婴儿出生后第一年的体重增加情况与第一型糖尿病有关


  【24drs.com】一篇针对丹麦与挪威出生之大约100,000名孩童的研究发现,出生后第一年的体重增加情况与第一型糖尿病风险有关。
  
  奥斯陆挪威公卫研究院的Maria Magnus博士等人发现,出生到1岁时的体重增加情况,与后续的第一型糖尿病诊断有正相关(汇整校正风险比:1.24/增加1标准差)。
  
  从出生到1岁时的体重增加情况,平均值刚好超过13磅(约5.9公斤),并未发现新生儿的身高增加情况与第一型糖尿病诊断之关联。
  
  Magnus博士等人在在线发表于12月7日JAMA小儿科期刊的报告中表示,这是第一篇提出新生儿第一年时的体重增加情况,与第一型糖尿病有正相关的前瞻性人口基础研究,这项结果支持了第一型糖尿病的早期环境起源。
  
  同样来自挪威公卫研究院的资深作者Lars Stene博士表示,应在对于影响第一型糖尿病之风险的环境和行为因素了解有限的情况下,看这些结果。
  
  我们知道,遗传因素决定了对疾病的易感性,但这些是不充分的,很可能是一些非基因因素以复杂的方式影响了[第一型糖尿病]的风险,我们的研究结果提供了一个与婴儿发育相关的重要线索,这是相当重要的。
  
  不过,作者们并未建议改变实务,Stene博士表示,为时尚早。
  
  尤其是,我们并未建议妈妈们或医师们试图减少婴儿的体重,以减少这些孩童的第一型糖尿病风险,因为这顶多是影响风险的诸多因素之一,任何这类行动也可能有潜在的副作用。
  
  作者们解释,第一型糖尿病是孩童时期发生的最常见慢性病,北欧国家的病患数最多。
  
  尽管遗传易感性的影响众所周知,从过去十年的发生率变化看来,环境因素在第一型糖尿病的发展扮演了某种角色。
  
  他们观察发现,虽然还未明确建立第一型糖尿病的单一环境因素,但他们认为,环境因素在生命初期产生了某种影响。
  
  以前的研究指出,婴幼童时期的发育与第一型糖尿病有关,但是,大部份都是回溯型研究或者仅限于某些遗传高风险的族群。
  
  为了进一步探讨,他们研究了1998-2009年出生的99,832名孩童— 59,221人来自「挪威母亲与孩童世代研究[MoBa]」,40,611人来自「丹麦国家出生世代研究[DNBC]」,MoBa世代在追踪结束时的平均年龄为8.6岁,DNBC世代为13岁。
  
  DNBC世代中,从12个月大到追踪期结束时的第一型糖尿病发生率为25例/100,000人-年,MoBa世代为31例/100,000人-年。
  
  研究者表示,他们假设,孩童时期过重是第一型糖尿病的一个风险因素,且可解释发生率的暂时性变化。
  
  我们的研究结果可以视为支持这个假设,体重增加情况至少解释了第一型糖尿病发生率的某些长期暂时性变化。
  
  不过,Stene博士指出,因为是观察型研究而非介入型研究,研究结果可能受到一些与婴儿体重增加和第一型糖尿病风险有关的其它干扰因素影响。我们有纳入一些因素,如出生时体重与母乳哺餵期间,但是这些因素无法解释我们的结果。
  
  他指出,我们不认为是婴儿体重数值直接影响了这些案例的风险,而是一些还需要研究的其它因素。长久以来的理论认为,与胰岛素阻抗性有关,但是这难以在婴儿进行测量,特别是像我们这种大范围研究。
  
  他们指出,可用来解释其研究结果的一般机转是,生长快速增加了β细胞分泌胰岛素的需求,在体外试验中,β细胞积极分泌胰岛素更容易造成细胞激素损伤。
  
  他们也推测,或许是某些相关的肠道菌群或发炎情况可用来解释研究结果。
  
  资料来源:http://www.24drs.com/
  
  Native link:Infant Weight Gain in First Year: Link to Type 1 Diabetes Risk

Infant Weight Gain in First Year: Link to Type 1 Diabetes Risk

By Marcia Frellick
Medscape Medical News

Weight gain in the first year of life has been linked to risk for type 1 diabetes in a study of nearly 100,000 children born in Norway and Denmark.

