CI 0.84, 1.00]). CONCLUSIONS/INTERPRETATION Higher plasma ascorbic acid levels may protect against islet autoimmunity in children genetically at risk for type 1 diabetes. Further studies are warranted to confirm these findings. DATA AVAILABILITY The datasets generated and analysed during the current study will be made available in the NIDDK Central Repository at https://www.niddkrepository.org/studies/teddy.
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Affiliation(s)
- Markus Mattila
- Faculty of Social Sciences/Health Sciences, Tampere University, Tampere, Finland
- Department of Public Health Solutions, National Institute for Health and Welfare, PO Box 30, FI-00271, Helsinki, Finland
| | - Iris Erlund
- Department of Public Health Solutions, National Institute for Health and Welfare, PO Box 30, FI-00271, Helsinki, Finland
- Department of Government Services, National Institute for Health and Welfare, Helsinki, Finland
| | - Hye-Seung Lee
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Sari Niinistö
- Department of Public Health Solutions, National Institute for Health and Welfare, PO Box 30, FI-00271, Helsinki, Finland
| | - Ulla Uusitalo
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | | | - Sandra Hummel
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Forschergruppe Diabetes e.V., Helmhtoltz Zentrum München, Munich, Germany
| | - Hemang Parikh
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA, USA
| | | | - 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
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Anette G Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Forschergruppe Diabetes e.V., Helmhtoltz Zentrum München, Munich, Germany
| | - Marian Rewers
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jeffrey P Krischer
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Jill M Norris
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
| | - Suvi M Virtanen
- Faculty of Social Sciences/Health Sciences, Tampere University, Tampere, Finland.
- Department of Public Health Solutions, National Institute for Health and Welfare, PO Box 30, FI-00271, Helsinki, Finland.
- Center for Child Health Research, Tampere University and Tampere University Hospital, Tampere, Finland.
- Science Centre, Tampere University Hospital, Tampere, Finland.
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5
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Esposito S, Toni G, Tascini G, Santi E, Berioli MG, Principi N. Environmental Factors Associated With Type 1 Diabetes. Front Endocrinol (Lausanne) 2019; 10:592. [PMID: 31555211 PMCID: PMC6722188 DOI: 10.3389/fendo.2019.00592] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/12/2019] [Indexed: 12/15/2022] Open
Abstract
Type 1 diabetes (T1D) is a chronic autoimmune disorder that leads to progressive pancreatic ß-cell destruction and culminates in absolute insulin deficiency and stable hyperglycaemia. It is very likely that environmental factors play a role in triggering islet autoimmunity. Knowing whether they have true relevance in favoring T1D development is essential for the effective prevention of the disease. Moreover, prevention could be obtained directly interfering with the development of autoimmunity through autoantigen-based immunotherapy. In this narrative review, the present possibilities for the prevention of T1D are discussed. Presently, interventions to prevent T1D are generally made in subjects in whom autoimmunity is already activated and autoantibodies against pancreatic cell components have been detected. Practically, the goal is to slow down the immune process by preserving the normal structure of the pancreatic islets for as long as possible. Unfortunately, presently methods able to avoid the risk of autoimmune activation are not available. Elimination of environmental factors associated with T1D development, reverse of epigenetic modifications that favor initiation of autoimmunity in subjects exposed to environmental factors and use of autoantigen-based immunotherapy are possible approaches, although for all these measures definitive conclusions cannot be drawn. However, the road is traced and it is possible that in a not so distant future an effective prevention of the disease to all the subjects at risk can be offered.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
- *Correspondence: Susanna Esposito
| | - Giada Toni
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Giorgia Tascini
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Elisa Santi
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Maria Giulia Berioli
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
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Principi N, Berioli MG, Bianchini S, Esposito S. Type 1 diabetes and viral infections: What is the relationship? J Clin Virol 2017; 96:26-31. [PMID: 28934695 DOI: 10.1016/j.jcv.2017.09.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 08/09/2017] [Accepted: 09/06/2017] [Indexed: 12/16/2022]
Abstract
Type 1 diabetes (T1D) is the most common chronic metabolic disorder in children. Epigenetic and environmental factors capable of altering the penetrance of major susceptibility genes or capable of increasing the penetrance of low-risk genes are currently thought to play a role in triggering autoimmunity and T1D development. This paper discusses the current knowledge of the role of viruses in T1D. Most studies that have evaluated the potential association between viral infections and T1D have indicated that it is highly likely that some of these infectious agents play a role in T1D development. However, most T1D cases are immune-mediated, and it is supposed that the initial viral infection is capable of creating, in genetically predisposed subjects, a particular condition in which chronic local inflammation occurs through the persistence of the infecting virus in pancreatic tissue and the activation of autoimmunity by means of molecular mimicry, bystander activation, or both. Theoretically, this knowledge could lead to possible prophylaxis and therapy for T1D. Further studies devoted to evaluating which infectious agents are linked to T1D and which immune mechanisms induce or protect against the disease are needed before adequate prophylactic and therapeutic measures can be developed.
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Affiliation(s)
- Nicola Principi
- Professor Emeritus, Università degli Studi di Milano, Milan, Italy
| | | | - Sonia Bianchini
- Pediatric Clinic, Università degli Studi di Perugia, Perugia, Italy
| | - Susanna Esposito
- Pediatric Clinic, Università degli Studi di Perugia, Perugia, Italy.
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7
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Miller KM, Hart PH, de Klerk NH, Davis EA, Lucas RM. Are low sun exposure and/or vitamin D risk factors for type 1 diabetes? Photochem Photobiol Sci 2017; 16:381-398. [DOI: 10.1039/c6pp00294c] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Ultraviolet radiation and vitamin D, with their known immunosuppressive effects, have the potential to delay or inhibit type 1 diabetes.
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Affiliation(s)
| | | | | | | | - R. M. Lucas
- National Centre for Epidemiology and Population Health
- The Australian National University
- Canberra 2600
- Australia
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8
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Saad HA, Patterson CC, Cardwell CR. Systematic review and meta-analysis of the association between mumps during childhood and risk of type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2016; 29:1123-1128. [PMID: 27658134 DOI: 10.1515/jpem-2016-0148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 08/04/2016] [Indexed: 11/15/2022]
Abstract
We conducted a systematic review and meta-analysis of the association between mumps and risk of type 1 diabetes mellitus (T1DM). Literature searches were conducted using Medline, EMBASE and Web of Science including studies published before February 2014. Crude and, where available, adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were extracted from the published reports of each included study. Combined OR estimates and tests of heterogeneity were obtained using meta-analysis techniques. The analysis was repeated in subgroups of studies on the basis of quality defined by the score on the Newcastle-Ottawa scale (NOS). In total, 18 articles met the eligibility criteria, and overall there was some evidence of a weak association between clinically diagnosed mumps and T1DM (OR=1.23, 95% CI 1.00-1.51; p=0.05) but marked heterogeneity between studies (I2=49%; p for heterogeneity=0.01). Restricting analyses to 13 high quality studies, there was little evidence of association between clinically diagnosed mumps and T1DM (OR=1.11, 95% CI 0.91-1.35; p=0.29) and there was much less heterogeneity (I2=26%; p for heterogeneity=0.18). Overall there was little evidence of any strong association between mumps infection and T1DM.
