Timing of initial cereal exposure in infancy and risk of islet autoimmunity
Timing of initial cereal exposure in infancy and risk of islet autoimmunity
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DOI：
10.1001/jama.290.13.1713
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发表时间：
2003-10-01
影响因子：
120.7
通讯作者：
Rewers, M
中科院分区：
文献类型：
--
作者：
Norris, JM;Barriga, K;Rewers, M
背景婴儿期饮食暴露与1型糖尿病（DM）的病因学有关，尽管不一致。目的研究婴儿饮食中谷物暴露与胰岛自身免疫（IA）的关系。设计出生队列研究，1994年至2002年进行，平均随访4年。科洛。1型糖尿病个体的一级亲属从Denver metropolitan area.Participants招募，我们招募了1183名1型糖尿病风险增加的儿童，定义为HLA基因型或1型糖尿病一级亲属，出生时前瞻性随访。我们获得了76%入选儿童的暴露和结局指标。参与者有不同长度的后续行动（9个月至9年）。主要成果措施抽血检测胰岛素自身抗体，谷氨酸脱羧酶自身抗体，或IA-2自身抗体在9，15，24个月和每年进行。A型糖尿病儿童（n=34）的定义为连续2次或2次以上的自身抗体检测结果为至少1种抗体阳性，且最近一次检测结果为阳性或患有糖尿病。（风险比[HR]，4.32; 95%置信区间[CI]，2.0-9.35）和7个月或更长时间暴露的受试者（HR，5.36; 95%CI，2.08-13.8）与在第4 - 6个月期间暴露的患者相比，在调整HLA基因型、1型DM家族史、种族和母亲年龄后，A的风险增加。在HLA-DRB 1 *03/04、DQB 8基因型阳性的儿童中，校正的HR为5.55（95% CI，1.92-16.03）和12.53（95%CI，3.19-49.23）对于0至3个月之间和7个月或以上的初始谷物暴露，结论婴幼儿期可能存在一个接触谷类食品的窗口期，在此窗口期外，易感儿童的初始暴露增加了A的风险。
Context Dietary exposures in infancy have been implicated, albeit inconsistently, in the etiology of type 1 diabetes mellitus (DM).Objective To examine the association between cereal exposures in the infant diet and appearance of islet autoimmunity (IA).Design Birth cohort study conducted from 1994 to 2002 with a mean follow-up of 4 years.Setting Newborn screening for HLA was done at St Joseph's Hospital in Denver, Colo. First-degree relatives of type 1 DM individuals were recruited from the Denver metropolitan area.Participants We enrolled 1183 children at increased type 1 DM risk, defined as either HLA genotype or having a first-degree relative with type 1 DM, at birth and followed them prospectively. We obtained exposure and outcome measures for 76% of enrolled children. Participants had variable lengths of follow-up (9 months to 9 years).Main Outcome Measures Blood draws for the detection of insulin autoantibody, glutamic acid decarboxylase autoantibody, or IA-2 autoantibody were performed at 9, 15, and 24 months and annually thereafter. Children with A (n=34) were defined as those testing positive for at least 1 of the autoantibodies on 2 or more consecutive visits and who tested positive or had diabetes on their most recent visit.Results Children initially exposed to cereals between ages 0 and 3 months (hazard ratio [HR], 4.32; 95% confidence interval [CI], 2.0-9.35) and those who were exposed at 7 months or older (HR, 5.36; 95% Cl, 2.08-13.8) had increased hazard of A compared with those who were exposed during the fourth through sixth month, after adjustment for HLA genotype, family history of type 1 DM, ethnicity, and maternal age. In children who were positive for the HLA-DRB1*03/04,DQB8 genotype, adjusted HRs Were 5.55 (95% Cl, 1.92-16.03) and 12.53 (95% Cl, 3.19-49.23) for initial cereal exposure between ages 0 to 3 months and at 7 months or older, respectively.Conclusion There maybe a window of exposure to cereals in infancy outside which initial exposure increases A risk in susceptible children.