Maria Magnus, PhD, of the Norwegian Institute of Public Health, in Oslo, and colleagues found a consistent positive association between increase in weight from birth to age 1 year and subsequent diagnosis of type 1 diabetes (pooled adjusted hazard ratio, 1.24 per 1 standard-deviation increase).

The average change in weight from birth to 12 months was just more than 13 pounds. No link was found between infant length increase and likelihood of a type 1 diabetes diagnosis.

"This is the first prospective population-based study providing evidence that weight increase during the first year of life is positively associated with type 1 diabetes. This supports the early environmental origins of type 1 diabetes," say Dr Magnus and colleagues in their paper, published online December 7 in JAMA Pediatrics.

Our finding provides an important clue that something related to infant growth may be important.

Senior author Lars Stene, PhD, also of the Norwegian Institute of Public Health, told Medscape Medical News the results must be viewed in the context of limited understanding of environmental and behavioral factors that may influence the risk of type 1 diabetes.

"We know that genetic factors determine the susceptibility to disease, but these are not sufficient," he said. "It is likely that a number of nongenetic factors interact in a complex way to influence the risk [of type 1 diabetes]. Our finding provides an important clue that something related to infant growth may be important."

However, the authors aren't suggesting practice change, Dr Stene said. "It's too early."

"In particular, we do not advise mothers or clinicians to attempt to reduce infant growth aiming to reduce the risk of type 1 diabetes in their child. At best, this would be only one among a number of factors that influence the risk, and any such action may have potential side effects."

Nordic Countries Have Highest Burden of Type 1 Diabetes

The authors explain that type 1 diabetes mellitus is among the most common chronic diseases with onset in childhood, and the Nordic countries have the highest disease burden.

Despite the well-known role of genetic susceptibility, a changing incidence during the past decades suggests a role for environmental factors in development of type 1 diabetes.

"While no single environmental factor has been established as a risk factor for type 1 diabetes, it is proposed that environmental factors might operate early in life," they observe.

Previous studies indicate that growth during early childhood might be associated with type 1 diabetes, but most studies have been retrospective or restricted to genetically high-risk populations, they note.

To investigate this further, they studied a total of 99,832 children born between 1998 and 2009 — 59,221 in the Norwegian Mother and Child Cohort Study (MoBa) and 40,611 in the Danish National Birth Cohort (DNBC). Mean age at end of follow-up for the MoBa cohort was 8.6 years and for the DNBC was 13 years.

The incidence rate of type 1 diabetes from age 12 months to the end of follow-up was 25 cases per 100,000 person-years in the DNBC and 31 cases per 100,000 person-years in the MoBa.

The researchers say it has been hypothesized that childhood overweight is a risk factor for type 1 diabetes and explains the temporal changes in incidence.

"Our results may be taken as support for the hypothesis that weight gain explains at least some of the long-term temporal changes in incidence of type 1 diabetes."

However, Dr Stene noted that because the study was based on observation rather than intervention, results could potentially be influenced by an unknown confounder related to both infant weight gain and risk of type 1 diabetes.

"We have accounted for many factors such as birth weight and duration of breastfeeding, but these could not explain our findings," he said.

"We do not believe that it is the pounds or kilograms of infant weight that directly influence the risk in our case but rather some other factor that we still have to search for. A long-held theory suggests that insulin resistance is involved. This is difficult to measure in infants, particularly in large-scale studies such as ours," he noted.

"A general mechanism that may plausibly explain our findings is that rapid growth increases the demand on β cells to secrete insulin, and it has been shown that β cells actively secreting insulin are more susceptible to cytokine damage in vitro," he and his colleagues add.

They also "speculate that perhaps gut microbiota or inflammation may be involved in relevant pathways to explain our findings."

The Norwegian Mother and Child Cohort Study is supported by the National Institutes of Health and the Norwegian Research Council/FUGE. The substudy PAGE (Prediction of Autoimmune Diabetes and Celiac Disease in Childhood by Genes and Perinatal Environment), based on MoBa, is supported by the Norwegian Research Council. Dr Magnus is supported by the Norwegian Extra Foundation for Health and Rehabilitation. Disclosures for the coauthors are listed in the article. The cooperation between the two cohorts was supported by EARNEST EU FP6 with the European Commission, the Innovation Fund Denmark from the Center for Fetal Programming, and the Danish Cancer Union.

JAMA Pediatr. Published online December 7, 2015.

    
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