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9
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Morgan E, Halliday SR, Campbell GR, Cardwell CR, Patterson CC. Vaccinations and childhood type 1 diabetes mellitus: a meta-analysis of observational studies. Diabetologia 2016; 59:237-43. [PMID: 26564178 PMCID: PMC4705121 DOI: 10.1007/s00125-015-3800-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 10/12/2015] [Indexed: 01/02/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to investigate the association between routine vaccinations and the risk of childhood type 1 diabetes mellitus by systematically reviewing the published literature and performing meta-analyses where possible. METHODS A comprehensive literature search was performed of MEDLINE and EMBASE to identify all studies that compared vaccination rates in children who subsequently developed type 1 diabetes mellitus and in control children. ORs and 95% CIs were obtained from published reports or derived from individual patient data and then combined using a random effects meta-analysis. RESULTS In total, 23 studies investigating 16 vaccinations met the inclusion criteria. Eleven of these contributed to meta-analyses which included data from between 359 and 11,828 childhood diabetes cases. Overall, there was no evidence to suggest an association between any of the childhood vaccinations investigated and type 1 diabetes mellitus. The pooled ORs ranged from 0.58 (95% CI 0.24, 1.40) for the measles, mumps and rubella (MMR) vaccination in five studies up to 1.04 (95% CI 0.94, 1.14) for the haemophilus influenza B (HiB) vaccination in 11 studies. Significant heterogeneity was present in most of the pooled analyses, but was markedly reduced when analyses were restricted to study reports with high methodology quality scores. Neither this restriction by quality nor the original authors' adjustments for potential confounding made a substantial difference to the pooled ORs. CONCLUSIONS/INTERPRETATION This study provides no evidence of an association between routine vaccinations and childhood type 1 diabetes.
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Affiliation(s)
- Eileen Morgan
- UKCRC Centre of Excellence for Public Health NI, Queen's University Belfast, Belfast, UK
- Centre for Public Health, Queen's University Belfast, Grosvenor Road, Belfast, BT12 6BJ, UK
| | - Sophia R Halliday
- UKCRC Centre of Excellence for Public Health NI, Queen's University Belfast, Belfast, UK
- Centre for Statistical Science and Operational Research, Queen's University Belfast, Belfast, UK
| | - Gemma R Campbell
- Centre for Public Health, Queen's University Belfast, Grosvenor Road, Belfast, BT12 6BJ, UK
| | - Chris R Cardwell
- Centre for Public Health, Queen's University Belfast, Grosvenor Road, Belfast, BT12 6BJ, UK
| | - Chris C Patterson
- UKCRC Centre of Excellence for Public Health NI, Queen's University Belfast, Belfast, UK.
- Centre for Public Health, Queen's University Belfast, Grosvenor Road, Belfast, BT12 6BJ, UK.
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10
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Wszolek K. Hand expressing in pregnancy and colostrum harvesting—preparation for successful breastfeeding? ACTA ACUST UNITED AC 2015. [DOI: 10.12968/bjom.2015.23.4.268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Spatial and temporal variation in type 1 diabetes incidence in Western Australia from 1991 to 2010: Increased risk at higher latitudes and over time. Health Place 2014; 28:194-204. [DOI: 10.1016/j.healthplace.2014.05.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 02/14/2014] [Accepted: 05/14/2014] [Indexed: 11/22/2022]
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12
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Scanlon PH, Aldington SJ, Stratton IM. Epidemiological issues in diabetic retinopathy. Middle East Afr J Ophthalmol 2013; 20:293-300. [PMID: 24339678 PMCID: PMC3841946 DOI: 10.4103/0974-9233.120007] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
There is currently an epidemic of diabetes in the world, principally type 2 diabetes that is linked to changing lifestyle, obesity, and increasing age of the population. Latest estimates from the International Diabetes Federation (IDF) forecasts a rise from 366 million people worldwide to 552 million by 2030. Type 1 diabetes is more common in the Northern hemisphere with the highest rates in Finland and there is evidence of a rise in some central European countries, particularly in the younger children under 5 years of age. Modifiable risk factors for progression of diabetic retinopathy (DR) are blood glucose, blood pressure, serum lipids, and smoking. Nonmodifiable risk factors are duration, age, genetic predisposition, and ethnicity. Other risk factors are pregnancy, microaneurysm count in an eye, microaneurysm formation rate, and the presence of any DR in the second eye. DR, macular edema (ME), and proliferative DR (PDR) develop with increased duration of diabetes and the rates are dependent on the above risk factors. In one study of type 1 diabetes, the median individual risk for the development of early retinal changes was 9.1 years of diabetes duration. Another study reported the 25 year incidence of proliferative retinopathy among population-based cohort of type 1 patients with diabetes was 42.9%. In recent years, people with diabetes have lower rates of progression than historically to PDR and severe visual loss, which may reflect better control of glucose, blood pressure, and serum lipids, and earlier diagnosis.
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Affiliation(s)
- Peter H Scanlon
- Gloucestershire Diabetic Retinopathy Research Group, Cheltenham General Hospital, Cheltenham, Gloucestershire, South West, UK
- English National Health Service Diabetic Eye Screening Programme, Victoria Warehouse, The Docks, Gloucester, Gloucestershire, South West, UK
| | - Stephen J Aldington
- Gloucestershire Diabetic Retinopathy Research Group, Cheltenham General Hospital, Cheltenham, Gloucestershire, South West, UK
| | - Irene M Stratton
- Gloucestershire Diabetic Retinopathy Research Group, Cheltenham General Hospital, Cheltenham, Gloucestershire, South West, UK
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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: 65] [Impact Index Per Article: 5.4] [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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14
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Cardwell CR, Stene LC, Joner G, Bulsara MK, Cinek O, Rosenbauer J, Ludvigsson J, Svensson J, Goldacre MJ, Waldhoer T, Jarosz-Chobot P, Gimeno SG, Chuang LM, Roberts CL, Parslow RC, Wadsworth EJ, Chetwynd A, Brigis G, Urbonaite B, Sipetic S, Schober E, Devoti G, Ionescu-Tirgoviste C, de Beaufort CE, Stoyanov D, Buschard K, Radon K, Glatthaar C, Patterson CC. Birth order and childhood type 1 diabetes risk: a pooled analysis of 31 observational studies. Int J Epidemiol 2010; 40:363-74. [DOI: 10.1093/ije/dyq207] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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15
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Brekke HK, Ludvigsson J. Daily vegetable intake during pregnancy negatively associated to islet autoimmunity in the offspring--the ABIS study. Pediatr Diabetes 2010; 11:244-50. [PMID: 19761530 DOI: 10.1111/j.1399-5448.2009.00563.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To investigate if maternal diet during pregnancy is associated with occurrence of islet autoimmunity (IA) in the offspring. METHODS Of 21 700 infants invited to the All Babies in South-east Sweden (ABIS) study, 16 004 screening questionnaires, including a 22-item food frequency questionnaire (FFQ) regarding the mothers' diet during pregnancy, were completed after delivery. Follow-up of the children (questionnaires and blood sampling) was performed at 1, 2.5 and 5 yr of age. IA was defined as being positive (above the 95th percentile for healthy children) in two or more measurements of autoantibodies [glutamic acid decarboxylase (GADA); tyrosine phosphatase (IA-2A), insulin autoantibodies (IAA)] analysed at the three time points or being diagnosed with type 1 diabetes during the 5-yr follow-up period. The 5 724 children in whom we carried out two to three possible blood samplings were included in the study. Logistic regression analysis was used to identify variables predicting IA. RESULTS Of 5 724 children,191 (3.3%) were considered positive for IA. In a univariate analysis, less than daily consumption of vegetables (3-5 times/week) in the mothers' diet was associated with increased risk of IA (OR 1.71, 95% CI:1.24-2.35, p = 0.001) compared to daily consumption (p for trend = 0.004). The association was strengthened when adjusting for known IA-risk factors (p for trend <0.001). CONCLUSIONS Daily consumption of vegetables in the mothers' diet during pregnancy was associated with a decreased risk of IA in the offspring.
