The effect of day care exposure on the risk of developing type I diabetes - A meta-analysis of case-control studies
The effect of day care exposure on the risk of developing type I diabetes - A meta-analysis of case-control studies
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DOI：
10.2337/diacare.24.8.1353
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发表时间：
2001-08-01
期刊：
影响因子：
16.2
通讯作者：
Taback, SP
中科院分区：
文献类型：
--
作者：
Kaila, B;Taback, SP
目的：婴儿期或儿童期暴露于感染可能在1型糖尿病的发病机制中起重要作用，但也有人提出了保护作用。我们测试的假设，增加早期接触传染性病原体，通过日托暴露，将降低1型糖尿病的风险在childhood.RESEARCH设计和方法-我们进行了系统的回顾病例对照研究。进行荟萃分析，结合联合收割机的结果，评估异质性，并探讨变异的研究design.Results -几个一般设计良好的病例对照研究显示，在统计学上显着的保护作用的日托对1型糖尿病。然而，荟萃分析显示太多的异质性，接受整体的综合结果，没有研究使用预先记录的数据。日托似乎有一个保护作用，在亚组的儿童谁将被诊断为1型糖尿病5岁之前（比值比= 0.6，95%CI 0.5-0.8）;然而，这一结果是基于只有两个study.CONCLUSIONS -回忆偏见是一个替代解释这些数据确认使用预先记录的数据是必需的。这些数据可以在高危儿童的队列研究中进行前瞻性测量。我们还建议在预防1型糖尿病的药物随机试验中测量有关日托出勤的信息，因为粘土护理暴露可能会改变预防药物的效果。
OBJECTIVE - Exposure to infections in infancy or childhood may be important in the pathogenesis of type 1 diabetes, but a protective role has also been suggested. We tested the hypothesis that increased early contact with infectious agents, measured by day care exposure, would decrease the risk of type 1 diabetes in childhood.RESEARCH DESIGN AND METHODS - We conducted a systematic review of case-control studies. Meta-analysis was performed to combine results, assess for heterogeneity, and explore variation in study design.RESULTS - Several generally well-designed case-control studies show a statistically significant protective effect of day care on type 1 diabetes. However, meta-analysis revealed too much heterogeneity to accept the overall synthesis results and none of the studies used prerecorded data. Day care does seem to have a protective effect in the subgroup of children who will be diagnosed with type 1 diabetes before the age of 5 years (odds ratio = 0.6, 95% CI 0.5-0.8); however, this result is based on only two studies.CONCLUSIONS - Recall bias is one alternate explanation for these data confirmation using prerecorded data is required. Such data could be prospectively measured in cohort studies of children at risk. We also suggest that information about day care attendance be measured in randomized trials of agents for the prevention of type 1 diabetes, as clay care exposure could potentially modify the effect of the preventive agent.