Environmental Factors Associated With Childhood-Onset Type 1 Diabetes Mellitus An Exploration of the Hygiene and Overload Hypotheses
Environmental Factors Associated With Childhood-Onset Type 1 Diabetes Mellitus An Exploration of the Hygiene and Overload Hypotheses
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DOI：
10.1001/archpediatrics.2010.115
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发表时间：
2010-08-01
影响因子：
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通讯作者：
Mueller, Beth A.
中科院分区：
文献类型：
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作者：
D'Angeli, Marisa A.;Merzon, Eugene;Mueller, Beth A.
目的：评估母婴特征与1型糖尿病风险的关系，特别是出生记录中可能与卫生或超负荷假设有关的特征。设计：以人群为基础的病例对照研究。地点：华盛顿州，1987-2005年。参与者：所有19岁以下因1型糖尿病住院的儿童(国际疾病分类，第九版，代码250.xl和250.x3)，从出院数据中确定(n=1852)，并与他们的出生证明相关联。对照组(n=7408)是从出生记录中随机选择的，出生频率与出生年份相匹配。主要暴露因素包括年龄、种族、教育程度、婚姻状况、是否使用医疗补助保险、体重指数、孕前体重、既往出生情况、产前护理的时机和充分性以及剖腹产。婴儿因素包括出生体重、胎龄大小和胎龄。主要结果：主要结果是1型糖尿病首次住院；调整后的优势比被估计为选定的母婴特征与1型糖尿病的关联。结果：与卫生假说一致，1型糖尿病与有较大的兄弟姐妹负相关(对于3个兄弟姐妹，优势比[OR]，0.56；95%可信区间[CI]，0.45-0.70)，与较低的经济状况或获得护理的指标，如未婚母亲(OR，0.79；95%CI，0.69-0.91)、产前护理不足(OR，0.53；95%CI，0.40-0.71)或医疗补助保险(OR，0.67；95%CI，0.58-0.77)。与超负荷假说相关，母亲体重指数大于或等于30(OR，1.29；95%CI，1.01~1.64)与糖尿病风险增加相关。结论：环境因素与早期抗原性刺激减少和母亲肥胖有关，可能与1型糖尿病有关。
Objective: To assess the relationship between selected maternal and infant characteristics and risk of type 1 diabetes mellitus, specifically characteristics identified from birth records that may pertain to the hygiene or overload hypotheses.Design: Population-based case-control study.Setting: Washington State from 1987 to 2005.Participants: All children younger than 19 years hospitalized for type 1 diabetes (International Classification of Diseases, Ninth Revision codes 250.xl and 250.x3) identified (n=1852) from hospital discharge data and linked with their birth certificates. Controls (n=7408) were randomly selected from birth records, frequency matched on year of birth.Main Exposures: Maternal factors included age, race, educational attainment, marital status, use of Medicaid insurance, body mass index, prepregnancy weight, prior births, timing and adequacy of prenatal care, and cesarean delivery. Infant factors included birth weight, size for gestational age, and gestational age.Main Outcome Measure: The main outcome was first hospitalization for type 1 diabetes mellitus; adjusted odds ratios were estimated for the association of selected maternal and infant characteristics with type 1 diabetes.Results: Consistent with the hygiene hypothesis, type 1 diabetes was negatively associated with having older siblings (for >= 3 siblings, odds ratio [OR], 0.56; 95% confidence interval [CI], 0.45-0.70) and with indicators of lower economic status or care access, such as an unmarried mother (OR, 0.79; 95% CI, 0.69-0.91), inadequate prenatal care (OR, 0.53; 95% CI, 0.40-0.71), or Medicaid insurance (OR, 0.67; 95% CI, 0.58-0.77). Related to the overload hypothesis, maternal body mass index of 30 or higher (OR, 1.29; 95% CI, 1.01-1.64) was associated with increased risk of diabetes.Conclusion: Environmental factors related to decreased antigenic stimulation in early life and maternal obesity may be associated with type 1 diabetes.