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Affiliation(s)
- Hilde K Brekke
- Department of Clinical Nutrition, Sahlgrenska Academy at Göteborg University, 405 30 Göteborg, Sweden.
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16
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Zipris D. Epidemiology of type 1 diabetes and what animal models teach us about the role of viruses in disease mechanisms. Clin Immunol 2009; 131:11-23. [PMID: 19185542 DOI: 10.1016/j.clim.2008.12.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Revised: 12/23/2008] [Accepted: 12/23/2008] [Indexed: 01/12/2023]
Abstract
There is a consensus among epidemiologists that the worldwide incidence rate of type 1 diabetes has been rising in recent decades. The cause of this rise is unknown, but epidemiological studies suggest the involvement of environmental factors, and viral infections in particular. Data demonstrating a cause-and-effect relationship between microbial infections and type 1 diabetes and how viruses may cause disease in humans are currently lacking. However, new evidence from animal models supports the hypothesis that viruses induce disease via mechanisms linked with innate immune upregulation. In the BioBreeding Diabetes Resistant rat, infection with a parvovirus induces islet destruction via upregulation of the toll-like receptor 9 (TLR9) signaling pathway. Data from mouse models of diabetes implicate TLR2, TLR3, and TLR7 in the disease process. Understanding the link between environmental agents and innate immune pathways involved in early stages of diabetes may advance the design of immune interventions to prevent disease in genetically susceptible individuals.
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Affiliation(s)
- Danny Zipris
- Department of Pediatrics, Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, CO 80045-6511, USA.
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17
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Uusitalo L, Kenward MG, Virtanen SM, Uusitalo U, Nevalainen J, Niinistö S, Kronberg-Kippilä C, Ovaskainen ML, Marjamäki L, Simell O, Ilonen J, Veijola R, Knip M. Intake of antioxidant vitamins and trace elements during pregnancy and risk of advanced beta cell autoimmunity in the child. Am J Clin Nutr 2008; 88:458-64. [PMID: 18689383 DOI: 10.1093/ajcn/88.2.458] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Type 1 diabetes may have its origins in the fetal period of life. Free radicals were implicated in the cause of type 1 diabetes. It was hypothesized that antioxidant nutrients could protect against type 1 diabetes. OBJECTIVE We assessed whether high maternal intake of selected dietary antioxidants during pregnancy is associated with a reduced risk of advanced beta cell autoimmunity in the child, defined as repeated positivity for islet cell antibodies plus >/=1 other antibody, overt type 1 diabetes, or both. DESIGN The study was carried out as part of the population-based birth cohort of the Type 1 Diabetes Prediction and Prevention Project. The data comprised 4297 children with increased genetic susceptibility to type 1 diabetes, born at the University Hospital of Oulu or Tampere, Finland, between October 1997 and December 2002. The children were monitored for diabetes-associated autoantibodies from samples obtained at 3-12-mo intervals. Maternal antioxidant intake during pregnancy was assessed postnatally with a self-administered food-frequency questionnaire, which contained a question about consumption of dietary supplements. RESULTS Maternal intake of none of the studied antioxidant nutrients showed association with the risk of advanced beta cell autoimmunity in the child. The hazard ratios, indicating the change in risk per a 2-fold increase in the intake of each antioxidant, were nonsignificant and close to 1. CONCLUSION High maternal intake of retinol, beta-carotene, vitamin C, vitamin E, selenium, zinc, or manganese does not protect the child from development of advanced beta cell autoimmunity in early childhood.
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Affiliation(s)
- Liisa Uusitalo
- Tampere School of Public Health, University of Tampere, Tampere, Finland
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18
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Lovett R, Fisher J, Al-Yaman F, Dance P, Vally H. A review of Australian health privacy regulation regarding the use and disclosure of identified data to conduct data linkage. Aust N Z J Public Health 2008; 32:282-5. [DOI: 10.1111/j.1753-6405.2008.00230.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Rosenbauer J, Herzig P, Giani G. Early infant feeding and risk of type 1 diabetes mellitus-a nationwide population-based case-control study in pre-school children. Diabetes Metab Res Rev 2008; 24:211-22. [PMID: 17968982 DOI: 10.1002/dmrr.791] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The evidence on the role of environmental factors in the development of type 1 diabetes is conflicting. Reducing potential bias and the variety of exposures, we investigated the association between type 1 diabetes risk and nutritional and environmental exposures in pre-school children. METHODS This nationwide population-based case-control study included 760 cases under 5 years of age newly diagnosed with type 1 diabetes during 1992-1995. From the general population, 1,871 controls were randomly selected and individually matched on age ( +/- 1 year), sex, and residence. Information on infant diet, foetal, perinatal and socio-economic factors, and familial diabetes was obtained by a parent-administered questionnaire. Data were analysed by multiple conditional logistic regression. RESULTS Duration of breastfeeding and age at introduction of bottle-feeding were inversely associated with type 1 diabetes risk according to a dose-response relationship (trend test p < 0.05). Adjusted odd ratios (95% CI) for a long breastfeeding period and a late introduction of bottle-feeding (>or=5 month versus < 2 weeks) were 0.71 (0.54-0.93) and 0.80 (0.62-1.04), respectively. Familial type 1 diabetes, maternal age > 40 years, and low birth weight were found more frequently among diabetic than among control children. Current cow's milk consumption, higher social status, and a larger family were associated with a reduced diabetes risk. Up to one half of the diabetic cases in the population could be attributed to modifiable exposures. CONCLUSIONS Our findings indicate that infant feeding is associated with type 1 diabetes risk and that a considerable part of new type 1 diabetic cases is potentially preventable.
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Affiliation(s)
- J Rosenbauer
- Institute of Biometrics and Epidemiology, German Diabetes Centre, Leibniz Institute at Heinrich-Heine University Düsseldorf, Germany. joachim.rosenbauer@ddz. uni-duesseldorf.de
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20
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Soltesz G, Patterson CC, Dahlquist G. Worldwide childhood type 1 diabetes incidence--what can we learn from epidemiology? Pediatr Diabetes 2007; 8 Suppl 6:6-14. [PMID: 17727380 DOI: 10.1111/j.1399-5448.2007.00280.x] [Citation(s) in RCA: 246] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Type 1 diabetes is the most common form of diabetes in most part of the world, although reliable data are still unavailable in several countries. Wide variations exist between the incidence rates of different populations, incidence is lowest in China and Venezuela (0.1 per 100,000 per year) and highest in Finland and Sardinia (37 per 100,000 per year). In most populations girls and boys are equally affected. In general, the incidence increases with age, the incidence peak is at puberty. After the pubertal years, the incidence rate significantly drops in young women, but remains relatively high in young adult males up to the age 29-35 years. Prospective national and large international registries (DIAMOND and EURODIAB) demonstrated an increasing trend in incidence in most regions of the world over the last few decades and increases seem to be the highest in the youngest age group. Analytical epidemiological studies have identified environmental risk factors operating early in life which might have contributed to the increasing trend in incidence. These include enteroviral infections in pregnant women, older maternal age (39-42 years), preeclampsia, cesarean section delivery, increased birthweight, early introduction of cow's milk proteins and an increased rate of postnatal growth (weight and height). Optimal vitamin D supplementation during early life has been shown to be protective. Some of these environmental risk factors such as viruses may initiate autoimmunity toward the beta cell, other exposures may put on overload on the already affected beta cell and thus accelerate the disease process.
