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Beyerlein A, Weigert M, Katz K, Küchenhoff H, Hartl W. Long-Term Trends in the Protection Against Severe Courses of COVID-19 by Vaccination. Dtsch Arztebl Int 2023; 120:873-878. [PMID: 37963066 PMCID: PMC10859745 DOI: 10.3238/arztebl.m2023.0230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/19/2023] [Accepted: 10/19/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND The long-term course of protection against severe COVID-19 courses by vaccine-induced or hybrid immunity in Germany is unclear. METHODS We studied 146 457 cases aged 60-99 years in the German federal state of Bavaria who were immunized against COVID-19 and tested positive for it from February 2022 to January 2023. We calculated adjusted hazard ratios for a severe course (hospitalization or death due to COVID-19) for different intervals between the onset of full primary or booster immunity and the date of the infection. RESULTS 3342 (2.3%) severe courses of COVID-19 were observed in the first 60 days after the infection. The risk of a severe course rose with the interval between the onset of immune protection and the infection (adjusted hazard ratios and 95% confidence intervals at 6, 9, 12, and 15 months: 1.14 [1.08; 1.20]; 1.33 [1.24; 1.42]; 1.39 [1.25; 1.54]; 1.61 [1.35; 1.93]). The risk rose more slowly when mRNA-based vaccines were used exclusively. In a previous study, we observed 82% initial efficacy in cases aged 60 and above who received a booster vaccination (compared to unvaccinated cases) and an absolute risk reduction of 2.1%. If one extrapolates these findings to the current study, the residual efficacy and absolute risk reduction are found to be approximately 71% and 1.8% (respectively) at 6 months, and 32% and 0.8% at 15 months. CONCLUSION These results indicate that, during the Omicron wave, the protection of older persons against a severe COVID-19 course gradually declined from six months after vaccination onward. The limitations of this study include confounders that could not be taken into account, possible misclassification of the cause of death, and selection bias due to missing information about vaccination status and severe COVID-19 courses.
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Affiliation(s)
| | - Maximilian Weigert
- Statistical Consulting Unit StaBLab, CODAG, Institute of Statistics, LMU Munich
- Munich Center for Machine Learning (MCML), Munich
| | - Katharina Katz
- Bavarian Health and Food Safety Authority, Oberschleißheim
| | - Helmut Küchenhoff
- Statistical Consulting Unit StaBLab, CODAG, Institute of Statistics, LMU Munich
- Munich Center for Machine Learning (MCML), Munich
- *Joint last authors
| | - Wolfgang Hartl
- Surgical Intensive Care Medicine, Department of General, Visceral, and Transplantation Surgery, University Hospital, Großhadern Campus, LMU Munich
- *Joint last authors
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Affiliation(s)
- Andreas Weiss
- Institute of Diabetes Research, Helmholtz Munich, Munich, Germany
| | - Ewan Donnachie
- Kassenärztliche Vereinigung Bayern (Bavarian Association of Statutory Health Insurance Physicians), Munich, Germany
| | - Andreas Beyerlein
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
| | - Anette-G Ziegler
- Institute of Diabetes Research, Helmholtz Munich, Munich, Germany
| | - Ezio Bonifacio
- Center for Regenerative Therapies Dresden, Technische Universität Dresden, Dresden, Germany
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Weigert M, Beyerlein A, Katz K, Schulte R, Hartl W, Küchenhoff H. Vaccine-induced or hybrid immunity and COVID-19-associated mortality during the Omicron wave. Deutsches Ärzteblatt international 2023:arztebl.m2023.0051. [PMID: 37013438 DOI: 10.3238/arztebl.m2023.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND It is not yet entirely clear to what extent vaccine-induced or hybrid immunity protects individuals in Germany from death during the omicron wave of the COVID-19 pandemic. METHODS In this retrospective study, we evaluated 470 159 cases over age 59 in the German federal state of Bavaria who tested positive for SARS-CoV-2 between 1 January and 30 June 2022. Cox models were used to estimate adjusted hazard ratios (aHR) for dying within 60 days of the infection, depending on sex, age, time point of infection, and a range of immunity levels. RESULTS Over the period of observation, 3836 COVID-19-associated deaths were registered (case fatality rate 0.82 %). Risk of death was significantly lower in cases with a higher immunity level than in unvaccinated cases (aHR for a full primary immunity level, if reached less than six months before the time of the infection: 0.30, 95 %-confidence interval [0.23; 0.39]; if reached more than six months before: aHR 0.46 [0.35; 0.60]). A boosted immunity level lowered risk of death even further (if reached less than three months before the infection: aHR 0.17 [0.15; 0.20]; if reached more than three months before: aHR 0.25 [0.21; 0.29]). CONCLUSION Among elderly persons in Bavaria, a higher immunity level was associated with a substantial degree of protection against death during the Omicron wave; the strength of protection may have diminished somewhat over time.
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Gomes D, Beyerlein A, Katz K, Hoelscher G, Nennstiel U, Liebl B, Überla K, von Kries R. Is the BNT162b2 COVID-19 vaccine effective in elderly populations? Results from population data from Bavaria, Germany. PLoS One 2021; 16:e0259370. [PMID: 34739520 PMCID: PMC8570490 DOI: 10.1371/journal.pone.0259370] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/18/2021] [Indexed: 11/19/2022] Open
Abstract
Background The efficacy of the BioNTech-Pfizer BNT162b2 vaccination in the elderly (≥80 years) could not be fully assessed in the BioNTech-Pfizer trial due to low numbers in this age group. We aimed to evaluate the effectiveness of the BioNTech-Pfizer (BNT162b2) vaccine to prevent SARS-CoV-2 infection and severe outcomes in octo- and novo-generians in a German state setting. Methods and findings A prospective observational study of 708,187 persons aged ≥80 years living in Bavaria, Germany, was conducted between Jan 9 to Apr 11, 2021. We assessed the vaccine effectiveness (VE) for two doses of the BNT162b2 vaccine with respect to SARS-CoV-2 infection and related hospitalisations and mortality. Additionally, differences in VE by age groups ≥80 to ≤89 years and ≥90 years were studied. Analyses were adjusted by sex. By the end of follow-up, 63.8% of the Bavarian population ≥80 years had received one dose, and 52.7% two doses, of the BNT162b2 vaccine. Two doses of the BNT162b2 vaccine lowered the proportion of SARS-CoV-2 infections and related outcomes, resulting in VE estimates of 68.3% (95% confidence interval (CI) 65.5%, 70.9%) for infection, 73.2% (95% CI 65.3%, 79.3%) for hospitalisation, and 85.1% (95% CI 80.0%, 89.0%) for mortality. Sex differences in the risk of COVID-19 outcomes observed among unvaccinated persons disappeared after two BNT162b2 vaccine doses. Overall, the BNT162b2 vaccine was equally effective in octo- and novo-genarians. Conclusions Two doses of BioNTech-Pfizer’s BNT162b2 vaccine is highly effective against COVID-19 outcomes in elderly persons.
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Affiliation(s)
- Delphina Gomes
- Division of Pediatric Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilians-University, Munich, Germany
| | - Andreas Beyerlein
- Division of Pediatric Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilians-University, Munich, Germany
| | - Katharina Katz
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
| | | | - Uta Nennstiel
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
| | - Bernhard Liebl
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
| | - Klaus Überla
- Institute of Clinical and Molecular Virology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Rüdiger von Kries
- Division of Pediatric Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilians-University, Munich, Germany
- * E-mail:
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Hummel S, Weiß A, Bonifacio E, Agardh D, Akolkar B, Aronsson CA, Hagopian WA, Koletzko S, Krischer JP, Lernmark Å, Lynch K, Norris JM, Rewers MJ, She JX, Toppari J, Uusitalo U, Vehik K, Virtanen SM, Beyerlein A, Ziegler AG. Associations of breastfeeding with childhood autoimmunity, allergies, and overweight: The Environmental Determinants of Diabetes in the Young (TEDDY) study. Am J Clin Nutr 2021; 114:134-142. [PMID: 33831944 PMCID: PMC8246624 DOI: 10.1093/ajcn/nqab065] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 02/19/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Breastfeeding has beneficial effects on numerous health outcomes. OBJECTIVES We investigated whether breastfeeding duration is associated with the development of early childhood autoimmunity, allergies, or obesity in a multinational prospective birth cohort. METHODS Infants with genetic susceptibility for type 1 diabetes (n = 8676) were followed for the development of autoantibodies to islet autoantigens or transglutaminase, allergies, and for anthropometric measurements to a median age of 8.3 y (IQR: 2.8-10.2 y). Information on breastfeeding was collected at 3 mo of age and prospectively thereafter. A propensity score for longer breastfeeding was calculated from the variables that were likely to influence any or exclusive breastfeeding. The risks of developing autoimmunity or allergy were assessed using Cox proportional hazards models, and the risk of obesity at 5.5 y of age was assessed using logistic regression with adjustment by the propensity score. RESULTS Breastfeeding duration was not associated with a lower risk of either islet or transglutaminase autoimmunity (any breastfeeding >6 mo, adjusted HR: 1.07; 95% CI: 0.96, 1.19; exclusive breastfeeding >3 mo, adjusted HR: 1.03; 95% CI: 0.92, 1.15). Exclusive breastfeeding >3 mo was associated with a decreased risk of seasonal allergic rhinitis (adjusted HR: 0.70; 95% CI: 0.53, 0.92; P < 0.01). Any breastfeeding >6 mo and exclusive breastfeeding >3 mo were associated with decreased risk of obesity (adjusted OR: 0.62; 95% CI: 0.47, 0.81; P < 0.001; and adjusted OR: 0.68; 95% CI: 0.47, 0.95; P < 0.05, respectively). CONCLUSIONS Longer breastfeeding was not associated with a lower risk of childhood (islet or transglutaminase) autoimmunity in genetically at-risk children but was associated with decreased risk of seasonal allergic rhinitis and obesity at 5.5 y of age.
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Affiliation(s)
- Sandra Hummel
- Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany; and Forschergruppe Diabetes, Technical University Munich, at Klinikum rechts der Isar, Munich, and Forschergruppe Diabetes eV, Neuherberg, Germany
| | - Andreas Weiß
- Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany; and Forschergruppe Diabetes, Technical University Munich, at Klinikum rechts der Isar, Munich, and Forschergruppe Diabetes eV, Neuherberg, Germany
| | - Ezio Bonifacio
- DFG Center for Regenerative Therapies Dresden, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Daniel Agardh
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Beena Akolkar
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Carin A Aronsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | | | - Sibylle Koletzko
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
- Department of Pediatrics, Gastroenterology and Nutrition, School of Medicine, Collegium Medicum University of Warmia and Mazury, Olsztyn, Poland
| | - Jeffrey P Krischer
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Kristian Lynch
- 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 Anschutz Medical Campus, Aurora, CO, USA
| | - Marian J Rewers
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jin-Xiong She
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Jorma Toppari
- Department of Pediatrics, Turku University Hospital, Turku, Finland
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, and Centre for Population Health Research, University of Turku, Turku, Finland
| | - Ulla Uusitalo
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Kendra Vehik
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Suvi M Virtanen
- Health and Well-Being Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Center for Child Health Research, Tampere University and Tampere University Hospital, Tampere, Finland
- The Science Center of Pirkanmaa Hospital District, Tampere, Finland
| | - Andreas Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany; and Forschergruppe Diabetes, Technical University Munich, at Klinikum rechts der Isar, Munich, and Forschergruppe Diabetes eV, Neuherberg, Germany
| | - Anette-G Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany; and Forschergruppe Diabetes, Technical University Munich, at Klinikum rechts der Isar, Munich, and Forschergruppe Diabetes eV, Neuherberg, Germany
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Sorg AL, Von Kries R, Klemme M, Gerstl L, Beyerlein A, Lack N, Felderhoff-Müser U, Dzietko M. Incidence and risk factors of cerebral sinovenous thrombosis in infants. Dev Med Child Neurol 2021; 63:697-704. [PMID: 33506500 DOI: 10.1111/dmcn.14816] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2020] [Indexed: 12/16/2022]
Abstract
AIM To describe the incidence of term and preterm neonatal cerebral sinovenous thrombosis (CSVT) and identify perinatal risk factors. METHOD This was a national capture-recapture calculation-corrected surveillance and nested case-control study. Infants born preterm and at term with magnetic resonance imaging-confirmed neonatal CSVT were identified by surveillance in all paediatric hospitals in Germany (2015-2017). Incidence was corrected for underreporting using a capture-recapture method in one federal state and then extrapolated nationwide. We reviewed PubMed for comparisons with previously reported incidence estimators. We used a population-based perinatal database for quality assurance to select four controls per case and applied univariate and multivariable regression for risk factor analysis. RESULTS Fifty-one newborn infants (34 males, 17 females; 14 born preterm) with neonatal CSVT were reported in the 3-year period. The incidence of term and preterm neonatal CSVT was 6.6 (95% confidence interval [CI] 4.4-8.7) per 100 000 live births. Median age at time of confirmation of the diagnosis was 9.95 days (range 0-39d). In the univariate analysis, male sex, preterm birth, hypoxia and related indicators (umbilical artery pH <7.1; 5-minute Apgar score <7; intubation/mask ventilation; perinatal asphyxia), operative vaginal delivery, emergency Caesarean section, and pathological fetal Doppler sonography were associated (p<0.05) with neonatal CSVT. Multivariable regression yielded hypoxia (odds ratio=20.3; 95% CI 8.1-50.8) as the independent risk factor. INTERPRETATION Incidence of neonatal CSVT was within the range of other population-based studies. The results suggest that hypoxia is an important perinatal risk factor for the aetiology of neonatal CSVT.
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Affiliation(s)
- Anna-Lisa Sorg
- Institute of Social Paediatrics and Adolescent Medicine, Division of Paediatric Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Rüdiger Von Kries
- Institute of Social Paediatrics and Adolescent Medicine, Division of Paediatric Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Mathias Klemme
- Department of Neonatology, University Children's Hospital and Perinatal Centre, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Lucia Gerstl
- Department of Paediatric Neurology, University Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Andreas Beyerlein
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Nicholas Lack
- Bavarian Quality Assurance for In-Patient Medical Care, Munich, Germany
| | | | - Mark Dzietko
- Department of Paediatrics I, Neonatology, University Duisburg-Essen, Essen, Germany
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Kunze S, Cecil A, Prehn C, Möller G, Ohlmann A, Wildner G, Thurau S, Unger K, Rößler U, Hölter SM, Tapio S, Wagner F, Beyerlein A, Theis F, Zitzelsberger H, Kulka U, Adamski J, Graw J, Dalke C. Posterior subcapsular cataracts are a late effect after acute exposure to 0.5 Gy ionizing radiation in mice. Int J Radiat Biol 2021; 97:529-540. [PMID: 33464160 DOI: 10.1080/09553002.2021.1876951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE The long-term effect of low and moderate doses of ionizing radiation on the lens is still a matter of debate and needs to be evaluated in more detail. MATERIAL AND METHODS We conducted a detailed histological analysis of eyes from B6C3F1 mice cohorts after acute gamma irradiation (60Co source; 0.063 Gy/min) at young adult age of 10 weeks with doses of 0.063, 0.125, and 0.5 Gy. Sham irradiated (0 Gy) mice were used as controls. To test for genetic susceptibility heterozygous Ercc2 mutant mice were used and compared to wild-type mice of the same strain background. Mice of both sexes were included in all cohorts. Eyes were collected 4 h, 12, 18 and 24 months after irradiation. For a better understanding of the underlying mechanisms, metabolomics analyses were performed in lenses and plasma samples of the same mouse cohorts at 4 and 12 h as well as 12, 18 and 24 months after irradiation. For this purpose, a targeted analysis was chosen. RESULTS This analysis revealed histological changes particularly in the posterior part of the lens that rarely can be observed by using Scheimpflug imaging, as we reported previously. We detected a significant increase of posterior subcapsular cataracts (PSCs) 18 and 24 months after irradiation with 0.5 Gy (odds ratio 9.3; 95% confidence interval 2.1-41.3) independent of sex and genotype. Doses below 0.5 Gy (i.e. 0.063 and 0.125 Gy) did not significantly increase the frequency of PSCs at any time point. In lenses, we observed a clear effect of sex and aging but not of irradiation or genotype. While metabolomics analyses of plasma from the same mice showed only a sex effect. CONCLUSIONS This article demonstrates a significant radiation-induced increase in the incidence of PSCs, which could not be identified using Scheimpflug imaging as the only diagnostic tool.