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Affiliation(s)
- G Soltesz
- Department of Pediatrics, University of Pécs, Hungary.
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21
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Ambler GR, Fairchild J, Craig ME, Cameron FJ. Contemporary Australian outcomes in childhood and adolescent type 1 diabetes: 10 years post the Diabetes Control and Complications Trial. J Paediatr Child Health 2006; 42:403-10. [PMID: 16898876 DOI: 10.1111/j.1440-1754.2006.00889.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The reporting of the results of the Diabetes Control and Complications Trial in 1993 has led to a major reappraisal of management practices and outcomes in type 1 diabetes in children and adolescents. A considerable body of outcome data has been generated from Australia in this post-Diabetes Control and Complications Trial era relating to incidence, metabolic control, growth, hypoglycaemia, microvascular and macrovascular complications, cognition, behaviour and quality of life. These data are important in planning future management strategies and resource allocation and as a basis for future research.
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Affiliation(s)
- Geoffrey R Ambler
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, and School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia.
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22
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Haynes A, Bulsara MK, Bower C, Codde JP, Jones TW, Davis EA. Independent effects of socioeconomic status and place of residence on the incidence of childhood type 1 diabetes in Western Australia. Pediatr Diabetes 2006; 7:94-100. [PMID: 16629715 DOI: 10.1111/j.1399-543x.2006.00153.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To analyze the incidence of type 1 diabetes in 0- to 14-year olds in Western Australia, from 1985 to 2002, by region and socioeconomic status. METHODS Primary case ascertainment was from the prospective population-based Western Australian Diabetes Register, and secondary case ascertainment was from the Western Australian Hospital Morbidity Data System. The address at diagnosis was used to categorize cases into urban, rural and remote areas and into five socioeconomic groups using the Index of Relative Socioeconomic Disadvantage. Denominator data were obtained from the Australian Bureau of Statistics. Poisson regression was used to analyze the incidence rates by area and socioeconomic status. RESULTS There were a total of 1143 cases (904 urban, 190 rural and 49 remote). Case ascertainment was estimated to be 99.8% complete. The mean annual age-standardized incidence from 1985 to 2002 was 18.1 per 100,000 person years in urban (95% CI: 16.3-19.9), 14.3 per 100,000 in rural (95% CI: 11.4-7.3) and 8.0 per 100,000 in remote areas (95% CI: 5.8-10.3). The incidence was significantly higher in urban compared with rural (rate ratio 1.27, p = 0.001) and remote (rate ratio 2.28, p < 0.001) areas. The incidence increased with higher socioeconomic status. The incidence in the highest socioeconomic group was 56% greater than the lowest socioeconomic group (rate ratio 1.56, p < 0.001). These differences in incidence by socioeconomic status and region were independent of each other. CONCLUSIONS Higher socioeconomic status and residence in the urban area are independently associated with an increased risk of childhood type 1 diabetes in Western Australia.
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Affiliation(s)
- Aveni Haynes
- Department of Endocrinology & Diabetes, Princess Margaret Hospital, Perth, Western Australia, Australia
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23
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Bloomfield SF, Stanwell-Smith R, Crevel RWR, Pickup J. Too clean, or not too clean: the hygiene hypothesis and home hygiene. Clin Exp Allergy 2006; 36:402-25. [PMID: 16630145 PMCID: PMC1448690 DOI: 10.1111/j.1365-2222.2006.02463.x] [Citation(s) in RCA: 136] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The 'hygiene hypothesis' as originally formulated by Strachan, proposes that a cause of the recent rapid rise in atopic disorders could be a lower incidence of infection in early childhood, transmitted by unhygienic contact with older siblings. Use of the term 'hygiene hypothesis' has led to several interpretations, some of which are not supported by a broader survey of the evidence. The increase in allergic disorders does not correlate with the decrease in infection with pathogenic organisms, nor can it be explained by changes in domestic hygiene. A consensus is beginning to develop round the view that more fundamental changes in lifestyle have led to decreased exposure to certain microbial or other species, such as helminths, that are important for the development of immunoregulatory mechanisms. Although this review concludes that the relationship of the hypothesis to hygiene practice is not proven, it lends strong support to initiatives seeking to improve hygiene practice. It would however be helpful if the hypothesis were renamed, e.g. as the 'microbial exposure' hypothesis, or 'microbial deprivation' hypothesis, as proposed for instance by Bjorksten. Avoiding the term 'hygiene' would help focus attention on determining the true impact of microbes on atopic diseases, while minimizing risks of discouraging good hygiene practice.
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Affiliation(s)
- S F Bloomfield
- London School of Hygiene and Tropical Medicine, London, UK.
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24
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Abstract
The relative risk of type 1 (autoimmune) diabetes mellitus for a sibling of an affected patient is fifteen times that of the general population, indicating a strong genetic contribution to the disease. Yet, the incidence of diabetes in most Western communities has doubled every fifteen years since the Second World War - a rate of increase that can only possibly be explained by a major etiological effect of environment. Here, the authors provide a selective review of risk factors identified to date. Recent reports of linkage of type 1 diabetes to genes encoding pathogen pattern recognition molecules, such as toll-like receptors, are discussed, providing a testable hypothesis regarding a mechanism by which genetic and environmental influences on disease progress are integrated.
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Affiliation(s)
| | | | - Alan G. Baxter
- Comparative Genomics Centre, Molecular Sciences Building 21, James Cook University, Townsville QLD 4811, Australia
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25
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Virtanen SM, Knip M. Nutritional risk predictors of beta cell autoimmunity and type 1 diabetes at a young age. Am J Clin Nutr 2004; 78:1053-67. [PMID: 14668264 DOI: 10.1093/ajcn/78.6.1053] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Type 1 diabetes is an immune-mediated disease characterized by a preclinical prodrome during which beta cell autoimmunity proceeds at a variable rate. Large geographic differences and a conspicuous increase in incidence, especially among young children since the 1950s, and the relatively low concordance in identical twins are factors that favor a critical role of environmental factors in the etiology of this disease. Only approximately 5% or fewer subjects with HLA-conferred genetic susceptibility to type 1 diabetes actually develop the clinical disease. Breastfeeding, nicotinamide, zinc, and vitamins C, D, and E have been reported as possibly protecting against type 1 diabetes, whereas N-nitroso compounds, cow milk, increased linear growth, and obesity may increase the risk. Thus far, only the significance of infant feeding, cow milk, and vitamin D have been studied in both case-control and cohort settings. The major shortcoming of most studies done so far is that only single dietary exposures have been assessed at single time points. Putative nutritional and other confounding factors have received little attention as have the limitations of the dietary methods used. There is little firm evidence of the significance of nutritional factors in the etiology of type 1 diabetes. The availability of good markers of preclinical type 1 diabetes and of genetic risk have decreased the sample sizes needed and made longitudinal cohort studies of the assessment of children's diets feasible.
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Affiliation(s)
- Suvi M Virtanen
- Department of Epidemiology and Health Promotion, National Public Health Institute, Mannerheimintie 166, FIN-00300 Helsinki, Finland.
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26
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Brameld KJ, Holman CDJ, Lawrence DM, Hobbs MST. Improved methods for estimating incidence from linked hospital morbidity data. Int J Epidemiol 2003; 32:617-24. [PMID: 12913039 DOI: 10.1093/ije/dyg191] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Linked hospital morbidity data can be used to estimate the incidence of serious chronic disease. However, incidence rates calculated from first-time hospital admissions tend to be overestimated as a result of the erroneous inclusion of prevalent cases that have had previous hospital admissions prior to the study observation period. To address this problem, we have developed the backcasting method. METHOD A retrograde survival model was implemented to calculate the level of over-ascertainment of incidence according to the number of years of linked data on which the estimates were based and corresponding correction factors were calculated. The method is illustrated using the example of linked hospital morbidity data on diabetes mellitus and then acute myocardial infarction, which was validated against the Perth MONICA database for cardiovascular disease. RESULTS Corrected estimates of the incidence of diabetes and acute myocardial infarction were produced. The incidence of diabetes was shown to be lower than in North America in accordance with prevalence estimates, whereas the incidence of acute myocardial infarction was overestimated by approximately 10%. CONCLUSION A new method is presented for estimating incidence trends in disease from linked hospital morbidity data. The advantages of this method are its ease of use with routinely collected data and the relatively low cost of applying it in comparison with community surveys or maintaining formal disease registers. The method has other applications using linked data, such as the study of trends in first-time health care procedures and pharmaceutical prescriptions.
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Affiliation(s)
- Kate J Brameld
- Department of Public Health, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, Australia.
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Abstract
A growing body of research suggests that infant feeding practices influence the risk for several chronic diseases of childhood and adolescence. Increased risks for type 1 diabetes, celiac disease, some childhood cancers, and inflammatory bowel disease have been associated with artificial infant feeding and short-term breastfeeding. As genetic susceptibility is understood more completely and gene-environment interactions are elucidated, evidence to either confirm or refute these findings will be forthcoming.
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Affiliation(s)
- M K Davis
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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28
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Padaiga Z, Tuomilehto J, Karvonen M, Dahlquist G, Podar T, Adojaan B, Urbonaite B, Zalinkevicius R, Brigis G, Virtala E, Kohtamäki K, Cepaitis Z, Tuomilehto-Wolf E. Seasonal variation in the incidence of Type 1 diabetes mellitus during 1983 to 1992 in the countries around the Baltic Sea. Diabet Med 1999; 16:736-43. [PMID: 10510949 DOI: 10.1046/j.1464-5491.1999.00140.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM To examine seasonal patterns of incidence of Type 1 diabetes mellitus incidence in children aged 0-14 years in Finland, Sweden, Estonia, Latvia and Lithuania during 1983-1992 (1987-1992 for Finland). METHODS The study used a method that models incidence data using combinations of sine waves to model seasonal variation around a possible linear trend. RESULTS In Finland, a significant pattern was found for combined sexes and age groups 0-9 and 10-14 years. A significant pattern was also confirmed for 10-14 year-old boys. In Sweden, the best model with significant pattern was found separately for boys and girls and age groups 0-9 and 10-14 years, however, a significant pattern was confirmed for older girls only. A seasonal pattern in older boys in Finland and girls in Sweden was characterized by two cycles with decreased incidence in June and November-December. The pattern among younger children (0-9 or 5-9 years) had one cycle with a decreased incidence in May-June. In Estonia, a significant pattern was found for the age group 0-14 years and combined sexes. No significant seasonal patterns were found in Latvia and Lithuania. CONCLUSIONS The seasonal pattern with two cycles among older children and one cycle only among younger children may indicate different triggers of Type 1 diabetes mellitus for different age groups.
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Affiliation(s)
- Z Padaiga
- Institute of Endocrinology, Kaunas Medical University, Lithuania
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30
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Affiliation(s)
- J M Norris
- Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver 80262, USA
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31
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Tai TY, Wang CY, Lin LL, Lee LT, Tsai ST, Chen CJ. A case-control study on risk factors for Type 1 diabetes in Taipei City. Diabetes Res Clin Pract 1998; 42:197-203. [PMID: 9925351 DOI: 10.1016/s0168-8227(98)00105-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
To search for non-genetic risk factors for Type 1 diabetes among Chinese, a total of 117 Type 1 diabetes patients identified from the Taipei Type 1 Diabetes Registry and 193 frequency-matched controls with normal glucose tolerance were recruited. The controls were selected from classmates or colleagues of cases with similar distributions of age, sex, and parental and individual educational levels. Information on Type 1 diabetes risk factors was obtained through standardized interviews according to a structured questionnaire administered by two trained nurses. In the univariate analyses, the order of pregnancy of the study subject, the number of spontaneous and induced abortions reported by the mother before giving birth to the study subjects, the duration of breast-feeding and monthly family income were significantly associated with Type 1 diabetes in a dose-response manner. There was a U-shaped relationship with Type 1 diabetes for birth weight and paternal age at the conception of the study subjects. After further adjustment for multiple risk factors through logistic regression analysis, the biological gradient for pregnancy order, duration of breast-feeding, and the U-shaped relationship for paternal age remained statistically significant.
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Affiliation(s)
- T Y Tai
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei
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Dahlquist G. The aetiology of type 1 diabetes: an epidemiological perspective. ACTA PAEDIATRICA (OSLO, NORWAY : 1992). SUPPLEMENT 1998; 425:5-10. [PMID: 9822187 DOI: 10.1111/j.1651-2227.1998.tb01244.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Type 1 diabetes is increasing rapidly in many parts of the Western world, most evidently in Scandinavia. A low concordance rate of insulin-dependent diabetes mellitus among monozygotic twins clearly indicates that genetic risk factors may be necessary, but are not sufficient for the disease to occur. The strongest genetic risk markers are located in the HLA region of chromosome 6, but these DNA specificities differ in different populations. Risk genes are indicated in other chromosomes of the human genome, suggesting a complex interaction between genes and environment as the cause of the disease. The pathogenesis of the disease is proposed to be autoimmune in nature and environmental risk factors may either initiate autoimmunity or accelerate an already ongoing beta-cell destruction. Risk factors disclosed by epidemiological studies that may accelerate the pathogenetic process are: a cold environment, a high growth rate, infections and stressful life events. Risk factors that may initiate the autoimmune process include early exposure to cow's milk proteins, nitrosamines or early foetal events such as blood group incompatibility or foetal viral infections. In conclusion, population-based epidemiological studies have helped to confirm proposed aetiological models that have arisen from experimental research. These epidemiological studies have also introduced important new findings that may reveal the complex aetiology of the disease and advance understanding closer to the ultimate goal of primary prevention.
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Affiliation(s)
- G Dahlquist
- Department of Pediatrics, Umeå University, Sweden
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Gimeno SGA, Souza JMPD. Amamentação ao seio, amamentação com leite de vaca e o diabetes mellitus tipo 1: examinando as evidências. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 1998. [DOI: 10.1590/s1415-790x1998000100002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A etiologia do diabetes mellitus tipo 1 (DM1) envolve tanto herança genética como a exposição a fatores ambientais. Evidências de estudos epidemiológicos e experimentais sugerem que a dieta pode ser importante na etiopatogenia dessa doença. Em 1984, Borch-Johnsen e col. sugeriram, com base nos resultados de um estudo caso-controle, que o leite materno seria um fator de proteção para o DM1; esse efeito se daria devido às propriedades anti-infecciosas desse tipo de leite, ou pelo fato de que a amamentação ao seio evitaria que as crianças pudessem ser precocemente expostas a outros agentes etiológicos contidos nos substitutos do leite materno. Esses mesmos achados foram poste-riormente encontrados em diversos estudos, mas o papel do leite materno no aparecimento do DM1 ainda permanece controverso. Em 1992, Karjalainen e col., ao compararem os soros de indivíduos com e sem DM1, observaram, entre os diabéticos, altas concentrações de anticorpos anti-albumina bovina. Os autores postularam a hipótese de que a albumina bovina poderia atuar como desencadeadora do processo destrutivo das células ß do pâncreas e, conseqüentemente, do diabetes. Resultados conflitantes foram observados nas publicações que se sucederam a essa. Neste artigo, resumem-se e discutem-se os achados de diferentes pesquisadores que investigaram a importância desses fatores dietéticos para o aparecimento do DM1.