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Affiliation(s)
- Sarah Kunze
- Institute of Developmental Genetics, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Neuherberg, Germany
| | - Alexander Cecil
- Research Unit Molecular Endocrinology and Metabolism, Genome Analysis Center, Helmholtz Center Munich German Research Center for Environmental Health, Neuherberg, Germany
| | - Cornelia Prehn
- Research Unit Molecular Endocrinology and Metabolism, Genome Analysis Center, Helmholtz Center Munich German Research Center for Environmental Health, Neuherberg, Germany
| | - Gabriele Möller
- Research Unit Molecular Endocrinology and Metabolism, Genome Analysis Center, Helmholtz Center Munich German Research Center for Environmental Health, Neuherberg, Germany
| | - Andreas Ohlmann
- Department of Ophthalmology, University Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Gerhild Wildner
- Department of Ophthalmology, University Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Stephan Thurau
- Department of Ophthalmology, University Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Kristian Unger
- Research Unit Radiation Cytogenetics, Helmholtz Center Munich German Research Center for Environmental Health, Neuherberg, Germany
| | - Ute Rößler
- Department Radiation Protection and Health, Federal Office of Radiation Protection, Oberschleissheim, Germany
| | - Sabine M Hölter
- Institute of Developmental Genetics, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Neuherberg, Germany
| | - Soile Tapio
- Institute of Radiation Biology, Helmholtz Center Munich German Research Center for Environmental Health, Neuherberg, Germany.,School of Medicine, Technical University of Munich, Munich, Germany
| | - Florian Wagner
- Institute of Radiation Medicine, Helmholtz Center Munich German Research Center for Environmental Health, Neuherberg, Germany
| | | | - Fabian Theis
- Institute of Computational Biology, Neuherberg, Germany
| | - Horst Zitzelsberger
- Research Unit Radiation Cytogenetics, Helmholtz Center Munich German Research Center for Environmental Health, Neuherberg, Germany
| | - Ulrike Kulka
- Department Radiation Protection and Health, Federal Office of Radiation Protection, Oberschleissheim, Germany
| | - Jerzy Adamski
- Research Unit Molecular Endocrinology and Metabolism, Genome Analysis Center, Helmholtz Center Munich German Research Center for Environmental Health, Neuherberg, Germany.,Lehrstuhl für Experimentelle Genetik, Technical University of Munich, Freising-Weihenstephan, Germany.,Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jochen Graw
- Institute of Developmental Genetics, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Neuherberg, Germany
| | - Claudia Dalke
- Institute of Developmental Genetics, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Neuherberg, Germany
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Beyerlein A, Lack N, Maier W. Associations of area-level deprivation with adverse obstetric and perinatal outcomes in Bavaria, Germany: Results from a cross-sectional study. PLoS One 2020; 15:e0236020. [PMID: 32687491 PMCID: PMC7371156 DOI: 10.1371/journal.pone.0236020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 06/26/2020] [Indexed: 01/06/2023] Open
Abstract
Background We investigated associations of area-level deprivation with obstetric and perinatal outcomes in a large population-based routine dataset. Methods We used the data of n = 827,105 deliveries who were born in hospitals between 2009 to 2016 in Bavaria, Germany. The Bavarian Index of Multiple Deprivation (BIMD) on district level was assigned to each mother by the zip code of her residential address. We calculated odds ratios (ORs) with 95% confidence intervals (CIs) for preterm deliveries, Caesarian sections (CS), stillbirths, small for gestational age (SGA) births and low 5-minute Apgar scores by BIMD quintiles with and without adjustment for potential confounders. Results We observed a significantly increased risk for preterm deliveries in mothers from the most deprived compared to the least deprived districts (e.g. OR [95% CI] for highest compared to lowest deprivation quintile: 1.06 [1.03, 1.09]) in adjusted analyses. Increased deprivation was also associated with higher SGA and secondary CS rates, but with lower proportions of stillbirths, primary CS and low Apgar scores. When one large clinic with an unusually high stillbirth rate was excluded, the association of BIMD with stillbirths was attenuated and almost disappeared. Conclusions We found that area-level deprivation in Bavaria was positively associated with preterm and SGA births, confirming previous studies. In contrast, the finding of an inverse association between deprivation and both stillbirth rates and low Apgar score came somewhat surprising. However, we conclude that the stillbirths finding is spurious and reflects regional bias due to a clinic which seems to specialize in termination of pregnancies.
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Affiliation(s)
- Andreas Beyerlein
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
- * E-mail:
| | - Nicholas Lack
- German Bavarian Quality Assurance Institute for Medical Care, Munich, Germany
| | - Werner Maier
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
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Sorg AL, von Kries R, Klemme M, Gerstl L, Weinberger R, Beyerlein A, Lack N, Felderhoff-Müser U, Dzietko M. Risk factors for perinatal arterial ischaemic stroke: a large case-control study. Dev Med Child Neurol 2020; 62:513-520. [PMID: 31489622 DOI: 10.1111/dmcn.14347] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2019] [Indexed: 12/14/2022]
Abstract
AIM To identify maternal, obstetric, and neonatal risk factors related to perinatal arterial ischaemic stroke (PAIS) diagnosed within 28 days after birth and to understand the underlying pathophysiology. METHOD For case and control ascertainment, we used active surveillance in 345 paediatric hospitals and a population-based perinatal database for quality assurance of hospital care. We analysed complete cases of PAIS using logistic regression. Multivariate analysis was guided by a directed acyclic graph. RESULTS After exclusion of records with missing data, we analysed 134 individuals with PAIS and 576 comparison individuals. In univariate analysis, male sex, preterm birth (<37wks gestational age), small for gestational age (SGA), low umbilical artery pH (<7.1), low 5-minute-Apgar score (<7), multiple pregnancies, hypoxia, intubation/mask ventilation, nulliparity, Caesarean section, vaginal-operative delivery, chorioamnionitis, and oligohydramnios were associated with an increased risk. Mutual adjustment yielded male sex (odds ratio [OR] 1.81; 95% confidence interval [CI] 1.20-2.73), multiple birth (OR 3.22; 95% CI 1.21-8.58), chorioamnionitis (OR 9.89; 95% CI 2.88-33.94), preterm birth (OR 1.86; 95% CI 1.01-3.43), and SGA (OR 3.05; 95% CI 1.76-5.28) as independent risk factors. INTERPRETATION We confirmed the increased risk in males and the role of chorioamnionitis and SGA for PAIS, pointing to the importance of inflammatory processes and fetal-placental insufficiency. Multiple birth and preterm birth were additional risk factors. WHAT THIS PAPER ADDS Chorioamnionitis and small for gestational age (SGA) precede perinatal arterial ischaemic stroke (PAIS). Chorioamnionitis and SGA are independent risk factors for PAIS. Inflammatory processes and fetal-placental insufficiency are the likely underlying mechanisms. Multiple birth and preterm birth are additional risk factors.
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Affiliation(s)
- Anna-Lisa Sorg
- Division of Pediatric Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Rüdiger von Kries
- Division of Pediatric Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Mathias Klemme
- Department of Neonatology, University Children's Hospital and Perinatal Center, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Lucia Gerstl
- Department of Pediatric Neurology, University Children's Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Raphael Weinberger
- Division of Pediatric Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Andreas Beyerlein
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Nicholas Lack
- Bavarian Quality Assurance for In-Patient Medical Care, Munich, Germany
| | | | - Mark Dzietko
- Department of Pediatrics I, Neonatology, University of Duisburg-Essen, Essen, Germany
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Johnson RK, Vanderlinden L, DeFelice BC, Kechris K, Uusitalo U, Fiehn O, Sontag M, Crume T, Beyerlein A, Lernmark Å, Toppari J, Ziegler AG, She JX, Hagopian W, Rewers M, Akolkar B, Krischer J, Virtanen SM, Norris JM. Metabolite-related dietary patterns and the development of islet autoimmunity. Sci Rep 2019; 9:14819. [PMID: 31616039 PMCID: PMC6794249 DOI: 10.1038/s41598-019-51251-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 09/24/2019] [Indexed: 12/16/2022] Open
Abstract
The role of diet in type 1 diabetes development is poorly understood. Metabolites, which reflect dietary response, may help elucidate this role. We explored metabolomics and lipidomics differences between 352 cases of islet autoimmunity (IA) and controls in the TEDDY (The Environmental Determinants of Diabetes in the Young) study. We created dietary patterns reflecting pre-IA metabolite differences between groups and examined their association with IA. Secondary outcomes included IA cases positive for multiple autoantibodies (mAb+). The association of 853 plasma metabolites with outcomes was tested at seroconversion to IA, just prior to seroconversion, and during infancy. Key compounds in enriched metabolite sets were used to create dietary patterns reflecting metabolite composition, which were then tested for association with outcomes in the nested case-control subset and the full TEDDY cohort. Unsaturated phosphatidylcholines, sphingomyelins, phosphatidylethanolamines, glucosylceramides, and phospholipid ethers in infancy were inversely associated with mAb+ risk, while dicarboxylic acids were associated with an increased risk. An infancy dietary pattern representing higher levels of unsaturated phosphatidylcholines and phospholipid ethers, and lower sphingomyelins was protective for mAb+ in the nested case-control study only. Characterization of this high-risk infant metabolomics profile may help shape the future of early diagnosis or prevention efforts.
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Affiliation(s)
- Randi K Johnson
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Lauren Vanderlinden
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Brian C DeFelice
- UC Davis Genome Center-Metabolomics, University of California Davis, Davis, USA
| | - Katerina Kechris
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Ulla Uusitalo
- Health Informatics Institute, University of South Florida, Tampa, USA
| | - Oliver Fiehn
- UC Davis Genome Center-Metabolomics, University of California Davis, Davis, USA.,Department of Molecular and Cellular Biology, University of California Davis, Davis, USA
| | - Marci Sontag
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Tessa Crume
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Andreas Beyerlein
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany.,Institute of Diabetes Research, Helmholtz Zentrum München, and Klinikum rechts der Isar, Technische Universität München, and Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University/CRC, Lund, Sweden
| | - Jorma Toppari
- Department of Pediatrics, Turku University Hospital, Turku, Finland.,Institute of Biomedicine, Research Centre for Integrated Physiology and Pharmacology, University of Turku, Turku, Finland
| | - Anette-G Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, and Klinikum rechts der Isar, Technische Universität München, and Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Jin-Xiong She
- Center for Biotechnology and Genomic Medicine, Augusta University, Augusta, USA
| | | | - Marian Rewers
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Beena Akolkar
- National Institutes of Diabetes and Digestive and Kidney Disorders, National Institutes of Health, Bethesda, USA
| | - Jeffrey Krischer
- Health Informatics Institute, University of South Florida, Tampa, USA
| | - Suvi M Virtanen
- National Institute for Health and Welfare, Tampere, Finland.,University of Tampere, Tampere, Finland.,Tampere University Hospital, Tampere, Finland
| | - Jill M Norris
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, USA.
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11
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Miller M, Sabrautzki S, Beyerlein A, Brielmeier M. Combining fish and environmental PCR for diagnostics of diseased laboratory zebrafish in recirculating systems. PLoS One 2019; 14:e0222360. [PMID: 31513657 PMCID: PMC6742364 DOI: 10.1371/journal.pone.0222360] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/27/2019] [Indexed: 01/10/2023] Open
Abstract
Precise knowledge of the health status of experimental fish is crucial to obtain high scientific and ethical standards in biomedical research. In addition to the use of sentinel fish, the examination of diseased fish is a fundamental part of all health monitoring concepts. PCR assays offer excellent sensitivity and the ability to test a broad variety of pathogenic agents in different sample types. Recently, it was shown that analysis of environmental samples such as water, sludge or detritus from static tanks can complement PCR analysis of fish and is actually more reliable for certain pathogens. In our study, we investigated whether the analysis of filtered water mixed with detritus of tanks including fish showing clinical signs of illness is suitable to complement health monitoring programs in recirculating systems. The obtained data indicate that pathogens such as Pseudoloma neurophilia or Myxidium streisingeri were exclusively or mainly found in fish, while mycobacteria were predominantly present in environmental samples. A combination of both sample types seems to be required for the detection of a broad range of infectious agents in zebrafish colonies using real-time PCR technology.
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Affiliation(s)
- Manuel Miller
- Research Unit Comparative Medicine, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- * E-mail:
| | - Sibylle Sabrautzki
- Research Unit Comparative Medicine, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Andreas Beyerlein
- Institute of Computational Biology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Markus Brielmeier
- Research Unit Comparative Medicine, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
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12
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Beyerlein A, Bonifacio E, Vehik K, Hippich M, Winkler C, Frohnert BI, Steck AK, Hagopian WA, Krischer JP, Lernmark Å, Rewers MJ, She JX, Toppari J, Akolkar B, Rich SS, Ziegler AG. Progression from islet autoimmunity to clinical type 1 diabetes is influenced by genetic factors: results from the prospective TEDDY study. J Med Genet 2019; 56:602-605. [PMID: 30287597 PMCID: PMC6690814 DOI: 10.1136/jmedgenet-2018-105532] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/16/2018] [Accepted: 09/13/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Progression time from islet autoimmunity to clinical type 1 diabetes is highly variable and the extent that genetic factors contribute is unknown. METHODS In 341 islet autoantibody-positive children with the human leucocyte antigen (HLA) DR3/DR4-DQ8 or the HLA DR4-DQ8/DR4-DQ8 genotype from the prospective TEDDY (The Environmental Determinants of Diabetes in the Young) study, we investigated whether a genetic risk score that had previously been shown to predict islet autoimmunity is also associated with disease progression. RESULTS Islet autoantibody-positive children with a genetic risk score in the lowest quartile had a slower progression from single to multiple autoantibodies (p=0.018), from single autoantibodies to diabetes (p=0.004), and by trend from multiple islet autoantibodies to diabetes (p=0.06). In a Cox proportional hazards analysis, faster progression was associated with an increased genetic risk score independently of HLA genotype (HR for progression from multiple autoantibodies to type 1 diabetes, 1.27, 95% CI 1.02 to 1.58 per unit increase), an earlier age of islet autoantibody development (HR, 0.68, 95% CI 0.58 to 0.81 per year increase in age) and female sex (HR, 1.94, 95% CI 1.28 to 2.93). CONCLUSIONS Genetic risk scores may be used to identify islet autoantibody-positive children with high-risk HLA genotypes who have a slow rate of progression to subsequent stages of autoimmunity and type 1 diabetes.