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Golding J, Emmett PM, Rogers IS. Does breast feeding have any impact on non-infectious, non-allergic disorders? Early Hum Dev 1997; 49 Suppl:S131-42. [PMID: 9363422 DOI: 10.1016/s0378-3782(97)00059-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Feeding of breast milk in the first weeks of life appears to have a strong protective effect against necrotising enterocolitis. Nevertheless breast milk also seems to be positively linked to the development of jaundice and to late haemorrhagic disease in infants who have not received vitamin K supplements. There is no consistent evidence that other childhood conditions such as insulin dependent diabetes or cancer are less prevalent among children who have been breast fed. Among adult conditions suggested to be less prevalent in the breast fed, only single reports of significant findings for multiple sclerosis and breast cancer exist and convincing corroboration is not available. There are a number of studies that indicate a relationship between breast feeding and later cholesterol levels--and one that has considered the mortality of ischaemic heart disease among adult males. There is some suggestion that breast feeding (during the first year of life) is the optimal protection against future raised lipid levels and mortality from coronary heart disease, but the evidence is far from conclusive. The major health advantage of breast feeding that has been clearly demonstrated remains in the protection of the infant from certain infections in early life. If there are other long-term health advantages they have yet to be fully elucidated and confirmed.
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Affiliation(s)
- J Golding
- Unit of Pediatric and Perinatal Epidemiology, University of Bristol, UK
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35
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Jacobson DL, Gange SJ, Rose NR, Graham NM. Epidemiology and estimated population burden of selected autoimmune diseases in the United States. CLINICAL IMMUNOLOGY AND IMMUNOPATHOLOGY 1997; 84:223-43. [PMID: 9281381 DOI: 10.1006/clin.1997.4412] [Citation(s) in RCA: 1040] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Autoimmune diseases cause significant and chronic morbidity and disability. The actual number of persons in the United States that are affected by autoimmune diseases and the resultant magnitude of their impact on the public's health are limited to a few specific diseases. In order to understand the clinical, public health and economic importance of these diseases it is necessary to have estimates of incidence and prevalence rates in the population. In this analysis, we estimate the number of persons affected by 24 autoimmune diseases in the United States by applying mean weighted prevalence and incidence rates obtained from published articles to U. S. Census data. The study was restricted to 24 autoimmune predefined diseases for which there was direct or indirect evidence for autoimmune pathogenesis. Subsequently, we used computerized search software and ancestry searching (bibliographies) to conduct a comprehensive search of articles published from 1965 to the present. Eligible studies included those which adhered to standard disease definitions and which included population-based estimates of incidence or prevalence rates. Mean weighted incidence and prevalence rates were calculated from eligible published studies with greater weight proportionately given to larger studies. The mean rates were then applied to the U.S. Census population figures to estimate the number of persons currently afflicted with each disease and the number of new cases occurring each year in the United States. Only U.S. and European studies were used to estimate prevalence and incidence rates when there were at least six eligible studies available for a disease. When there were fewer than six studies, all available studies were included, regardless of country of origin. The number of eligible incidence and prevalence studies found in the literature varied considerably between the 24 autoimmune diseases selected. The largest number of eligible prevalence studies were conducted on multiple sclerosis (MS), rheumatoid arthritis, and systemic lupus erythematosus (SLE) (>/=23), followed by insulin-dependent diabetes (IDDM), myasthenia gravis, primary biliary cirrhosis, and scleroderma (>/=7). There were only one to four eligible studies done on 11 other diseases, and no prevalence studies on 6 diseases. Incidence studies were less frequent but the largest number of studies were conducted on IDDM (n = 37) and MS (n = 28), followed by Graves' disease/hyperthyroidism, glomerulonephritis, primary biliary cirrhosis, rheumatic fever, rheumatoid arthritis, scleroderma, and SLE (>/=9). On the other 11 diseases, there were one to six eligible studies, and no studies on 5 diseases. There were no eligible incidence or prevalence studies on Goodpasture's syndrome, idiopathic thrombocytopenia purpura, or relapsing polychondritis. Overall we estimate that 8,511,845 persons in the United States or approximately 1 in 31 Americans are currently afflicted with one of these autoimmune diseases. The diseases with the highest prevalence rates were Graves'/hyperthyroidism, IDDM, pernicious anemia, rheumatoid arthritis, thyroiditis, and vitiligo, comprising an estimated 7,939, 280 people or 93% of the total number estimated. Glomerulonephritis, MS, and SLE added an estimated 323,232 people. The prevalence of the other diseases reviewed were rare, less than 5.14/100,000. Most diseases were more common in women. From the incidence data we estimate that 237,203 Americans will develop an autoimmune disease in 1996 and that approximately 1,186,015 new cases of these autoimmune diseases occur in the United States every 5 years. Women were at 2.7 times greater risk than men to acquire an autoimmune disease. After reviewing the medical literature for incidence and prevalence rates of 24 autoimmune diseases, we conclude that many autoimmune diseases are infrequently studied by epidemiologists. As a result the total burden of disease may be an underestimate. (ABSTRACT TRUNCATED)
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Affiliation(s)
- D L Jacobson
- School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland, 21205, USA
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36
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Abstract
Breastfeeding, a valuable natural resource, promotes health, helps prevent infant and childhood disease, and saves health care costs. Additional annual national health care costs, incurred for treatment of four medical conditions in infant who were not breastfed were estimated. Infant diarrhea in nonbreastfed infants costs $291.3 million; respiratory syncytial virus, $225 million; insulin-dependent diabetes mellitus, from $9.6 to $124.8 million; and otitis media, $660 million. Thus, these four medical diagnoses alone create just over $1 billion of extra health care costs each year. Breastfeeding may also enhance intellectual development of children according to at least one medical research study. The potential societal benefits of more intelligent children is incalculable even though it cannot be directly measured in terms of dollars. Finally, it was calculated that an additional $2,665,715 in federal funds is needed yearly in order for WIC to provide infant formula to nonbreastfeeding mothers. For the average family, the cost of purchasing formula is twice the cost of supplemental food for the breastfeeding mother. Breastfeeding education and support should be an integral part of health care, especially under managed care which rewards the prevention of health problems and reduced use of health services.