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Affiliation(s)
- Andreas Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Technical University of Munich, at Klinikum rechts der Isar, Munich-Neuherberg, Germany
| | - Ezio Bonifacio
- DFG Center for Regenerative Therapies Dresden, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Forschergruppe Diabetes eV at Helmholtz Zentrum München, Munich-Neuherberg, Germany
| | - Kendra Vehik
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Markus Hippich
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Technical University of Munich, at Klinikum rechts der Isar, Munich-Neuherberg, Germany
| | - Christiane Winkler
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Technical University of Munich, at Klinikum rechts der Isar, Munich-Neuherberg, Germany
- Forschergruppe Diabetes eV at Helmholtz Zentrum München, Munich-Neuherberg, Germany
| | - Brigitte I Frohnert
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, Colorado, USA
| | - Andrea K Steck
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, Colorado, USA
| | | | - Jeffrey P Krischer
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmo, Sweden
| | - Marian J Rewers
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, Colorado, USA
| | - Jin-Xiong She
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Jorma Toppari
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, Turku University Hospital, Turku, Finland
- Department of Physiology, University of Turku, Turku, Finland
| | - Beena Akolkar
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia, USA
| | - Anette-G Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Technical University of Munich, at Klinikum rechts der Isar, Munich-Neuherberg, Germany
- Forschergruppe Diabetes eV at Helmholtz Zentrum München, Munich-Neuherberg, Germany
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13
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Peplow C, Assfalg R, Beyerlein A, Hasford J, Bonifacio E, Ziegler A. Blood draws up to 3% of blood volume in clinical trials are safe in children. Acta Paediatr 2019; 108:940-944. [PMID: 30291644 PMCID: PMC6587985 DOI: 10.1111/apa.14607] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 09/13/2018] [Accepted: 09/28/2018] [Indexed: 11/29/2022]
Abstract
Aim Recommendations for maximum blood draw in children range from 1 to 5% despite limited evidence. The aim of the study was to assess the safety of blood draws in children aged six months to 12 years targeting volumes of 3% of total blood volume. Methods Children who experienced three‐monthly blood draws during participation in one of three investigators initiated clinical trials conducted in our institution were examined. In total, 629 venous blood draws were performed in 141 children. Adverse events and blood counts were assessed. Results Overall, 608 adverse events were reported. None of these included symptoms that reflected concerns on blood draw volumes or frequency. Anaemia and red cell or haemoglobin measurements outside the normal age range were not observed. A reduction in haemoglobin, haematocrit, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration and mean corpuscular volume was noted in children participating in one of the three trials analysed. Conclusion Regular blood draws of up to 3% of total blood volume were not associated with signs of anaemia or hypovolaemia in young children. We suggest that the European recommendations be revised for clinical studies in which children are not exposed to treatments that are associated with anaemia risk.
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Affiliation(s)
- Claudia Peplow
- Institute of Diabetes Research Helmholtz Zentrum München and Forschergruppe Diabetes, Klinikum rechts der Isar Technische Universität München Neuherberg Germany
| | - Robin Assfalg
- Institute of Diabetes Research Helmholtz Zentrum München and Forschergruppe Diabetes, Klinikum rechts der Isar Technische Universität München Neuherberg Germany
| | - Andreas Beyerlein
- Institute of Diabetes Research Helmholtz Zentrum München and Forschergruppe Diabetes, Klinikum rechts der Isar Technische Universität München Neuherberg Germany
| | - Joerg Hasford
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie Ludwig‐Maximilians‐Universität München Munich Germany
| | - Ezio Bonifacio
- DFG Center for Regenerative Therapies Dresden Faculty of Medicine Technische Universität Dresden Dresden Germany
| | - Anette‐G Ziegler
- Institute of Diabetes Research Helmholtz Zentrum München and Forschergruppe Diabetes, Klinikum rechts der Isar Technische Universität München Neuherberg Germany
- Forschergruppe Diabetes e.V. Neuherberg Germany
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14
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Hippich M, Beyerlein A, Hagopian WA, Krischer JP, Vehik K, Knoop J, Winker C, Toppari J, Lernmark Å, Rewers MJ, Steck AK, She JX, Akolkar B, Robertson CC, Onengut-Gumuscu S, Rich SS, Bonifacio E, Ziegler AG. Genetic Contribution to the Divergence in Type 1 Diabetes Risk Between Children From the General Population and Children From Affected Families. Diabetes 2019; 68:847-857. [PMID: 30655385 PMCID: PMC6425872 DOI: 10.2337/db18-0882] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 01/04/2019] [Indexed: 12/20/2022]
Abstract
The risk for autoimmunity and subsequently type 1 diabetes is 10-fold higher in children with a first-degree family history of type 1 diabetes (FDR children) than in children in the general population (GP children). We analyzed children with high-risk HLA genotypes (n = 4,573) in the longitudinal TEDDY birth cohort to determine how much of the divergent risk is attributable to genetic enrichment in affected families. Enrichment for susceptible genotypes of multiple type 1 diabetes-associated genes and a novel risk gene, BTNL2, was identified in FDR children compared with GP children. After correction for genetic enrichment, the risks in the FDR and GP children converged but were not identical for multiple islet autoantibodies (hazard ratio [HR] 2.26 [95% CI 1.6-3.02]) and for diabetes (HR 2.92 [95% CI 2.05-4.16]). Convergence varied depending upon the degree of genetic susceptibility. Risks were similar in the highest genetic susceptibility group for multiple islet autoantibodies (14.3% vs .12.7%) and diabetes (4.8% vs. 4.1%) and were up to 5.8-fold divergent for children in the lowest genetic susceptibility group, decreasing incrementally in GP children but not in FDR children. These findings suggest that additional factors enriched within affected families preferentially increase the risk of autoimmunity and type 1 diabetes in lower genetic susceptibility strata.
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Affiliation(s)
- Markus Hippich
- Institute of Diabetes Research, Helmholtz Zentrum München (German Research Center for Environmental Health), Munich-Neuherberg, Germany
| | - Andreas Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München (German Research Center for Environmental Health), Munich-Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | | | - Jeffrey P Krischer
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Kendra Vehik
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Jan Knoop
- Institute of Diabetes Research, Helmholtz Zentrum München (German Research Center for Environmental Health), Munich-Neuherberg, Germany
| | - Christiane Winker
- Institute of Diabetes Research, Helmholtz Zentrum München (German Research Center for Environmental Health), Munich-Neuherberg, Germany
- Forschergruppe Diabetes e.V., Helmholtz Zentrum München (German Research Center for Environmental Health), Munich-Neuherberg, Germany
| | - Jorma Toppari
- Department of Pediatrics, Turku University Hospital, and Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmo, Sweden
| | - Marian J Rewers
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, CO
| | - Andrea K Steck
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, CO
| | - Jin-Xiong She
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA
| | - Beena Akolkar
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | | | | | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA
| | - Ezio Bonifacio
- Forschergruppe Diabetes e.V., Helmholtz Zentrum München (German Research Center for Environmental Health), Munich-Neuherberg, Germany
- DFG Center for Regenerative Therapies Dresden, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Anette-G Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München (German Research Center for Environmental Health), Munich-Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
- Forschergruppe Diabetes e.V., Helmholtz Zentrum München (German Research Center for Environmental Health), Munich-Neuherberg, Germany
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15
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Ungethüm K, Jolink M, Hippich M, Lachmann L, Haupt F, Winkler C, Hummel S, Pitchika A, Kordonouri O, Ziegler AG, Beyerlein A. Physical activity is associated with lower insulin and C-peptide during glucose challenge in children and adolescents with family background of diabetes. Diabet Med 2019; 36:366-375. [PMID: 30242901 DOI: 10.1111/dme.13819] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2018] [Indexed: 01/03/2023]
Abstract
AIMS Children and adolescents with a family history of diabetes are at increased risk of overweight, but little is known about the potentially beneficial effects of physical activity on these children. The objective of this study was to investigate the association between moderate to vigorous physical activity (MVPA) and metabolic and inflammatory risks in children and adolescents with a family background of Type 1 diabetes or gestational diabetes. METHODS Valid MVPA measurements, made with accelerometers, were available from 234 participants (median age, 10.2 years) who had a first-degree relative with either Type 1 or gestational diabetes. Anthropometric and metabolic measurements were made and cytokines measured, and were correlated with MVPA measurements, with stepwise adjustment for confounding factors, in a cross-sectional analysis. RESULTS MVPA was negatively associated with insulin and C-peptide during challenge with an oral glucose tolerance test. MVPA was also significantly positively associated with the insulin sensitivity index, whereas no consistently significant associations were found between MVPA and BMI, blood pressure or cytokine levels. DISCUSSION Our findings indicate that physical activity may have beneficial effects on insulin and C-peptide metabolism in children and adolescents with a family background of diabetes, but show no evidence of a protective association with other health-related outcomes.
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Affiliation(s)
- K Ungethüm
- Institute of Diabetes Research, Helmholtz Zentrum München, Neuherberg and Forschergruppe Diabetes der Technischen Universität München, Munich
| | - M Jolink
- Institute of Diabetes Research, Helmholtz Zentrum München, Neuherberg and Forschergruppe Diabetes der Technischen Universität München, Munich
| | - M Hippich
- Institute of Diabetes Research, Helmholtz Zentrum München, Neuherberg and Forschergruppe Diabetes der Technischen Universität München, Munich
| | - L Lachmann
- Institute of Diabetes Research, Helmholtz Zentrum München, Neuherberg and Forschergruppe Diabetes der Technischen Universität München, Munich
| | - F Haupt
- Institute of Diabetes Research, Helmholtz Zentrum München, Neuherberg and Forschergruppe Diabetes der Technischen Universität München, Munich
| | - C Winkler
- Institute of Diabetes Research, Helmholtz Zentrum München, Neuherberg and Forschergruppe Diabetes der Technischen Universität München, Munich
- Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Neuherberg
| | - S Hummel
- Institute of Diabetes Research, Helmholtz Zentrum München, Neuherberg and Forschergruppe Diabetes der Technischen Universität München, Munich
- Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Neuherberg
| | - A Pitchika
- Institute of Diabetes Research, Helmholtz Zentrum München, Neuherberg and Forschergruppe Diabetes der Technischen Universität München, Munich
| | - O Kordonouri
- Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Germany
| | - A-G Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, Neuherberg and Forschergruppe Diabetes der Technischen Universität München, Munich
- Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Neuherberg
| | - A Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, Neuherberg and Forschergruppe Diabetes der Technischen Universität München, Munich
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16
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Heinrich M, Maison N, Achenbach P, Assfalg R, Braig S, Böcker D, Dunstheimer D, Ermer U, Gavazzeni A, Gerstl EM, Hummel S, Kick K, Müller H, Nellen-Hellmuth N, Ockert C, Sindichakis M, Tretter S, Warncke K, Ziegler AG, Beyerlein A. Fasting hypoglycemia is associated with disease progression in presymptomatic early stage type 1 diabetes. Pediatr Diabetes 2018; 19:1238-1242. [PMID: 30098103 DOI: 10.1111/pedi.12739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/22/2018] [Accepted: 07/02/2018] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE In children with presymptomatic type 1 diabetes, intermittent hyperglycemia and rising hemoglobin A1c levels are a known signal of progression toward insulin-dependency. Episodes of hypoglycemia, however, have also been reported in one published case. We investigated the prevalence of hypoglycemia and its association with disease progression in children with presymptomatic type 1 diabetes. METHODS We compared the frequency of hypoglycemic fasting blood glucose levels (<60 mg/dL) in 48 autoantibody negative and 167 multiple β-cell autoantibody positive children aged 2 to 5 years. We classified the autoantibody positive children into three categories based on their glucose levels in fasting state (hypoglycemic [<60 mg/dL], normoglycemic [60-99 mg/dL] or hyperglycemic [≥100 mg/dL]). We then compared the glucose levels under challenge during oral glucose tolerance tests (OGTTs) between the three categories. RESULTS In the autoantibody positive children, 5.1% of the fasting samples were hypoglycemic, while in the autoantibody negative children no hypoglycemia was observed. Hypoglycemia occurred more often in autoantibody positive children who had already entered stage 2 or stage 3 of type 1 diabetes than in stage 1 patients (P = 0.02). Children who had hypoglycemic compared to normoglycemic fasting blood glucose values had higher 120-minute blood glucose values under OGTT challenge, and a higher rate of pathological OGTTs (P = 0.04). CONCLUSIONS Fasting hypoglycemia seems to be an indicator of disease progression in presymptomatic type 1 diabetes and may therefore represent a novel marker for the identification of children who should be monitored more closely for progression toward insulin-dependent type 1 diabetes.
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Affiliation(s)
- Melanie Heinrich
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany, and Forschergruppe Diabetes der Technischen Universität München, Munich, Germany
| | - Nicole Maison
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany, and Forschergruppe Diabetes der Technischen Universität München, Munich, Germany
| | - Peter Achenbach
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany, and Forschergruppe Diabetes der Technischen Universität München, Munich, Germany
| | - Robin Assfalg
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany, and Forschergruppe Diabetes der Technischen Universität München, Munich, Germany
| | - Sonja Braig
- Department of Pediatrics, Klinikum Bayreuth, Bayreuth, Germany
| | - Dominik Böcker
- Department of Pediatrics, Klinikum Nürnberg Nord, Nuremberg, Germany
| | | | - Uwe Ermer
- Department of Pediatrics, Kliniken St Elisabeth, Neuburg an der Donau, Germany
| | | | - Eva-Maria Gerstl
- Department of Pediatric Diabetology, Pediatric Hospital Dritter Orden Passau, Passau, Germany
| | - Sandra Hummel
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany, and Forschergruppe Diabetes der Technischen Universität München, Munich, Germany
| | - Kerstin Kick
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany, and Forschergruppe Diabetes der Technischen Universität München, Munich, Germany
| | - Herbert Müller
- Department of Pediatrics, Klinikum Kempten, Kempten, Germany
| | | | | | | | - Stefanie Tretter
- Department of Pediatrics, Kliniken Nordoberpfalz, Weiden, Germany
| | - Katharina Warncke
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany, and Forschergruppe Diabetes der Technischen Universität München, Munich, Germany.,Department of Pediatrics, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Anette-Gabriele Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany, and Forschergruppe Diabetes der Technischen Universität München, Munich, Germany
| | - Andreas Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany, and Forschergruppe Diabetes der Technischen Universität München, Munich, Germany
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17
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Pitchika A, Jolink M, Winkler C, Hummel S, Hummel N, Krumsiek J, Kastenmüller G, Raab J, Kordonouri O, Ziegler AG, Beyerlein A. Associations of maternal type 1 diabetes with childhood adiposity and metabolic health in the offspring: a prospective cohort study. Diabetologia 2018; 61:2319-2332. [PMID: 30008062 DOI: 10.1007/s00125-018-4688-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/13/2018] [Indexed: 01/14/2023]
Abstract
AIMS/HYPOTHESIS Exposure to an intrauterine hyperglycaemic environment has been suggested to increase the offspring's later risk for being overweight or having metabolic abnormalities, but conclusive evidence for pregnancies affected by maternal type 1 diabetes is still lacking. This study aims to analyse the relationship between maternal type 1 diabetes and the offspring's metabolic health and investigate whether birthweight and/or changes in the offspring's metabolome are in the potential pathway. METHODS We analysed data from 610 and 2169 offspring having a first-degree relative with type 1 diabetes from the TEENDIAB and BABYDIAB/BABYDIET cohorts, respectively. Anthropometric and metabolic outcomes, assessed longitudinally at 0.3-18 years of age, were compared between offspring of mothers with type 1 diabetes and offspring of non-diabetic mothers but with fathers or siblings with type 1 diabetes using mixed regression models. Non-targeted metabolomic measurements were carried out in 500 individuals from TEENDIAB and analysed with maternal type 1 diabetes and offspring overweight status. RESULTS The offspring of mothers with type 1 diabetes had a higher BMI SD score (SDS) and an increased risk for being overweight than the offspring of non-diabetic mothers (e.g. OR for overweight status in TEENDIAB 2.40 [95% CI 1.41, 4.06]). Further, waist circumference SDS, fasting levels of glucose, insulin and C-peptide, and insulin resistance and abdominal obesity were significantly increased in the offspring of mothers with type 1 diabetes, even when adjusted for potential confounders and birthweight. Metabolite patterns related to androgenic steroids and branched-chain amino acids were found to be associated with offspring's overweight status, but no significant associations were observed between maternal type 1 diabetes and metabolite concentrations in the offspring. CONCLUSIONS/INTERPRETATION Maternal type 1 diabetes is associated with offspring's overweight status and metabolic health in later life, but this is unlikely to be caused by alterations in the offspring's metabolome.
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Affiliation(s)
- Anitha Pitchika
- Institute of Diabetes Research, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Munich-Neuherberg, Germany
- Forschergruppe Diabetes, Technical University Munich, Klinikum rechts der Isar, Munich-Neuherberg, Germany
| | - Manja Jolink
- Institute of Diabetes Research, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Munich-Neuherberg, Germany
- Forschergruppe Diabetes, Technical University Munich, Klinikum rechts der Isar, Munich-Neuherberg, Germany
| | - Christiane Winkler
- Institute of Diabetes Research, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Munich-Neuherberg, Germany
- Forschergruppe Diabetes, Technical University Munich, Klinikum rechts der Isar, Munich-Neuherberg, Germany
- Forschergruppe Diabetes e.V., Helmholtz Zentrum München, Munich-Neuherberg, Germany
| | - Sandra Hummel
- Institute of Diabetes Research, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Munich-Neuherberg, Germany
- Forschergruppe Diabetes, Technical University Munich, Klinikum rechts der Isar, Munich-Neuherberg, Germany
- Forschergruppe Diabetes e.V., Helmholtz Zentrum München, Munich-Neuherberg, Germany
| | - Nadine Hummel
- Institute of Diabetes Research, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Munich-Neuherberg, Germany
- Forschergruppe Diabetes, Technical University Munich, Klinikum rechts der Isar, Munich-Neuherberg, Germany
| | - Jan Krumsiek
- Institute of Computational Biology, Helmholtz Zentrum München, Munich-Neuherberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Gabi Kastenmüller
- Institute of Bioinformatics and Systems Biology, Helmholtz Zentrum München, Munich-Neuherberg, Germany
| | - Jennifer Raab
- Institute of Diabetes Research, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Munich-Neuherberg, Germany
- Forschergruppe Diabetes, Technical University Munich, Klinikum rechts der Isar, Munich-Neuherberg, Germany
| | - Olga Kordonouri
- Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Germany
| | - Anette-Gabriele Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Munich-Neuherberg, Germany.
- Forschergruppe Diabetes, Technical University Munich, Klinikum rechts der Isar, Munich-Neuherberg, Germany.
- Forschergruppe Diabetes e.V., Helmholtz Zentrum München, Munich-Neuherberg, Germany.
| | - Andreas Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Munich-Neuherberg, Germany
- Forschergruppe Diabetes, Technical University Munich, Klinikum rechts der Isar, Munich-Neuherberg, Germany
- Institute of Computational Biology, Helmholtz Zentrum München, Munich-Neuherberg, Germany
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18
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Beyerlein A, Lack N, von Kries R. No further improvement in pregnancy-related outcomes in the offspring of mothers with pre-gestational diabetes in Bavaria, Germany, between 2001 and 2016. Diabet Med 2018; 35:1420-1424. [PMID: 29797595 DOI: 10.1111/dme.13691] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2018] [Indexed: 11/27/2022]
Abstract
AIMS To investigate whether there has been further improvement in the risk of adverse outcomes in pregnancies in women with diabetes during 2008-2016 in Bavaria, Germany. METHODS Using cross-sectional data on all 1716 170 deliveries in Bavarian hospitals between 2001 and 2016, we assessed the risks of stillbirth, early neonatal death, preterm delivery, large for gestational age, malformations, low Apgar score and low umbilical cord pH by maternal group with diabetes (gestational, pre-gestational, or none) separately for 2001-2007 and 2008-2016. We also investigated the associations of specific risk factors such as maternal smoking with respect to early mortality and malformations in each group with diabetes during 2008-2016. RESULTS No further reduction in the risk for any adverse outcome in mothers with pre-gestational diabetes and their offspring during 2008-2016 was observed. Maternal smoking, multiple delivery and substandard antenatal care were the strongest additional predictors of both early perinatal mortality and malformations for mothers with pre-gestational diabetes. The respective risks were lower and also decreased over time for mothers with gestational diabetes. CONCLUSIONS No significant improvement has been achieved in the management of pregnancies affected by pre-gestational diabetes during the last decade. The apparent risk reductions in women with gestational diabetes may partly be due to a change in diagnostic criteria over time. Women with pre-gestational diabetes who smoke, carry more than one child, or are not regularly seen during pregnancy, may need particular attention.
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Affiliation(s)
- A Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, Neuherberg, Germany
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - N Lack
- German Bavarian Quality Assurance Institute for Medical Care, Munich, Germany
| | - R von Kries
- Institute of Social Paediatrics and Adolescent Medicine, Ludwig-Maximilians University of Munich, Munich, Germany
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19
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Pitchika A, Vehik K, Hummel S, Norris JM, Uusitalo UM, Yang J, Virtanen SM, Koletzko S, Andrén Aronsson C, Ziegler AG, Beyerlein A. Associations of Maternal Diabetes During Pregnancy with Overweight in Offspring: Results from the Prospective TEDDY Study. Obesity (Silver Spring) 2018; 26:1457-1466. [PMID: 30226003 PMCID: PMC6146413 DOI: 10.1002/oby.22264] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/02/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study aimed to determine the relationship between different forms of, and potential pathways between, maternal diabetes and childhood obesity at different ages. METHODS Prospective cohort data from The Environmental Determinants of Diabetes in the Young (TEDDY) study, which was composed of 5,324 children examined from 0.25 to 6 years of age, were analyzed. Cross-sectional and longitudinal analyses taking into account potential confounders and effect modifiers such as maternal prepregnancy BMI and birth weight z scores were performed. RESULTS Offspring of mothers with gestational diabetes mellitus (GDM) or type 1 diabetes mellitus (T1DM) showed a higher BMI standard deviation score and increased risk for overweight and obesity at 5.5 years of age than offspring of mothers without diabetes. While these associations could be substantially explained by maternal prepregnancy BMI in offspring of mothers with GDM, significant associations disappeared after adjustment for birth weight z scores in offspring of T1DM mothers. Furthermore, overweight risk became stronger with increasing age in offspring of mothers with diabetes compared with offspring of mothers without diabetes. CONCLUSIONS Maternal diabetes is associated with increased risk of offspring overweight, and the association appears to get stronger as children grow older. Indeed, intrauterine exposure to maternal T1DM may predispose children to later obesity through increased birth weight, while maternal BMI is more important in children exposed to GDM.
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Affiliation(s)
- Anitha Pitchika
- Institute of Diabetes Research, Helmhtoltz Zentrum München, Munich, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Forschergruppe Diabetes e.V, Helmhtoltz Zentrum München, Munich, Germany
| | - Kendra Vehik
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Sandra Hummel
- Institute of Diabetes Research, Helmhtoltz Zentrum München, Munich, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Forschergruppe Diabetes e.V, Helmhtoltz Zentrum München, Munich, Germany
| | - Jill M Norris
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ulla M Uusitalo
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Jimin Yang
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Suvi M Virtanen
- Unit of Nutrition, National Institute for Health and Welfare, Helsinki, Finland
- Faculty of Social Sciences/Health Sciences, University of Tampere, Tampere, Finland
- Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
- The Science Center of Pirkanmaa Hospital District, Tampere, Finland
| | - Sibylle Koletzko
- Dr. v. Hauner Children's Hospital, University Medical Center, LMU, Munich, Germany
| | - Carin Andrén Aronsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital SUS, Malmö, Sweden
| | - Anette-G Ziegler
- Institute of Diabetes Research, Helmhtoltz Zentrum München, Munich, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Forschergruppe Diabetes e.V, Helmhtoltz Zentrum München, Munich, Germany
| | - Andreas Beyerlein
- Institute of Diabetes Research, Helmhtoltz Zentrum München, Munich, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Forschergruppe Diabetes e.V, Helmhtoltz Zentrum München, Munich, Germany
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20
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Bonifacio E, Beyerlein A, Hippich M, Winkler C, Vehik K, Weedon MN, Laimighofer M, Hattersley AT, Krumsiek J, Frohnert BI, Steck AK, Hagopian WA, Krischer JP, Lernmark Å, Rewers MJ, She JX, Toppari J, Akolkar B, Oram RA, Rich SS, Ziegler AG. Genetic scores to stratify risk of developing multiple islet autoantibodies and type 1 diabetes: A prospective study in children. PLoS Med 2018; 15:e1002548. [PMID: 29614081 PMCID: PMC5882115 DOI: 10.1371/journal.pmed.1002548] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/01/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Around 0.3% of newborns will develop autoimmunity to pancreatic beta cells in childhood and subsequently develop type 1 diabetes before adulthood. Primary prevention of type 1 diabetes will require early intervention in genetically at-risk infants. The objective of this study was to determine to what extent genetic scores (two previous genetic scores and a merged genetic score) can improve the prediction of type 1 diabetes. METHODS AND FINDINGS The Environmental Determinants of Diabetes in the Young (TEDDY) study followed genetically at-risk children at 3- to 6-monthly intervals from birth for the development of islet autoantibodies and type 1 diabetes. Infants were enrolled between 1 September 2004 and 28 February 2010 and monitored until 31 May 2016. The risk (positive predictive value) for developing multiple islet autoantibodies (pre-symptomatic type 1 diabetes) and type 1 diabetes was determined in 4,543 children who had no first-degree relatives with type 1 diabetes and either a heterozygous HLA DR3 and DR4-DQ8 risk genotype or a homozygous DR4-DQ8 genotype, and in 3,498 of these children in whom genetic scores were calculated from 41 single nucleotide polymorphisms. In the children with the HLA risk genotypes, risk for developing multiple islet autoantibodies was 5.8% (95% CI 5.0%-6.6%) by age 6 years, and risk for diabetes by age 10 years was 3.7% (95% CI 3.0%-4.4%). Risk for developing multiple islet autoantibodies was 11.0% (95% CI 8.7%-13.3%) in children with a merged genetic score of >14.4 (upper quartile; n = 907) compared to 4.1% (95% CI 3.3%-4.9%, P < 0.001) in children with a genetic score of ≤14.4 (n = 2,591). Risk for developing diabetes by age 10 years was 7.6% (95% CI 5.3%-9.9%) in children with a merged score of >14.4 compared with 2.7% (95% CI 1.9%-3.6%) in children with a score of ≤14.4 (P < 0.001). Of 173 children with multiple islet autoantibodies by age 6 years and 107 children with diabetes by age 10 years, 82 (sensitivity, 47.4%; 95% CI 40.1%-54.8%) and 52 (sensitivity, 48.6%, 95% CI 39.3%-60.0%), respectively, had a score >14.4. Scores were higher in European versus US children (P = 0.003). In children with a merged score of >14.4, risk for multiple islet autoantibodies was similar and consistently >10% in Europe and in the US; risk was greater in males than in females (P = 0.01). Limitations of the study include that the genetic scores were originally developed from case-control studies of clinical diabetes in individuals of mainly European decent. It is, therefore, possible that it may not be suitable to all populations. CONCLUSIONS A type 1 diabetes genetic score identified infants without family history of type 1 diabetes who had a greater than 10% risk for pre-symptomatic type 1 diabetes, and a nearly 2-fold higher risk than children identified by high-risk HLA genotypes alone. This finding extends the possibilities for enrolling children into type 1 diabetes primary prevention trials.
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Affiliation(s)
- Ezio Bonifacio
- DFG–Center for Regenerative Therapies Dresden, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Andreas Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany
- Forschergruppe Diabetes, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, Munich, Germany
| | - Markus Hippich
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany
- Forschergruppe Diabetes, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, Munich, Germany
| | - Christiane Winkler
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany
- Forschergruppe Diabetes, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, Munich, Germany
| | - Kendra Vehik
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America
| | - Michael N. Weedon
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, United Kingdom
| | - Michael Laimighofer
- Institute of Computational Biology, Helmholtz Zentrum München, Munich, Germany
| | - Andrew T. Hattersley
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, United Kingdom
| | - Jan Krumsiek
- Institute of Computational Biology, Helmholtz Zentrum München, Munich, Germany
| | - Brigitte I. Frohnert
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, Colorado, United States of America
| | - Andrea K. Steck
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, Colorado, United States of America
| | - William A. Hagopian
- Pacific Northwest Diabetes Research Institute, Seattle, Washington, United States of America
| | - Jeffrey P. Krischer
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America
| | - Åke Lernmark
- Department of Clinical Sciences, Clinical Research Centre, Skåne University Hospital, Lund University, Malmo, Sweden
| | - Marian J. Rewers
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, Colorado, United States of America
| | - Jin-Xiong She
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, United States of America
| | - Jorma Toppari
- Department of Pediatrics, Turku University Hospital, Turku, Finland
- Department of Physiology, University of Turku, Turku, Finland
| | - Beena Akolkar
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Richard A. Oram
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, United Kingdom
- Clinical Islet Transplant Program, University of Alberta, Edmonton, Alberta, Canada
- National Institute for Health Research, Exeter Clinical Research Facility, Exeter, United Kingdom
| | - Stephen S. Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia, United States of America
| | - Anette-G. Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany
- Forschergruppe Diabetes, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, Munich, Germany
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Koletzko S, Lee HS, Beyerlein A, Aronsson CA, Hummel M, Liu E, Simell V, Kurppa K, Lernmark Å, Hagopian W, Rewers M, She JX, Simell O, Toppari J, Ziegler AG, Krischer J, Agardh D. Cesarean Section on the Risk of Celiac Disease in the Offspring: The Teddy Study. J Pediatr Gastroenterol Nutr 2018; 66:417-424. [PMID: 28753178 PMCID: PMC5787038 DOI: 10.1097/mpg.0000000000001682] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Cesarean section (C-section) is associated with various immune-mediated diseases in the offspring. We investigated the relationship between mode of delivery and celiac disease (CD) and CD autoimmunity (CDA) in a multinational birth cohort. METHODS From 2004 to 2010, infants from the general population who tested positive for HLA DR3-DQ2 or DR4-DQ8 were enrolled in The Environmental Determinants for Diabetes in the Young (TEDDY) study. Children were annually screened for transglutaminase autoantibodies, if positive, they are retested after 3 to 6 months and those persistently positive defined as CDA. Associations of C-section with maternal (age, education level, parity, pre-pregnancy weight, diabetes, smoking, weight gain during pregnancy) and child characteristics (gestational age, birth weight) were examined by Fisher exact test or Wilcoxon rank-sum test. Hazard ratios (HRs) for CDA or CD were calculated by Cox proportional hazard regression models. RESULTS Of 6087 analyzed singletons, 1600 (26%) were born by C-section (Germany 38%, United States 37%, Finland 18%, Sweden 16%), and the remaining were born vaginally without instrumental support; 979 (16%) had developed CDA and 343 (6%) developed CD. C-section was associated with lower risk for CDA (hazard ratio [HR] = 0.85; 95% confidence interval [CI] 0.73, 0.99 P = 0.032) and CD (HR = 0.75; 95% CI 0.58, 0.98; P = 0.034). After adjusting for country, sex, HLA-genotype, CD in family, maternal education, and breast-feeding duration, significance was lost for CDA (HR = 0.91; 95% CI 0.78, 1.06; P = 0.20) and CD (HR = 0.85; 95% CI 0.65, 1.11; P = 0.24). Presurgical ruptured membranes had no influence on CDA or CD development. CONCLUSION C-section is not associated with increased risk for CDA or CD in the offspring.