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Affiliation(s)
- J M Riordan
- School of Nursing, Wichita State University, Kansas, USA
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37
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Patterson CC, Carson DJ, Hadden DR. Epidemiology of childhood IDDM in Northern Ireland 1989-1994: low incidence in areas with highest population density and most household crowding. Northern Ireland Diabetes Study Group. Diabetologia 1996; 39:1063-9. [PMID: 8877290 DOI: 10.1007/bf00400655] [Citation(s) in RCA: 103] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
During the period 1989-1994, 462 cases of insulin-dependent diabetes mellitus were registered among children from Northern Ireland aged under 15 years. The estimated completeness of the register was 98.8% (95% confidence interval (CI) 97.7%, 99.9%). A standardised rate of 19.6 (95% CI 17.8, 21.4) per 100 000 person years was obtained, placing Northern Ireland near the top of the range of published incidence in the United Kingdom, with a rate close to that reported for Scotland. In an analysis based on 217 postcode sectors, areas with a high population density and the most material deprivation were observed to have the lowest incidence rates. After inclusion of population density in a Poisson regression analysis, the component of deprivation which was found to be most significant was household crowding. Relative to children living in areas of low population density, there was a reduced risk for children in medium (relative incidence 0.85 (95% confidence limits CI 0.67, 1.09)) and high (0.62 (95% CI 0.48,0.80)) population density areas. Similarly, relative to children living in areas with low levels of household crowding, there was a reduced risk for children in medium (relative incidence 0.73 (95% CI 0.58,0.93)) and high (0.67 (95% CI 0.53, 0.83)) levels of household crowding. Tests for space-time clustering at diagnosis and at birth were negative. A possible explanation for the differences in incidence rate observed in this study is that exposure to infections very early in childhood is a protective factor. Later infections may act as either initiators or promoters of diabetes, but the absence of space-time clustering suggests that no single specific infectious agent is responsible.
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Affiliation(s)
- C C Patterson
- Department of Epidemiology and Public Health, Queen's University of Belfast, Northern Ireland, UK
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38
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Dahlquist G. Environmental risk factors in human type 1 diabetes--an epidemiological perspective. DIABETES/METABOLISM REVIEWS 1995; 11:37-46. [PMID: 7600906 DOI: 10.1002/dmr.5610110104] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- G Dahlquist
- Department of Pediatrics, Umeå University, Sweden
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39
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Karges WJ, Ilonen J, Robinson BH, Dosch HM. Self and non-self antigen in diabetic autoimmunity: molecules and mechanisms. Mol Aspects Med 1995; 16:79-213. [PMID: 7658921 DOI: 10.1016/0098-2997(95)00001-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In this article, we have summarized current facts, models and views of the autoimmunity that leads to destruction of insulin-producing beta-cells and consequent Type 1 (insulin-dependent) diabetes mellitus. The presence of strong susceptibility and resistance gene loci distinguishes this condition from other autoimmune disorders, but environmental disease factors must conspire to produce disease. The mapping of most of the genetic risk (or disease resistance) to specific alleles in the major histocompatibility locus (MHC class II) has direct functional implications for our understanding of autoimmunity in diabetes and directly implies that presentation of a likely narrow set of peptides is critical to the development of diabetic autoimmunity. While many core scientific questions remain to be answered, current insight into the disease process is beginning to have direct clinical impact with concerted efforts towards disease prevention or intervention by immunological means. In this process, identification of the critical antigenic epitopes recognized by diabetes-associated T cells has achieved highest priority.
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Affiliation(s)
- W J Karges
- Department of Pediatrics and Immunology, Hospital for Sick Children, University of Toronto, Canada
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40
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Abstract
Quite different nutrition-related environmental factors influence the development of type 1 insulin-dependent diabetes (IDDM) and type 2 non-insulin-dependent diabetes (NIDDM). IDDM is characterized by progressive beta-cell destruction which leads to complete insulin deficiency; at the time of diagnosis 80-90% of beta cells have been destroyed. In children there is epidemiological evidence that high intake of nitrites and N-nitroso compounds, early introduction of cow's milk to the diet and short duration or absence of breastfeeding increase the risk of IDDM. Studies in experimental animals suggest that cow's milk and soy proteins may be diabetogenic. There is current interest in the effects of free radical scavengers, particularly niacin and natural and synthetic antioxidants on the incidence of IDDM. These findings from ecological, animal, and human case-control studies remain to be evaluated in prospective cohort studies covering infancy and childhood and finally in human intervention trials. NIDDM is characterized by insulin resistance which is complicated by impaired insulin secretion at the time of appearance of hyperglycaemia and clinical diabetes. Its preclinical development is insidious and poorly defined, and there is little direct evidence that the same factors which influence metabolic control in clinical diabetes also affect the preclinical development of the disorder. Obesity, particularly of the abdominal type, is common in people who develop NIDDM, and weight control by appropriate diet and physical activity is probably the most important measure for preventing NIDDM. High (saturated) fat intake seems to be associated with insulin resistance, obesity and increased risk of NIDDM, and diets high in carbohydrate seem to protect from glucose intolerance and diabetes, mainly owing to their high fibre content.
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Affiliation(s)
- S M Virtanen
- Department of Applied Chemistry and Microbiology, University of Helsinki, Finland
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41
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Kelly HA, Russell MT, Jones TW, Byrne GC. Dramatic increase in incidence of insulin dependent diabetes mellitus in Western Australia. Med J Aust 1994; 161:426-9. [PMID: 7935096 DOI: 10.5694/j.1326-5377.1994.tb127523.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To document and suggest possible reasons for a dramatic increase in the incidence of insulin dependent diabetes mellitus (IDDM) in Western Australia in 1992. PATIENTS Children aged 0-14 years with IDDM diagnosed in Western Australia from 1985 to 1992 inclusive. DESIGN A population-based register in Western Australia, using name-identified data from two separate ascertainment sources, provided numerator data. Denominator data were estimated from census figures collected in 1986 and 1991 by the Australian Bureau of Statistics. The completeness of case ascertainment was estimated by the capture-recapture method. RESULTS Case ascertainment for 1985-1992 was estimated as 99.6% complete. Between 1985 and 1991 the incidence of IDDM in the 0-14 year age group varied between 11.8 and 15.5 per 100,000 person-years without a significant increase. In 1992, however, based on the previous seven years, 52 cases would have been expected but 84 cases were observed, an incidence of 22.2 per 100,000 person-years. The increase in incidence occurred across all age groups and in both sexes. Place of residence at diagnosis, the prevalence of islet cell antibody positivity at diagnosis and the proportion of new cases with a first degree relative with IDDM were no different in 1992 than in preceding years. CONCLUSION This is the first report of a significant increase in the incidence of IDDM in Australia. It appears to be a period, rather than a cohort, effect and provides further evidence for environmental antigens as disease triggers.
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Affiliation(s)
- H A Kelly
- Department of Diabetes and Endocrinology, Princess Margaret Hospital for Children, Perth, WA
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42
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Abstract
A retrospective case-control study was undertaken to investigate the relationship between the early introduction of cow's milk and the subsequent risk of developing Type 1 diabetes (< 15 years at diagnosis). A total of 268 children who developed diabetes during the period 1980-1990 (11 years inclusive) in Leicestershire were identified. Age-, sex-, and race-matched controls were identified using the Leicestershire population register. Parents of children with diabetes and their controls completed a structured questionnaire on infant feeding habits from birth. A total of 184 questionnaires (67%) were analysed. There was no difference between the diabetic and control children with respect to the introduction of cow's milk at an early age and the risk of developing diabetes (odds ratio: 0.98 (0.65-1.47)). In addition, short duration of breast-feeding (< 3 months) had no influence on the incidence of diabetes (1.05 (0.64-1.75)). This study does not support the hypothesis that the early introduction of cow's milk or a short duration of breast-feeding increases the risk of developing Type 1 diabetes.