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Affiliation(s)
- Sibylle Koletzko
- Dr. v. Hauner Children’s Hospital, University Munich Medical Center, Munich, Germany
| | - Hye-Seung Lee
- Health Informatics Institute, Department of Paediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Andreas Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, Klinikum rechts der Isar, Technische Universität München, and Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Carin A. Aronsson
- Department of Clinical Sciences, Lund University, Skane University Hosptial, Malmo, Sweden
| | - Michael Hummel
- Institute of Diabetes Research, Helmholtz Zentrum München, Klinikum rechts der Isar, Technische Universität München, and Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Edwin Liu
- Digestive Health Institute, University of Colorado, Children’s Hospital Colorado, Aurora, CO, USA
| | - Ville Simell
- Medicity Laboratory, University of Turku, Turku, Finland
| | - Kalle Kurppa
- Tampere Centre for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University, Skane University Hosptial, Malmo, Sweden
| | | | - Marian Rewers
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora CO, USA
| | - Jin-Xiong She
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta GA, USA
| | - Olli Simell
- Department of Paediatrics, Turku University Hospital, Turku, Finland
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Jorma Toppari
- Department of Paediatrics, Turku University Hospital, Turku, Finland
- Departments of Physiology, University of Turku, Turku, Finland
| | - Anette-G. Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, Klinikum rechts der Isar, Technische Universität München, and Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Jeffrey Krischer
- Health Informatics Institute, Department of Paediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Daniel Agardh
- Department of Clinical Sciences, Lund University, Skane University Hosptial, Malmo, Sweden
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22
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Hummel S, Beyerlein A, Pfirrmann M, Hofelich A, Much D, Hivner S, Bunk M, Herbst M, Peplow C, Walter M, Kohn D, Hummel N, Kratzsch J, Hummel M, Füchtenbusch M, Hasford J, Ziegler AG. Efficacy of vildagliptin for prevention of postpartum diabetes in women with a recent history of insulin-requiring gestational diabetes: A phase II, randomized, double-blind, placebo-controlled study. Mol Metab 2018; 9:168-175. [PMID: 29396374 PMCID: PMC5869734 DOI: 10.1016/j.molmet.2017.12.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 12/14/2017] [Accepted: 12/24/2017] [Indexed: 01/22/2023] Open
Abstract
Objective Women with insulin-requiring gestational diabetes mellitus (GDM) are at high risk of developing diabetes within a few years postpartum. We implemented this phase II study to test the hypothesis that vildagliptin, a dipeptidyl peptidase-4 inhibitor, is superior to placebo in terms of reducing the risk of postpartum diabetes. Methods Women with insulin-requiring GDM were randomized to either placebo or 50 mg vildagliptin twice daily for 24 months followed by a 12-month observation period (EudraCT: 2007-000634-39). Both groups received lifestyle counseling. The primary efficacy outcomes were the diagnosis of diabetes (American Diabetes Association (ADA) criteria) or impaired fasting glucose (IFG)/impaired glucose tolerance (IGT). Results Between 2008 and 2015, 113 patients (58 vildagliptin, 55 placebo) were randomized within 2.2–10.4 (median 8.6) months after delivery. At the interim analysis, nine diabetic events and 28 IFG/IGT events had occurred. Fifty-two women withdrew before completing the treatment phase. Because of the low diabetes rate, the study was terminated. Lifestyle adherence was similar in both groups. At 24 months, the cumulative probability of postpartum diabetes was 3% and 5% (hazard ratio: 1.03; 95% confidence interval: 0.15–7.36) and IFG/IGT was 43% and 22% (hazard ratio: 0.55; 95% confidence interval: 0.26–1.19) in the placebo and vildagliptin groups, respectively. Vildagliptin was well tolerated with no unexpected adverse events. Conclusions The study did not show significant superiority of vildagliptin over placebo in terms of reducing the risk of postpartum diabetes. However, treatment was safe and suggested some improvements in glycemic control, insulin resistance, and β-cell function. The study identified critical issues in performing clinical trials in the early postpartum period in women with GDM hampering efficacy assessments. With this knowledge, we have set a basis for which properly powered trials could be performed in women with recent GDM. Trial registration number at ClinicalTrials.gov NCT01018602. Treatment with vildagliptin suggested positive effects on β-cell function and HbA1c. Treatment with vildagliptin was safe. Contraindication of vildagliptin during lactation led to exclusion of women with early postpartum diabetes. Slow enrolment and high drop-out rates are major challenges in studies of women with GDM.
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Affiliation(s)
- Sandra Hummel
- Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Andreas Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Markus Pfirrmann
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians University Munich, Marchioninistr. 15, 81377 München, Germany
| | - Anna Hofelich
- Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Daniela Much
- Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Susanne Hivner
- Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Melanie Bunk
- Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Melanie Herbst
- Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Claudia Peplow
- Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Markus Walter
- Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Denise Kohn
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians University Munich, Marchioninistr. 15, 81377 München, Germany
| | - Nadine Hummel
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Jürgen Kratzsch
- Institut für Laboratoriumsmedizin, Klinische Chemie und Molekulare Diagnostik, Uniklinikum Leipzig, Paul-List-Str. 13/15, 04103 Leipzig, Germany
| | - Michael Hummel
- Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Martin Füchtenbusch
- Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Joerg Hasford
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians University Munich, Marchioninistr. 15, 81377 München, Germany
| | - Anette-G Ziegler
- Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany.
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23
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Abstract
It has been suggested that early infections are associated with increased risk for later celiac disease (CD). We analyzed prospective claims data of infants from Bavaria, Germany, born between 2005 and 2007 (n = 295,420), containing information on medically attended infectious diseases according to International Classification of Diseases, Tenth Revision, codes in quarterly intervals. We calculated hazard ratios and 95% confidence intervals for time to CD diagnosis by infection exposure, adjusting for sex, calendar month of birth, and number of previous healthcare visits. CD risk was higher among children who had had a gastrointestinal infection during the first year of life (hazard ratio = 1.32, 95% confidence interval: 1.12, 1.55) and, to a lesser extent, among children who had had a respiratory infection during the first year of life (hazard ratio = 1.22, 95% confidence interval: 1.04, 1.43). Repeated gastrointestinal infections during the first year of life were associated with particularly increased risk of CD in later life. These findings indicate that early gastrointestinal infections may be relevant for CD development.
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Affiliation(s)
- Andreas Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany
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24
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Köhler M, Beyerlein A, Vehik K, Greven S, Umlauf N, Lernmark Å, Hagopian WA, Rewers M, She JX, Toppari J, Akolkar B, Krischer JP, Bonifacio E, Ziegler AG. Joint modeling of longitudinal autoantibody patterns and progression to type 1 diabetes: results from the TEDDY study. Acta Diabetol 2017; 54:1009-1017. [PMID: 28856522 PMCID: PMC5645259 DOI: 10.1007/s00592-017-1033-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/22/2017] [Indexed: 10/19/2022]
Abstract
AIMS The onset of clinical type 1 diabetes (T1D) is preceded by the occurrence of disease-specific autoantibodies. The level of autoantibody titers is known to be associated with progression time from the first emergence of autoantibodies to the onset of clinical symptoms, but detailed analyses of this complex relationship are lacking. We aimed to fill this gap by applying advanced statistical models. METHODS We investigated data of 613 children from the prospective TEDDY study who were persistent positive for IAA, GADA and/or IA2A autoantibodies. We used a novel approach of Bayesian joint modeling of longitudinal and survival data to assess the potentially time- and covariate-dependent association between the longitudinal autoantibody titers and progression time to T1D. RESULTS For all autoantibodies we observed a positive association between the titers and the T1D progression risk. This association was estimated as time-constant for IA2A, but decreased over time for IAA and GADA. For example the hazard ratio [95% credibility interval] for IAA (per transformed unit) was 3.38 [2.66, 4.38] at 6 months after seroconversion, and 2.02 [1.55, 2.68] at 36 months after seroconversion. CONCLUSIONS These findings indicate that T1D progression risk stratification based on autoantibody titers should focus on time points early after seroconversion. Joint modeling techniques allow for new insights into these associations.
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Affiliation(s)
- Meike Köhler
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany
- Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Andreas Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany
- Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Kendra Vehik
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Sonja Greven
- Department of Statistics, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Nikolaus Umlauf
- Department of Statistics, University of Innsbruck, Innsbruck, Austria
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden
| | | | - Marian Rewers
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jin-Xiong She
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Georgia Regents University, Augusta, GA, USA
| | - Jorma Toppari
- Department of Physiology Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Beena Akolkar
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Jeffrey P Krischer
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Ezio Bonifacio
- Center for Regenerative Therapies Dresden and Paul Langerhans Institute Dresden, Technische Universität Dresden, Dresden, Germany
| | - Anette-G Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany.
- Forschergruppe Diabetes e.V., Neuherberg, Germany.
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25
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Warncke K, Lickert R, Eitel S, Gloning KP, Bonifacio E, Sedlmeier EM, Becker P, Knoop J, Beyerlein A, Ziegler AG. Thymus Growth and Fetal Immune Responses in Diabetic Pregnancies. Horm Metab Res 2017; 49:892-898. [PMID: 29136677 DOI: 10.1055/s-0043-120671] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Type 1 diabetes (T1D) during pregnancy possibly affects the development of the thymus and the maturation of the immune system in the offspring. The aim of the ImmunDiabRisk study was to investigate thymus growth and maternal and fetal immune responses in pregnancies with and without T1D. The thymus circumferences of the fetuses of pregnant women with T1D (n=49) and without diabetes (n=59) were measured using ultrasound around the 29th gestational week and standardized for gestational age. Simultaneously, the frequencies and total numbers of cell markers were analyzed by flow cytometry in maternal peripheral blood, and at birth in umbilical cord blood. The standardized circumference of the thymus was similar in fetuses of mothers with and without T1D (p=0.26). We observed higher numbers of FOXP3 Tregs, memory Tregs, erythrocytes, and lymphocytes in the cord blood from T1D pregnancies (p=0.01, p=0.002, p=0.002 and p=0.02, respectively). The frequencies of CD4+/CD8+ T cells correlated positively in maternal blood and umbilical cord blood of mother-child pairs, as did the levels of neutrophils (Spearman's correlation coefficient r=0.43, p=0.02 for CD4+/CD8+ cells; r=0.46, p=0.03 for neutrophils), while no significant correlations were observed between thymus circumference and any cell markers in the child. Parts of the prenatal immune system seem to develop differently in the offspring of mothers with and without T1D. The correlation of Tregs between maternal blood and cord blood may indicate a significant cross-talk between the maternal and fetal immune system.
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Affiliation(s)
- Katharina Warncke
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany
- Forschergruppe Diabetes e.V., Neuherberg, Germany
- Department of Pediatrics, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Ramona Lickert
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany
| | - Stephanie Eitel
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany
| | | | - Ezio Bonifacio
- Center for Regenerative Therapies - Dresden, Technische Universität, Dresden, Germany
- Institute for Diabetes and Obesity, Helmholtz Zentrum München, Neuherberg, Germany
| | - Eva-Maria Sedlmeier
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany
| | - Petra Becker
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany
| | - Jan Knoop
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany
| | - Andreas Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany
| | - Anette-Gabriele Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany
- Forschergruppe Diabetes e.V., Neuherberg, Germany
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26
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Köhler M, Umlauf N, Beyerlein A, Winkler C, Ziegler AG, Greven S. Flexible Bayesian additive joint models with an application to type 1 diabetes research. Biom J 2017; 59:1144-1165. [PMID: 28796339 DOI: 10.1002/bimj.201600224] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 06/07/2017] [Accepted: 06/08/2017] [Indexed: 01/13/2023]
Abstract
The joint modeling of longitudinal and time-to-event data is an important tool of growing popularity to gain insights into the association between a biomarker and an event process. We develop a general framework of flexible additive joint models that allows the specification of a variety of effects, such as smooth nonlinear, time-varying and random effects, in the longitudinal and survival parts of the models. Our extensions are motivated by the investigation of the relationship between fluctuating disease-specific markers, in this case autoantibodies, and the progression to the autoimmune disease type 1 diabetes. Using Bayesian P-splines, we are in particular able to capture highly nonlinear subject-specific marker trajectories as well as a time-varying association between the marker and event process allowing new insights into disease progression. The model is estimated within a Bayesian framework and implemented in the R-package bamlss.
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Affiliation(s)
- Meike Köhler
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany
| | - Nikolaus Umlauf
- Department of Statistics, Faculty of Economics and Statistics, Universität Innsbruck, Innsbruck, Austria
| | - Andreas Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany
| | - Christiane Winkler
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany
| | - Anette-Gabriele Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany.,Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Sonja Greven
- Department of Statistics, Ludwig-Maximilians-Universität München, München, Germany
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27
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Beyerlein A, Uusitalo UM, Virtanen SM, Vehik K, Yang J, Winkler C, Kersting M, Koletzko S, Schatz D, Aronsson CA, Larsson HE, Krischer JP, Ziegler AG, Norris JM, Hummel S. Intake of Energy and Protein is Associated with Overweight Risk at Age 5.5 Years: Results from the Prospective TEDDY Study. Obesity (Silver Spring) 2017; 25:1435-1441. [PMID: 28650578 PMCID: PMC5529234 DOI: 10.1002/oby.21897] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/03/2017] [Accepted: 05/09/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The associations of energy, protein, carbohydrate, and fat intake with weight status up to the age of 5.5 years were prospectively assessed in The Environmental Determinants of Diabetes in the Young (TEDDY) study. METHODS Food record data (over 3 days) and BMI measurements between 0.25 and 5.5 years were available from 5,563 children with an increased genetic risk for type 1 diabetes followed from shortly after birth. Odds ratios (ORs) were calculated for overweight and obesity by previous intake of energy, protein, carbohydrate, and fat with adjustment for potential confounders. RESULTS Having overweight or obesity at the age of 5.5 years was positively associated with mean energy intake in previous age intervals (e.g., adjusted OR [95% CI] for overweight: 1.06 [1.04-1.09] per 100 kcal intake at the age of 4.5-5.0 years) and with protein intake after the age of 3.5 and 4.5 years, respectively (e.g., adjusted OR for overweight: 1.06 [1.03-1.09] per 1% of energy intake at the age of 4.5-5.0 years). The respective associations with carbohydrate and fat intake were less consistent. CONCLUSIONS These findings indicate that energy and protein intake are positively associated with increased risk for overweight in childhood but yield no evidence for potential programming effects of protein intake in infancy.
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Affiliation(s)
- Andreas Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Ulla M. Uusitalo
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Suvi M. Virtanen
- Unit of Nutrition, National Institute for Health and Welfare, Helsinki; University of Tampere, Tampere, School of Health Sciences; Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere; and The Science Center of Pirkanmaa Hospital District, Tampere, Finland
| | - Kendra Vehik
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Jimin Yang
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Christiane Winkler
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Mathilde Kersting
- Research Institute of Child Nutrition (FKE), Pediatric University Clinic, Ruhr-University Bochum, Germany
| | - Sibylle Koletzko
- Dr. v. Hauner Children’s Hospital, University Munich Medical Center, Munich, Germany
| | - Desmond Schatz
- Departments of Pediatrics and Pathology and Laboratory Medicine, University of Florida, Gainesville, Florida
| | - Carin Andrén Aronsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital SUS, Malmö, Sweden
| | - Helena Elding Larsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital SUS, Malmö, Sweden
| | - Jeffrey P. Krischer
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Anette-G. Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Jill M. Norris
- Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Sandra Hummel
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Forschergruppe Diabetes e.V., Neuherberg, Germany
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28
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Jolink M, Huang D, Haupt F, Winkler C, Smith M, Ziegler AG, Beyerlein A. Untersuchung der körperlichen Aktivität bei Kindern mit erhöhtem genetischen Risiko für Typ 1 Diabetes. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- M Jolink
- Helmholtz Zentrum München, Institut für Diabetesforschung, München, Germany
| | - D Huang
- Helmholtz Zentrum München, Institut für Diabetesforschung, München, Germany
| | - F Haupt
- Helmholtz Zentrum München, Institut für Diabetesforschung, München, Germany
| | - C Winkler
- Helmholtz Zentrum München, Institut für Diabetesforschung, München, Germany
| | - M Smith
- Helmholtz Zentrum München, Institut für Epidemiologie 1, München, Germany
| | - AG Ziegler
- Helmholtz Zentrum München, Institut für Diabetesforschung, München, Germany
| | - A Beyerlein
- Helmholtz Zentrum München, Institut für Diabetesforschung, München, Germany
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29
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Beyerlein A, Strobl AN, Winkler C, Carpus M, Knopff A, Donnachie E, Ankerst DP, Ziegler AG. Vaccinations in early life are not associated with development of islet autoimmunity in type 1 diabetes high-risk children: Results from prospective cohort data. Vaccine 2017; 35:1735-1741. [PMID: 28268073 DOI: 10.1016/j.vaccine.2017.02.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/20/2017] [Accepted: 02/23/2017] [Indexed: 10/20/2022]
Abstract
AIMS/HYPOTHESIS Vaccinations in early childhood potentially stimulate the immune system and may thus be relevant for the pathogenesis of autoimmune diseases such as type 1 diabetes (T1D). We determined the association of vaccination burden with T1D-associated islet autoimmunity in children with high familial risk followed prospectively from birth. METHODS A total of 20,570 certified vaccination records from 1918 children were correlated with time to onset of T1D-associated islet autoimmunity using Cox regression, considering multiple time periods up until age two years and vaccination types, and adjusting for HLA genotype, sex, delivery mode, season of birth, preterm delivery and maternal T1D status. Additionally, prospective claims data of 295,420 subjects were used to validate associations for the tick-borne encephalitis (TBE) vaccination. RESULTS Most vaccinations were not associated with a significantly increased hazard ratio (HR) for islet autoimmunity (e.g. HR [95% confidence interval]: 1.08 [0.96-1.21] per additional vaccination against measles, mumps and rubella at age 0-24months). TBE vaccinations within the first two years of life were nominally associated with a significantly increased autoimmunity risk (HR: 1.44 [1.06-1.96] per additional vaccination at age 0-24months), but this could not be confirmed with respect to outcome T1D in the validation cohort (HR: 1.02 [0.90-1.16]). CONCLUSIONS We found no evidence that early vaccinations increase the risk of T1D-associated islet autoimmunity development. The potential association with early TBE vaccinations could not be confirmed in an independent cohort and appears to be a false positive finding.
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Affiliation(s)
- Andreas Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany; Forschergruppe Diabetes der Technischen Universität München, Munich, Germany
| | - Andreas N Strobl
- Department of Mathematics of the Technische Universität München, Munich, Germany
| | - Christiane Winkler
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany; Forschergruppe Diabetes der Technischen Universität München, Munich, Germany
| | - Michaela Carpus
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany; Forschergruppe Diabetes der Technischen Universität München, Munich, Germany
| | - Annette Knopff
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany; Forschergruppe Diabetes der Technischen Universität München, Munich, Germany
| | - Ewan Donnachie
- Kassenärztliche Vereinigung Bayerns (Bavarian Association of Statutory Health Insurance Physicians), Munich, Germany
| | - Donna P Ankerst
- Department of Mathematics of the Technische Universität München, Munich, Germany; Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Anette-G Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany; Forschergruppe Diabetes der Technischen Universität München, Munich, Germany.
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30
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Hummel S, Beyerlein A, Tamura R, Uusitalo U, Andrén Aronsson C, Yang J, Riikonen A, Lernmark Å, Rewers MJ, Hagopian WA, She JX, Simell OG, Toppari J, Ziegler AG, Akolkar B, Krischer JP, Virtanen SM, Norris JM. First Infant Formula Type and Risk of Islet Autoimmunity in The Environmental Determinants of Diabetes in the Young (TEDDY) Study. Diabetes Care 2017; 40:398-404. [PMID: 28096222 PMCID: PMC5319477 DOI: 10.2337/dc16-1624] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 12/22/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Studies on the introduction of infant formulas and its effect on the risk of islet autoimmunity and type 1 diabetes (T1D) have yielded inconsistent results. We investigated whether the introduction of formula based on hydrolyzed cow's milk as the first formula is associated with reduced islet autoimmunity risk in a large prospective cohort. RESEARCH DESIGN AND METHODS The Environmental Determinants of Diabetes in the Young (TEDDY) study prospectively monitors 8,676 children at increased genetic risk for T1D. Autoantibodies to insulin, GAD65, and IA2 were measured regularly to define islet autoimmunity. Information on formula feeding was collected by questionnaires at 3 months of age. RESULTS In survival analyses, after adjustment for family history with T1D, HLA genotype, sex, country, delivery mode, breast-feeding ≥3 months, and seasonality of birth, we observed no significant association with islet autoimmunity in infants who received extensively hydrolyzed compared with nonhydrolyzed cow's milk-based formula as the first formula during the first 3 months (adjusted hazard ratio 1.38 [95% CI 0.95; 2.01]), and a significantly increased risk for extensively hydrolyzed formula introduced during the first 7 days (adjusted hazard ratio 1.57 [1.04; 2.38]). Using a partially hydrolyzed or other formula as the first formula, or no formula, was not associated with islet autoimmunity risk. CONCLUSIONS These results add to the existing evidence that islet autoimmunity risk is not reduced, and may be increased, by using hydrolyzed compared with nonhydrolyzed cow's milk-based infant formula as the first formula in infants at increased genetic risk for T1D.
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Affiliation(s)
- Sandra Hummel
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Andreas Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Roy Tamura
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Ulla Uusitalo
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Carin Andrén Aronsson
- Department of Clinical Sciences, Lund University/Clinical Research Centre, Skåne University Hospital (SUS), Malmö, Sweden
| | - Jimin Yang
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Anne Riikonen
- Unit of Nutrition, National Institute for Health and Welfare, Helsinki, and Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University/Clinical Research Centre, Skåne University Hospital (SUS), Malmö, Sweden
| | - Marian J Rewers
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Jin-Xiong She
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA
| | - Olli G Simell
- Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Jorma Toppari
- Department of Pediatrics, Turku University Hospital, Turku, Finland
- Department of Physiology, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Anette-G Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Beena Akolkar
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Jeffrey P Krischer
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Suvi M Virtanen
- Unit of Nutrition, National Institute for Health and Welfare, Helsinki, and Faculty of Social Sciences, University of Tampere, Tampere, Finland
- Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, and The Science Center of Pirkanmaa Hospital District, Tampere, Finland
| | - Jill M Norris
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
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Yassouridis C, Leisch F, Winkler C, Ziegler AG, Beyerlein A. Associations of growth patterns and islet autoimmunity in children with increased risk for type 1 diabetes: a functional analysis approach. Pediatr Diabetes 2017; 18:103-110. [PMID: 26890567 DOI: 10.1111/pedi.12368] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 01/08/2016] [Accepted: 01/08/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Several studies indicate associations between early growth and type 1 diabetes (T1D). However, it remains an open question whether these findings can be translated to typical growth patterns associated with increased risk for T1D-associated islet autoimmunity. METHODS We analyzed pooled data from 2236 children followed up in two large prospective German birth cohorts with a genetically increased risk for T1D including 18 564 measurements of height and weight, which were transformed to sex- and age-specific standard deviation scores (SDS). A total of 191 children developed any islet autoantibodies, 101 multiple islet autoantibodies. We applied a model-based clustering technique to derive typical height and body mass index (BMI) growth patterns, stratified for maternal T1D status. These patterns were used to predict islet autoimmunity in logistic regression models, adjusted for potential confounders. RESULTS Growth patterns were not associated with islet autoimmunity in the whole dataset and in children of diabetic mothers, respectively. In children of non-diabetic mothers ,however, islet autoimmunity was associated with rapidly increasing BMI SDS values until the age of 3 yr [adjusted odds ratio (95% confidence interval): 2.02 (1.03, 3.73) for development of any islet autoantibodies) and with consistently above average height SDS values [odds ratio: 2.21 (1.15, 4.17)]. In contrast, a pattern of high height SDS values at birth followed by a decrease to average values after 3 yr was associated with a reduced rate of islet autoimmunity [odds ratio: 0.16 (0.01, 0.62)]. CONCLUSION Early growth patterns may be associated with T1D-related islet autoimmunity risk in children of non-diabetic mothers.
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Affiliation(s)
- Christina Yassouridis
- Institute for Applied Statistics and Computing, University of Natural Resources and Life Sciences, Vienna, Austria
| | - Friedrich Leisch
- Institute for Applied Statistics and Computing, University of Natural Resources and Life Sciences, Vienna, Austria
| | - Christiane Winkler
- Institute for Diabetes Research, Helmholtz Zentrum München, Neuherberg, Germany.,Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany
| | - Anette-Gabriele Ziegler
- Institute for Diabetes Research, Helmholtz Zentrum München, Neuherberg, Germany.,Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany
| | - Andreas Beyerlein
- Institute for Diabetes Research, Helmholtz Zentrum München, Neuherberg, Germany.,Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany
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Heninger AK, Eugster A, Kuehn D, Buettner F, Kuhn M, Lindner A, Dietz S, Jergens S, Wilhelm C, Beyerlein A, Ziegler AG, Bonifacio E. A divergent population of autoantigen-responsive CD4+T cells in infants prior to β cell autoimmunity. Sci Transl Med 2017; 9:9/378/eaaf8848. [DOI: 10.1126/scitranslmed.aaf8848] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 12/30/2016] [Indexed: 12/14/2022]
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von Toerne C, Laimighofer M, Achenbach P, Beyerlein A, de Las Heras Gala T, Krumsiek J, Theis FJ, Ziegler AG, Hauck SM. Peptide serum markers in islet autoantibody-positive children. Diabetologia 2017; 60:287-295. [PMID: 27815605 DOI: 10.1007/s00125-016-4150-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 10/05/2016] [Indexed: 01/13/2023]
Abstract
AIMS/HYPOTHESIS We sought to identify minimal sets of serum peptide signatures as markers for islet autoimmunity and predictors of progression rates to clinical type 1 diabetes in a case-control study. METHODS A double cross-validation approach was applied to first prioritise peptides from a shotgun proteomic approach in 45 islet autoantibody-positive and -negative children from the BABYDIAB/BABYDIET birth cohorts. Targeted proteomics for 82 discriminating peptides were then applied to samples from another 140 children from these cohorts. RESULTS A total of 41 peptides (26 proteins) enriched for the functional category lipid metabolism were significantly different between islet autoantibody-positive and autoantibody-negative children. Two peptides (from apolipoprotein M and apolipoprotein C-IV) were sufficient to discriminate autoantibody-positive from autoantibody-negative children. Hepatocyte growth factor activator, complement factor H, ceruloplasmin and age predicted progression time to type 1 diabetes with a significant improvement compared with age alone. CONCLUSION/INTERPRETATION Distinct peptide signatures indicate islet autoimmunity prior to the clinical manifestation of type 1 diabetes and enable refined staging of the presymptomatic disease period.
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Affiliation(s)
- Christine von Toerne
- Research Unit Protein Science, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstraße 1, D-85764, München, Germany
| | - Michael Laimighofer
- Institute of Computational Biology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Department of Mathematics, Technische Universität München, Garching, Germany
| | - Peter Achenbach
- Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstraße 1, D-85764, München, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Andreas Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstraße 1, D-85764, München, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Tonia de Las Heras Gala
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Jan Krumsiek
- Institute of Computational Biology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Fabian J Theis
- Institute of Computational Biology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Department of Mathematics, Technische Universität München, Garching, Germany
| | - Anette G Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstraße 1, D-85764, München, Germany.
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
- Forschergruppe Diabetes e.V., Neuherberg, Germany.
| | - Stefanie M Hauck
- Research Unit Protein Science, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstraße 1, D-85764, München, Germany.
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Beyerlein A, Wehweck F, Ziegler AG, Pflueger M. Miscalculation and Errors in Numbers Reported in Table. JAMA Pediatr 2017; 171:93. [PMID: 27893061 DOI: 10.1001/jamapediatrics.2016.3893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Andreas Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München and Forschergruppe Diabetes der Technischen Universität München, Munich, Germany
| | - Fabienne Wehweck
- Institute of Diabetes Research, Helmholtz Zentrum München and Forschergruppe Diabetes der Technischen Universität München, Munich, Germany
| | - Anette-Gabriele Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München and Forschergruppe Diabetes der Technischen Universität München, Munich, Germany2Forschergruppe Diabetes e. V. am Helmholtz Zentrum München, Munich, Germany
| | - Maren Pflueger
- Institute of Diabetes Research, Helmholtz Zentrum München and Forschergruppe Diabetes der Technischen Universität München, Munich, Germany3Leibniz-Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
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Ziegler AG, Haupt F, Scholz M, Weininger K, Wittich S, Löbner S, Matzke C, Gezginci C, Riethausen S, Beyerlein A, Zillmer S, Amoroso M, Coles R, Powell M, Furmaniak J, Smith BR, Winkler C, Bonifacio E, Achenbach P. 3 Screen ELISA for High-Throughput Detection of Beta Cell Autoantibodies in Capillary Blood. Diabetes Technol Ther 2016; 18:687-693. [PMID: 27552135 DOI: 10.1089/dia.2016.0199] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Testing for beta cell autoantibodies is used for wide-scale identification of early stages of type 1 diabetes. This requires suitable screening assays. We aimed to establish screening that utilized a first step assay (3 Screen) able to detect autoantibodies to the target antigens glutamic acid decarboxylase-65 (GAD), insulinoma-associated antigen 2 (IA-2), and zinc transporter 8 (ZnT8) to identify children positive for multiple beta cell autoantibodies. METHODS An ELISA format was used where plates were coated with a mixture of recombinant GAD, IA-2, and ZnT8325W/R-dimer molecules. The performance was determined in venous blood from 686 first-degree relatives of patients with type 1 diabetes, and 200 patients at onset of type 1 diabetes, and applied as a screening assay in capillary blood from 33,639 general population children. RESULTS The 3 Screen assay sensitivity for detecting autoantibody-positive patients at onset of type 1 diabetes was similar to that achieved by separate radiobinding assays (RBAs) for antibodies to GAD, IA-2, and ZnT8. Results in venous and capillary serum were correlated (R = 0.987). At a threshold corresponding to the 98th centile (29.1 U/mL) of all 33,639 capillary samples, the 3 Screen was positive in 123 samples with two or more RBA-positive antibodies to insulin, GAD, IA-2, or ZnT8, 146 with one antibody, and 479 that were RBA negative for beta cell autoantibodies. CONCLUSION A 3 Screen ELISA was developed that was suitable for first step screening of multiple beta cell autoantibodies in capillary blood.