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43
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Norris J, Pietropaolo M. A bovine albumin peptide as a possible trigger of insulin-dependent diabetes mellitus. J Endocrinol Invest 1994; 17:565-72. [PMID: 7829831 DOI: 10.1007/bf03347751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- J Norris
- University of Colorado Health Sciences Center, Dept of preventive medicine and biometrics, Denver 80262
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44
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Strand FT. Primary prevention of insulin-dependent diabetes mellitus: simple approaches using thermal modification of milk. Med Hypotheses 1994; 42:110-4. [PMID: 8022328 DOI: 10.1016/0306-9877(94)90085-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Evidence is presented that new cases of primary insulin dependent diabetes mellitus (IDDM) will cease to occur when milk-processing temperatures are increased from current levels (72 degrees C) to at least 85 degrees C. This temperature is sufficient to denature bovine serum albumin (BSA), the environmental trigger molecule for IDDM. Morbidity and mortality from atherosclerotic vascular disease (ASVD) and a number of autoimmune diseases may also be reduced by such increases in milk-processing temperatures. BSA-free milk products commercially available now include those canned (> 100 degrees C), ultrapasteurized (138 degrees C), and ultrahigh-temperature (UHT) processed (149 degrees C). At less than 6400 feet elevation, BSA can be denatured by simply bringing milk to a boil (> 85 degrees C). Until such time as all milk is routinely heat-treated to denature BSA, the safest course to maintain good nutrition and prevent IDDM and other BSA-triggered diseases is selection of milk products processed at temperatures above 85 degrees C.
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45
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Dahlquist G. Etiological aspects of insulin-dependent diabetes mellitus: an epidemiological perspective. Autoimmunity 1993; 15:61-5. [PMID: 8218832 DOI: 10.3109/08916939309004840] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The mechanism of beta-cell destruction leading to insulin dependent diabetes is probably a cell mediated auto-immune process occurring in genetically susceptible individuals. Since 50-70% of monozygotic twins will not get the disease non-genetic risk factors must play an important role in the etiology of the disease. During the past decade population based epidemiological studies have identified several risk determinants for insulin dependent diabetes. Based on these studies a multifactorial hypothesis of causation is proposed. Some risk determinants (maternal child blood group incompatibility, fetal viral infections, early exposure to cow's milk proteins, a high exposure level of nitrosamines) may independently initiate the autoimmune process by causing the initial damage of the beta-cell, leading to antigen release. Other risk determinants may promote an already ongoing autoimmune destructive process through induction of lymphokine release or by causing an increased work load on the beta-cell. Risk factors that may increase the peripheral need for insulin (infectious diseases, cold environment, a high growth rate and stressful life events) may act as promoters of the beta-cell destruction but also disclose the beta-cell impairment and make the disease clinically overt. Possibilities of different risk profiles in different age groups and of synergism between different risk factors are also discussed.
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Affiliation(s)
- G Dahlquist
- Department of Pediatrics, University Hospital, Umeå, Sweden
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46
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Guest CS, O'Dea K. Diabetes in aborigines and other Australian populations. AUSTRALIAN JOURNAL OF PUBLIC HEALTH 1992; 16:340-9. [PMID: 1296781 DOI: 10.1111/j.1753-6405.1992.tb00079.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The aetiology of diabetes mellitus is reviewed in the light of Australian epidemiological studies. The prevalence of diabetes has been studied in a wide variety of Australian settings. Comparisons of prevalences in Aborigines and other populations suggest that occurrence of this disease has both genetic and environmental determinants. Diet and obesity are associated with diabetes, but to increase physical exercise may be the most feasible intervention. Public health approaches are discussed.
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Affiliation(s)
- C S Guest
- Department of Medicine Royal Melbourne Hospital, University of Melbourne
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47
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Virtanen SM, Räsänen L, Aro A, Ylönen K, Lounamaa R, Tuomilehto J, Akerblom HK. Feeding in infancy and the risk of type 1 diabetes mellitus in Finnish children. The 'Childhood Diabetes in Finland' Study Group. Diabet Med 1992; 9:815-9. [PMID: 1473321 DOI: 10.1111/j.1464-5491.1992.tb01899.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In a case-control design the feeding in infancy of newly diagnosed 7- to 14-year-old diabetic children (n = 426) was compared with that of age- and sex-matched non-diabetic children (n = 426) randomly selected from the Finnish population registry. All 7- to 14-year-old diabetic children diagnosed from September 1986 to the end of April 1989 from all hospitals which treat diabetic children in Finland were invited to participate in the study. Breast-feeding was initiated in almost all children, but during the birth years of this study population (1972-1982), an increase was observed in the duration of breast-feeding (whether alone or in combination with supplementary feeding) and in the age of introduction of supplementary milk feeding. The risk of Type 1 diabetes was decreased in the children who were totally breast-fed for at least 2 months (odds ratio (OR) 0.64, 95% confidence interval (CI) 0.42-0.98) or 3 months (OR 0.67, 95% CI 0.48-0.95) or exclusively breast-fed for at least 2 months (OR 0.60, 95% CI 0.41-0.89) or 3 months (OR 0.63, 95% CI 0.43-0.93). Those children who were younger than 2 months (OR 1.54, 95% CI 1.08-2.18) or 3 months (OR 1.52, 95% CI 1.11-2.08) at the time when supplementary milk feeding was begun had an increased risk of Type 1 diabetes. These associations remained significant after adjusting for the mother's education. The results suggest that early infant feeding patterns are associated with the risk of Type 1 diabetes developing at the age of 7 to 14 years.
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Affiliation(s)
- S M Virtanen
- Department of Applied Chemistry and Microbiology, Children's Hospital, Helsinki, Finland
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48
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Abstract
The etiology of Insulin Dependent Diabetes Mellitus (IDDM) is reviewed and discussed using Rothman's deterministic model for causal inference. Intercontinental comparisons, familial aggregation, seasonal variation, maternal age, breast-feeding and infectious agents are reviewed within the context of IDDM causation. Genetic, viral and other environmental factors play a major role in this etiologic model.
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Affiliation(s)
- D Sumburèru
- Department of Community Medicine and Rural Health, University of North Dakota School of Medicine, Grand Forks 58203
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49
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50
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Sutton L, Plant AJ, Lyle DM. Services and cost of hospitalization for children and adolescents with insulin-dependent diabetes mellitus in New South Wales. Med J Aust 1990; 152:130-6. [PMID: 2300012 DOI: 10.5694/j.1326-5377.1990.tb125119.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Data on services for Australian children and adolescents with diabetes are limited. The purpose of the present study was to examine the availability, utilization and some of the costs of services for persons of less than 20 years of age with insulin-dependent diabetes mellitus in New South Wales, and to make recommendations for future services. The numbers of prevalent and incident cases of insulin-dependent diabetes mellitus in the zero- to 19-years' age-group in each of the health regions of the State were estimated using data from the insulin-dependent diabetes mellitus register of the Southern Metropolitan Health Region. Information on the available services for young persons with diabetes was obtained from doctors and diabetes educators around the State, and on the utilization of services in the Southern Metropolitan Health Region from interviewing the families of persons whose names are listed in the diabetes register. An estimated range of the annual direct cost of hospital admissions for diabetes in the zero- to 19-years' age-group in New South Wales was calculated by use of the data collected from the diabetes register, the hospital separation data from the NSW Department of Health, the NSW Department of Health estimated bed-day cost and the estimated average cost of a bed day for diabetic patients at The Children's Hospital Camperdown. Services for children and adolescents with insulin-dependent diabetes mellitus in this State are most comprehensive in central Sydney. However, even these excellent services are not utilized fully by the children and their families. The annual cost of hospitalization for diabetes in the zero- to 19-years' age-group in New South Wales is estimated to be approximately +1.5 million. There needs to be an equally high standard of care for all diabetic children in the State; however, the utilization of services, as well as the services themselves, need to be improved and the cost-effectiveness of new services needs to be evaluated.
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Affiliation(s)
- L Sutton
- Department of Public Health, University of Sydney, NSW
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