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Affiliation(s)
- Anette-G Ziegler
- 1 Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München , Neuherberg, Germany
- 2 Forschergruppe Diabetes e.V. , Neuherberg, Germany
| | - Florian Haupt
- 1 Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München , Neuherberg, Germany
| | - Marlon Scholz
- 1 Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München , Neuherberg, Germany
| | - Katharina Weininger
- 1 Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München , Neuherberg, Germany
| | - Susanne Wittich
- 1 Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München , Neuherberg, Germany
| | - Stephanie Löbner
- 1 Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München , Neuherberg, Germany
| | - Claudia Matzke
- 1 Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München , Neuherberg, Germany
| | - Cigdem Gezginci
- 1 Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München , Neuherberg, Germany
| | - Stephanie Riethausen
- 1 Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München , Neuherberg, Germany
| | - Andreas Beyerlein
- 1 Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München , Neuherberg, Germany
| | - Stephanie Zillmer
- 1 Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München , Neuherberg, Germany
| | - Marie Amoroso
- 3 FIRS Laboratories , RSR Ltd., Parc Ty Glas, Llanishen, Cardiff, United Kingdom
| | - Rebecca Coles
- 3 FIRS Laboratories , RSR Ltd., Parc Ty Glas, Llanishen, Cardiff, United Kingdom
| | - Michael Powell
- 3 FIRS Laboratories , RSR Ltd., Parc Ty Glas, Llanishen, Cardiff, United Kingdom
| | - Jadwiga Furmaniak
- 3 FIRS Laboratories , RSR Ltd., Parc Ty Glas, Llanishen, Cardiff, United Kingdom
| | - Bernard Rees Smith
- 3 FIRS Laboratories , RSR Ltd., Parc Ty Glas, Llanishen, Cardiff, United Kingdom
| | - Christiane Winkler
- 1 Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München , Neuherberg, Germany
- 2 Forschergruppe Diabetes e.V. , Neuherberg, Germany
| | - Ezio Bonifacio
- 4 Centre for Regenerative Therapies Dresden, Faculty of Medicine, Technische Universität , Dresden, Germany
- 5 Paul Langerhans Institute Dresden of Helmholtz Centre Munich at University Clinic Carl Gustav Carus of Technische Universität , Dresden, Germany
| | - Peter Achenbach
- 1 Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München , Neuherberg, Germany
- 2 Forschergruppe Diabetes e.V. , Neuherberg, Germany
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Much D, Beyerlein A, Kindt A, Krumsiek J, Stückler F, Rossbauer M, Hofelich A, Wiesenäcker D, Hivner S, Herbst M, Römisch-Margl W, Prehn C, Adamski J, Kastenmüller G, Theis F, Ziegler AG, Hummel S. Lactation is associated with altered metabolomic signatures in women with gestational diabetes. Diabetologia 2016; 59:2193-202. [PMID: 27423999 DOI: 10.1007/s00125-016-4055-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/20/2016] [Indexed: 01/11/2023]
Abstract
AIMS/HYPOTHESIS Lactation for >3 months in women with gestational diabetes is associated with a reduced risk of type 2 diabetes that persists for up to 15 years postpartum. However, the underlying mechanisms are unknown. We examined whether in women with gestational diabetes lactation for >3 months is associated with altered metabolomic signatures postpartum. METHODS We enrolled 197 women with gestational diabetes at a median of 3.6 years (interquartile range 0.7-6.5 years) after delivery. Targeted metabolomics profiles (including 156 metabolites) were obtained during a glucose challenge test. Comparisons of metabolite concentrations and ratios between women who lactated for >3 months and women who lactated for ≤3 months or not at all were performed using linear regression with adjustment for age and BMI at the postpartum visit, time since delivery, and maternal education level, and correction for multiple testing. Gaussian graphical modelling was used to generate metabolite networks. RESULTS Lactation for >3 months was associated with a higher total lysophosphatidylcholine/total phosphatidylcholine ratio; in women with short-term follow-up, it was also associated with lower leucine concentrations and a lower total branched-chain amino acid concentration. Gaussian graphical modelling identified subgroups of closely linked metabolites within phosphatidylcholines and branched-chain amino acids that were affected by lactation for >3 months and have been linked to the pathophysiology of type 2 diabetes in previous studies. CONCLUSIONS/INTERPRETATION Lactation for >3 months in women with gestational diabetes is associated with changes in the metabolomics profile that have been linked to the early pathogenesis of type 2 diabetes.
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Affiliation(s)
- Daniela Much
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Forschergruppe Diabetes e.V., Neuherberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Andreas Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Alida Kindt
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Jan Krumsiek
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Ferdinand Stückler
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Michaela Rossbauer
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Anna Hofelich
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - David Wiesenäcker
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Department of Pediatrics, Kinderklinik München Schwabing, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Susanne Hivner
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Forschergruppe Diabetes e.V., Neuherberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Melanie Herbst
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Forschergruppe Diabetes e.V., Neuherberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Werner Römisch-Margl
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Institute of Bioinformatics and Systems Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Cornelia Prehn
- Genome Analysis Center, Institute of Experimental Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Jerzy Adamski
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Genome Analysis Center, Institute of Experimental Genetics, Helmholtz Zentrum München, Neuherberg, Germany
- Lehrstuhl für Experimentelle Genetik, Technische Universität München, Freising-Weihenstephan, Germany
| | - Gabi Kastenmüller
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Institute of Bioinformatics and Systems Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Fabian Theis
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Anette-G Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Forschergruppe Diabetes e.V., Neuherberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Sandra Hummel
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany.
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
- Forschergruppe Diabetes e.V., Neuherberg, Germany.
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
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Beyerlein A, Koller D, Ziegler AG, Lack N, Maier W. Does charge-free screening improve detection of gestational diabetes in women from deprived areas: a cross-sectional study. BMC Pregnancy Childbirth 2016; 16:266. [PMID: 27613387 PMCID: PMC5016952 DOI: 10.1186/s12884-016-1060-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 09/06/2016] [Indexed: 11/25/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) occurs in 2–6 % of all pregnancies. We investigated whether area level deprivation is associated with a higher risk for GDM and whether GDM detection rates in deprived regions changed after the introduction of charge-free GDM screening in Germany in 2012. Methods We analyzed population-based data from Bavaria, Germany, comprising n = 587,621 deliveries in obstetric units between 2008 and 2014. Area level deprivation was assessed municipality-based using the Bavarian Index of Multiple Deprivation (BIMD), divided into quintiles and assigned to each mother based on her residential address. We estimated annual odds ratios (ORs) for GDM diagnosis by BIMD quintile with adjustment for maternal obesity, maternal age, migration background and single mother status. Results Women from the most deprived regions were less likely to be diagnosed with GDM before introduction of charge-free GDM screening (OR = 0.76 [95 % confidence interval: 0.66, 0.86] compared to least deprived areas), in 2008. In contrast, high area level deprivation was associated with significantly increased risk of GDM diagnosis in 2013 (OR [95 % confidence interval] = 1.15 [1.02, 1.29]). The OR was also elevated, although not significantly, in 2014 (OR [95 % confidence interval] = 1.05 [0.93, 1.18]). Conclusions The prevalence of GDM seems to have been underreported in women from highly deprived areas before introduction of the charge-free GDM screening in Germany. In fact, women living in deprived regions seem to have an increased risk for GDM and may profit from access to charge-free GDM screening.
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Affiliation(s)
- Andreas Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, Neuherberg, Germany. .,Forschergruppe Diabetes der Technischen Universität München, Munich, Germany.
| | - Daniela Koller
- Department of Health Services Management, Munich School of Management, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Anette-Gabriele Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, Neuherberg, Germany.,Forschergruppe Diabetes der Technischen Universität München, Munich, Germany.,Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Munich, Germany.,German Center for Diabetes Research (DZD), Partner, Neuherberg, Germany
| | - Nicholas Lack
- German Bavarian Quality Assurance Institute for Medical Care, Munich, Germany
| | - Werner Maier
- German Center for Diabetes Research (DZD), Partner, Neuherberg, Germany.,Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
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Beyerlein A, Donnachie E, Ziegler AG. Association of Infection in Early Life and Risk of Developing Type 1 Diabetes--Reply. JAMA 2016; 316:883. [PMID: 27552631 DOI: 10.1001/jama.2016.10294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Andreas Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany
| | - Ewan Donnachie
- Bavarian Association of Statutory Health Insurance Physicians, Munich, Germany
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Warncke K, Puff R, Eitel S, Beyerlein A, Gloning KP, Bonifacio E, Becker P, Ziegler AG. Einfluss von Diabetes während der Schwangerschaft auf das Immunsystem und die Entwicklung des fetalen Thymus. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1584108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Köhler M, Ziegler AG, Beyerlein A. Development of a simple tool to predict the risk of postpartum diabetes in women with gestational diabetes mellitus. Acta Diabetol 2016; 53:433-7. [PMID: 26482741 DOI: 10.1007/s00592-015-0814-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/30/2015] [Indexed: 10/22/2022]
Abstract
AIMS Women with gestational diabetes mellitus (GDM) have an increased risk of diabetes postpartum. We developed a score to predict the long-term risk of postpartum diabetes using clinical and anamnestic variables recorded during or shortly after delivery. METHODS Data from 257 GDM women who were prospectively followed for diabetes outcome over 20 years of follow-up were used to develop and validate the risk score. Participants were divided into training and test sets. The risk score was calculated using Lasso Cox regression and divided into four risk categories, and its prediction performance was assessed in the test set. RESULTS Postpartum diabetes developed in 110 women. The computed training set risk score of 5 × body mass index in early pregnancy (per kg/m(2)) + 132 if GDM was treated with insulin (otherwise 0) + 44 if the woman had a family history of diabetes (otherwise 0) - 35 if the woman lactated (otherwise 0) had R (2) values of 0.23, 0.25, and 0.33 at 5, 10, and 15 years postpartum, respectively, and a C-Index of 0.75. Application of the risk score in the test set resulted in observed risk of postpartum diabetes at 5 years of 11 % for low risk scores ≤140, 29 % for scores 141-220, 64 % for scores 221-300, and 80 % for scores >300. CONCLUSIONS The derived risk score is easy to calculate, allows accurate prediction of GDM-related postpartum diabetes, and may thus be a useful prediction tool for clinicians and general practitioners.
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Affiliation(s)
- M Köhler
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | - A G Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.
- Forschergruppe Diabetes e.V., Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.
| | - A Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
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Raab J, Haupt F, Scholz M, Matzke C, Warncke K, Lange K, Assfalg R, Weininger K, Wittich S, Löbner S, Beyerlein A, Nennstiel-Ratzel U, Lang M, Laub O, Dunstheimer D, Bonifacio E, Achenbach P, Winkler C, Ziegler AG. Capillary blood islet autoantibody screening for identifying pre-type 1 diabetes in the general population: design and initial results of the Fr1da study. BMJ Open 2016; 6:e011144. [PMID: 27194320 PMCID: PMC4874167 DOI: 10.1136/bmjopen-2016-011144] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/16/2016] [Accepted: 04/14/2016] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Type 1 diabetes can be diagnosed at an early presymptomatic stage by the detection of islet autoantibodies. The Fr1da study aims to assess whether early staging of type 1 diabetes (1) is feasible at a population-based level, (2) prevents severe metabolic decompensation observed at the clinical manifestation of type 1 diabetes and (3) reduces psychological distress through preventive teaching and care. METHODS AND ANALYSIS Children aged 2-5 years in Bavaria, Germany, will be tested for the presence of multiple islet autoantibodies. Between February 2015 and December 2016, 100 000 children will be screened by primary care paediatricians. Islet autoantibodies are measured in capillary blood samples using a multiplex three-screen ELISA. Samples with ELISA results >97.5th centile are retested using reference radiobinding assays. A venous blood sample is also obtained to confirm the autoantibody status of children with at least two autoantibodies. Children with confirmed multiple islet autoantibodies are diagnosed with pre-type 1 diabetes. These children and their parents are invited to participate in an education and counselling programme at a local diabetes centre. Depression and anxiety, and burden of early diagnosis are also assessed. RESULTS Of the 1027 Bavarian paediatricians, 39.3% are participating in the study. Overall, 26 760 children have been screened between February 2015 and November 2015. Capillary blood collection was sufficient in volume for islet autoantibody detection in 99.46% of the children. The remaining 0.54% had insufficient blood volume collected. Of the 26 760 capillary samples tested, 0.39% were positive for at least two islet autoantibodies. DISCUSSION Staging for early type 1 diabetes within a public health setting appears to be feasible. The study may set new standards for the early diagnosis of type 1 diabetes and education. ETHICS DISSEMINATION The study was approved by the ethics committee of Technische Universität München (Nr. 70/14).
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Affiliation(s)
- Jennifer Raab
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany
| | - Florian Haupt
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany
| | - Marlon Scholz
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany
| | - Claudia Matzke
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany
| | - Katharina Warncke
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany
- Forschergruppe Diabetes e.V., Neuherberg, Germany
- Department of Pediatrics, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Karin Lange
- Department of Medical Psychology, Hannover Medical School, Hannover, Germany
| | - Robin Assfalg
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany
| | - Katharina Weininger
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany
| | - Susanne Wittich
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany
| | - Stephanie Löbner
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany
| | - Andreas Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany
| | | | - Martin Lang
- Berufsverband der Kinder- und Jugendärzte e.V., Landesverband Bayern, Augsburg, Germany
| | - Otto Laub
- PaedNetz Bayern e.V., Rosenheim, Germany
| | | | - Ezio Bonifacio
- Centre for Regenerative Therapies Dresden, Faculty of Medicine, Technische Universität, Dresden, Germany
- Paul Langerhans Institute Dresden of Helmholtz Centre Munich at University Clinic Carl Gustav Carus of Technische Universität, Dresden, Germany
| | - Peter Achenbach
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany
- Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Christiane Winkler
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany
- Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Anette-G Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany
- Forschergruppe Diabetes e.V., Neuherberg, Germany
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Affiliation(s)
- Andreas Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany
| | - Ewan Donnachie
- Kassenärztliche Vereinigung Bayern (Bavarian Association of Statutory Health Insurance Physicians), Munich, Germany
| | - Sibille Jergens
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany
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Much D, Beyerlein A, Kindt A, Krumsiek J, Stückler F, Rossbauer M, Hofelich A, Wiesenäcker D, Hivner S, Herbst M, Römisch-Margl W, Prehn C, Adamski J, Kastenmüller G, Theis F, Ziegler AG, Hummel S. Lactation is associated with altered metabolomic signatures in women with gestational diabetes. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Much D, Jaschinski H, Lack N, Hummel S, Füchtenbusch M, Hummel M, Ziegler AG, Beyerlein A. Risk Stratification in Women with Gestational Diabetes According to and Beyond Current WHO Criteria. Horm Metab Res 2016; 48:16-9. [PMID: 26566100 DOI: 10.1055/s-0035-1565084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The pregnancy outcomes in women with gestational diabetes mellitus (GDM) and 'overt diabetes in pregnancy' were compared and the need for further subclassification was investigated with respect to postpartum outcome risk. Data from 944 women who had been uniformly diagnosed as having GDM in Munich, Germany, between 1998 and 2010, were re-classified into GDM and 'overt diabetes in pregnancy'. Pregnancy related outcomes in the offspring were derived from Bavarian birth registry data. Classification and regression trees were used to identify further GDM sub-phenotypes. In total, 88 women (9.3%) were re-classified as having 'overt diabetes in pregnancy'. Compared to women with GDM, women with 'overt diabetes in pregnancy' used insulin more frequently, and were at increased risk for large for gestational age infants [odds ratio 2.50 (95% confidence interval 1.02, 6.13)], preterm delivery [odds ratio 3.28 (1.02, 10.50)], and low APGAR-score at 5 min [odds ratio 12.70 (1.58, 102.2)]. In the 856 women with GDM, classification and regression tree analyses provided further risk stratification in that a combination of fasting glucose>5.3 mmol/l and 1-h glucose>11.1 mmol/l at GDM diagnosis predicted insulin requirement [OR 5.57 (3.75, 8.27) compared to the rest], and maternal body mass index (BMI)≥35 kg/m(2) predicted large for gestational age status. The new differentiation between GDM and 'overt diabetes in pregnancy' is a first step towards refining classification relevant to fetal and maternal postpartum risk. A combination of glucose levels and maternal BMI at diagnosis of GDM may provide further improvement.
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Affiliation(s)
- D Much
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstraße, Neuherberg, Germany
| | - H Jaschinski
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstraße, Neuherberg, Germany
| | - N Lack
- Bavarian Quality Assurance Institute for Medical Care, Munich, Germany
| | - S Hummel
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstraße, Neuherberg, Germany
| | - M Füchtenbusch
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstraße, Neuherberg, Germany
| | - M Hummel
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstraße, Neuherberg, Germany
| | - A-G Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstraße, Neuherberg, Germany
| | - A Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstraße, Neuherberg, Germany
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Giannopoulou EZ, Winkler C, Chmiel R, Matzke C, Scholz M, Beyerlein A, Achenbach P, Bonifacio E, Ziegler AG. Islet autoantibody phenotypes and incidence in children at increased risk for type 1 diabetes. Diabetologia 2015; 58:2317-23. [PMID: 26138334 DOI: 10.1007/s00125-015-3672-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 05/31/2015] [Indexed: 12/11/2022]
Abstract
AIMS/HYPOTHESIS Autoantibodies that precede type 1 diabetes frequently develop in early childhood and target distinct beta cell proteins. The aim of this study was to determine the heterogeneity of islet autoantibody development and fate. METHODS The ages of development of insulin autoantibodies (IAA) and GAD autoantibodies (GADA), followed by multiple islet autoantibodies and progression to diabetes were examined in 2,441 children participating in two German birth cohorts. RESULTS In 218 children who developed islet autoantibodies, the first islet autoantibody-positive sample was characterised by single IAA in 80 (37%), multiple islet autoantibodies in 68 (31%) and single GADA in 63 (29%) children. Of the children who were single antibody positive at seroconversion, 35 (44%) IAA-positive and 15 (24%) GADA-positive children developed multiple islet autoantibodies. Single persistent antibodies had heterogeneous affinities; GADA were also heterogeneous in their binding to N-terminally truncated GAD65 and in an ELISA. Progression to diabetes occurred in >50% of children within 10 years in all groups that developed multiple islet autoantibodies and in 44% of children with persistent single high-affinity IAA or persistent single GADA that were positive in both a radiobinding assay and ELISA. The earliest autoantibody development was seen in children with single IAA that progressed to multiple islet autoantibodies or in those with persistent high-affinity single IAA, with a sharp peak in incidence observed at age 9 months. The peak incidence occurred at age 2 years for children who underwent seroconversion directly to multiple islet autoantibodies and at 5 years for children who first seroconverted to GADA and subsequently developed other autoantibodies. Seroconversion to low-affinity IAA or persistent single GADA occurred at a low incidence after the age of 9 months. CONCLUSIONS/INTERPRETATION Children of different ages have differing susceptibilities to autoimmunisation against specific beta cell autoantigens.
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Affiliation(s)
- Eleni Z Giannopoulou
- Institute of Diabetes Research, Helmholtz Zentrum München and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
| | - Christiane Winkler
- Institute of Diabetes Research, Helmholtz Zentrum München and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
- Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Ruth Chmiel
- Institute of Diabetes Research, Helmholtz Zentrum München and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
| | - Claudia Matzke
- Institute of Diabetes Research, Helmholtz Zentrum München and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
| | - Marlon Scholz
- Institute of Diabetes Research, Helmholtz Zentrum München and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
| | - Andreas Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
| | - Peter Achenbach
- Institute of Diabetes Research, Helmholtz Zentrum München and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
- Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Ezio Bonifacio
- Center for Regenerative Therapies Dresden, Faculty of Medicine, Technische Universität, Dresden, Germany
- Paul Langerhans Institute of the Helmholtz Zentrum München at University Clinic Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Institute of Diabetes and Obesity, Helmholtz Zentrum München, Neuherberg, Germany
| | - Anette-G Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany.
- Forschergruppe Diabetes e.V., Neuherberg, Germany.
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Beyerlein A, Liu X, Uusitalo UM, Harsunen M, Norris JM, Foterek K, Virtanen SM, Rewers MJ, She JX, Simell O, Lernmark Å, Hagopian W, Akolkar B, Ziegler AG, Krischer JP, Hummel S. Dietary intake of soluble fiber and risk of islet autoimmunity by 5 y of age: results from the TEDDY study. Am J Clin Nutr 2015; 102:345-52. [PMID: 26156735 PMCID: PMC4515865 DOI: 10.3945/ajcn.115.108159] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 05/20/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Deficient soluble fiber intake has been suggested to dysregulate the immune response either directly or through alterations of the microbial composition in the gut. OBJECTIVE We hypothesized that a high intake of dietary soluble fiber in early childhood decreases the risk of type 1 diabetes (T1D)-associated islet autoimmunity. DESIGN We analyzed 17,620 food records collected between age 9 and 48 mo from 3358 children from the United States and Germany prospectively followed in the TEDDY (The Environmental Determinants of Diabetes in the Young) study. HRs for the development of any/multiple islet autoantibodies (242 and 151 events, respectively) and T1D (71 events) by soluble fiber intake were calculated in Cox regression models and adjusted for potential confounders. RESULTS There were no statistically significantly protective associations observed between a high intake of soluble fiber and islet autoimmunity or T1D. For example, the adjusted HRs (95% CIs) for high intake (highest compared with lowest quintile) at age 12 mo were 0.90 (0.55, 1.45) for any islet autoantibody, 1.20 (0.69, 2.11) for multiple islet autoantibodies, and 1.24 (0.57, 2.70) for T1D. In analyzing soluble fiber intake as a time-varying covariate, there were also no short-term associations between soluble fiber intake and islet autoimmunity development, with adjusted HRs of 0.85 (0.51, 1.42) for high intake and development of any islet autoantibody, for example. CONCLUSION These results indicate that the intake level of dietary soluble fiber is not associated with islet autoimmunity or T1D in early life.
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Affiliation(s)
- Andreas Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany;
| | - Xiang Liu
- Department of Pediatrics, Pediatrics Epidemiology Center, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Ulla M Uusitalo
- Department of Pediatrics, Pediatrics Epidemiology Center, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Minna Harsunen
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany
| | - Jill M Norris
- Colorado School of Public Health, University of Colorado, Aurora, CO
| | - Kristina Foterek
- Research Institute of Child Nutrition (Forschungsinstitut für Kinderernährung), Dortmund, Germany
| | - Suvi M Virtanen
- Unit of Nutrition, National Institute for Health and Welfare, Helsinki, Finland; School of Health Sciences, University of Tampere, Tampere, Finland; Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland; The Science Center of Pirkanmaa Hospital District, Tampere, Finland
| | - Marian J Rewers
- Colorado School of Public Health, University of Colorado, Aurora, CO
| | - Jin-Xiong She
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Georgia Regents University, Augusta, GA
| | - Olli Simell
- Department of Pediatrics, University of Turku, Turku, Finland
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University/Clinical Research Centre, Skåne University Hospital SUS, Malmö, Sweden
| | | | - Beena Akolkar
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Anette-G Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany
| | - Jeffrey P Krischer
- Department of Pediatrics, Pediatrics Epidemiology Center, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Sandra Hummel
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany
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Chmiel R, Beyerlein A, Knopff A, Hummel S, Ziegler AG, Winkler C. Early infant feeding and risk of developing islet autoimmunity and type 1 diabetes. Acta Diabetol 2015; 52:621-4. [PMID: 25038720 DOI: 10.1007/s00592-014-0628-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 07/01/2014] [Indexed: 10/25/2022]
Abstract
We investigated whether food supplementation within the first year life or age at introduction of gluten-containing foods influenced the risk of developing islet autoimmunity and type 1 diabetes. A total of 2,291 children with a family history of type 1 diabetes were prospectively followed from birth for 28,983 patient years (median 13.1 years). Dietary exposure data were collected by questionnaires, food records and by family interview. Exposure to gluten-containing foods before age 3 months, which occurred in 19 children, increased the risk of developing islet autoantibodies (n = 4), multiple islet autoantibodies (n = 4), and type 1 diabetes (n = 3) compared to exclusive breastfeeding within the first 3 months [adjusted hazard ratio (HR) 3.97 (95 % confidence interval 1.41-11.17), 5.39 (1.89-15.35), and 3.45 (1.04-11.48), respectively] and also compared to first exposure to gluten between 3.1 and 6.0 months of age [adjusted HR 3.40 (1.19-9.70), 4.25 (1.47-12.26), and 3.43 (1.01-11.66), respectively]. Children who received infant formula or other solid food within the first 3 months and children who received gluten-containing foods after age 6 months did not have an increased risk of islet autoantibodies, multiple islet autoantibodies or type 1 diabetes. Our present data affirm that compliance to infant feeding guidelines is a possible way to reduce type 1 diabetes risk in genetically susceptible children.
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Affiliation(s)
- Ruth Chmiel
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany
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Bechtold S, Beyerlein A, Bonfig W, Dalla Pozza R, Putzker S, Otto R, Schmidt H, Schwarz HP. Sexual difference in bone geometry of adult patients with classical congenital adrenal hyperplasia: data using peripheral quantitative computed tomography. Horm Res Paediatr 2015; 82:171-8. [PMID: 25171196 DOI: 10.1159/000362759] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 04/07/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Glucocorticoid treatment may influence bone and muscle development in patients with congenital adrenal hyperplasia (CAH). This study evaluated bone mineral density (BMD), bone geometry and muscle mass. METHODS 73 adult patients with classical CAH were followed. BMD, bone geometry and muscle mass were measured using peripheral quantitative computed tomography (pQCT). Glucocorticoid-equivalent doses throughout life were calculated and at the time pQCT androgen levels were measured. RESULTS In males the mean standard deviation (SD) score for trabecular BMD (-0.33 ± 0.71) was reduced, whereas mean cortical BMD (1.05 ± 1.11) was elevated. Mean total (0.86 ± 1.12) and medullary cross-sectional area (CSA; 1.12 ± 1.17) were significantly increased (p < 0.001). In all patients SD scores for cortical thickness (-0.65 ± 0.91) and muscle CSA (-0.83 ± 0.91) were reduced. Treatment duration was associated with lower trabecular BMD in males (r = -0.63, p < 0.001). Suppressed androgens and simple virilizing CAH had an adverse effect on the muscle CSA SD score (OR 0.58 and 0.46, respectively, p < 0.05). CONCLUSION There was a sexual difference with enlarged total and medullary CSA in females, whereas in males trabecular BMD was reduced and cortical BMD elevated. Cortical thickness and muscle CSA were reduced in all CAH patients with a possible long-term impact on bone development and stability. Monitoring of bone and muscle development might be warranted.
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Affiliation(s)
- Susanne Bechtold
- Division of Endocrinology and Diabetology, University Children's Hospital, Ludwig Maximilians University, Munich, Germany
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Jung NH, Pereira B, Nehring I, Brix O, Bernius P, Schroeder SA, Kluger GJ, Koehler T, Beyerlein A, Weir S, von Kries R, Narayanan UG, Berweck S, Mall V. Does hip displacement influence health-related quality of life in children with cerebral palsy? Dev Neurorehabil 2014; 17:420-5. [PMID: 25057804 DOI: 10.3109/17518423.2014.941116] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the association of hip lateralisation with health-related quality of life (HRQL) in children with cerebral palsy (CP) using the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD(®)) questionnaire. METHODS We assessed n = 34 patients (mean age: 10.2 years, SD: 4.7 years; female: n = 16) with bilateral CP and Gross Motor Function Classification System (GMFCS) Level III-V using the CPCHILD(®) questionnaire. Hip lateralisation was measured by Reimer`s migration percentage (MP). RESULTS There was an association between both, MP and GMFCS with CPCHILD(®) total score. Stratified analyses did not suggest interaction of the association between MP and CPCHILD(®) total score by GMFCS level. After adjustment for GMFCS level, we found a significant linear decrease of CPCHILD(®) total score of -0.188 points by 1% increment in MP. CONCLUSIONS There was an association between MP and HRQL, which could not be explained by the GMFCS level.
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Affiliation(s)
- Nikolai H Jung
- Department of Pediatrics, Technische Universität München , Munich , Germany
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Stumpp C, Beyerlein A, Ziegler AG, Bonifacio E. Neonatal and infant beta cell hormone concentrations in relation to type 1 diabetes risk. Pediatr Diabetes 2014; 15:528-33. [PMID: 24552441 DOI: 10.1111/pedi.12122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 12/19/2013] [Accepted: 01/06/2014] [Indexed: 11/30/2022] Open
Abstract
Type 1 diabetes is preceded by the appearance of islet autoantibodies. Seroconversion to islet autoantibodies is greatest around 1 yr of age and is more frequent in children born to fathers with type 1 diabetes as compared to children born to mothers with type 1 diabetes. Here we asked whether changes in beta-cell function in the neonate and infant reflect variations in the incidence of islet autoantibody seroconversion. Insulin, proinsulin, and c-peptide concentrations were measured in sequential samples taken from birth to age 2 yr in 103 children who had a first degree relative with type 1 diabetes and who had been followed for islet autoantibody seroconversion. Serum insulin and proinsulin concentrations were highest at birth declining by age 3 months and stable thereafter until age 2 yr. C-peptide concentrations, proinsulin/insulin, and proinsulin/c-peptide ratios were stable from age 3 months. No differences were observed between children who developed islet autoantibodies and children who remained islet autoantibody negative. Children born to a mother with type 1 diabetes had higher birth concentrations of insulin (p = 0.005) and proinsulin (p = 0.014) as compared with children of non-diabetic mothers. Increased insulin concentrations in children of type 1 diabetes mothers persisted until age 6 months. In conclusion, we could not relate excursions in beta-cell hormones to autoantibody development, but suggest that the higher exposure to insulin and proinsulin in neonates born to mothers with type 1 diabetes may be linked to the relative protection against islet autoantibody seroconversion observed in these children.
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Affiliation(s)
- Christian Stumpp
- DFG Research Center for Regenerative Therapies Dresden, Technische Universität Dresden, Dresden, Germany; Paul Langerhans Institute Dresden, German Center for Diabetes Research (DZD), Dresden, Germany
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