嬰兒出生後第一年的體重增加情況與第一型糖尿病有關


  【24drs.com】一篇針對丹麥與挪威出生之大約100,000名孩童的研究發現,出生後第一年的體重增加情況與第一型糖尿病風險有關。
  
  奧斯陸挪威公衛研究院的Maria Magnus博士等人發現,出生到1歲時的體重增加情況,與後續的第一型糖尿病診斷有正相關(彙整校正風險比:1.24/增加1標準差)。
  
  從出生到1歲時的體重增加情況,平均值剛好超過13磅(約5.9公斤),並未發現新生兒的身高增加情況與第一型糖尿病診斷之關聯。
  
  Magnus博士等人在線上發表於12月7日JAMA小兒科期刊的報告中表示,這是第一篇提出新生兒第一年時的體重增加情況,與第一型糖尿病有正相關的前瞻性人口基礎研究,這項結果支持了第一型糖尿病的早期環境起源。
  
  同樣來自挪威公衛研究院的資深作者Lars Stene博士表示,應在對於影響第一型糖尿病之風險的環境和行為因素瞭解有限的情況下,看這些結果。
  
  我們知道,遺傳因素決定了對疾病的易感性,但這些是不充分的,很可能是一些非基因因素以複雜的方式影響了[第一型糖尿病]的風險,我們的研究結果提供了一個與嬰兒發育相關的重要線索,這是相當重要的。
  
  不過,作者們並未建議改變實務,Stene博士表示,為時尚早。
  
  尤其是,我們並未建議媽媽們或醫師們試圖減少嬰兒的體重,以減少這些孩童的第一型糖尿病風險,因為這頂多是影響風險的諸多因素之一,任何這類行動也可能有潛在的副作用。
  
  作者們解釋,第一型糖尿病是孩童時期發生的最常見慢性病,北歐國家的病患數最多。
  
  儘管遺傳易感性的影響眾所周知,從過去十年的發生率變化看來,環境因素在第一型糖尿病的發展扮演了某種角色。
  
  他們觀察發現,雖然還未明確建立第一型糖尿病的單一環境因素,但他們認為,環境因素在生命初期產生了某種影響。
  
  以前的研究指出,嬰幼童時期的發育與第一型糖尿病有關,但是,大部份都是回溯型研究或者僅限於某些遺傳高風險的族群。
  
  為了進一步探討,他們研究了1998-2009年出生的99,832名孩童— 59,221人來自「挪威母親與孩童世代研究[MoBa]」,40,611人來自「丹麥國家出生世代研究[DNBC]」,MoBa世代在追蹤結束時的平均年齡為8.6歲,DNBC世代為13歲。
  
  DNBC世代中,從12個月大到追蹤期結束時的第一型糖尿病發生率為25例/100,000人-年,MoBa世代為31例/100,000人-年。
  
  研究者表示,他們假設,孩童時期過重是第一型糖尿病的一個風險因素,且可解釋發生率的暫時性變化。
  
  我們的研究結果可以視為支持這個假設,體重增加情況至少解釋了第一型糖尿病發生率的某些長期暫時性變化。
  
  不過,Stene博士指出,因為是觀察型研究而非介入型研究,研究結果可能受到一些與嬰兒體重增加和第一型糖尿病風險有關的其他干擾因素影響。我們有納入一些因素,如出生時體重與母乳哺餵期間,但是這些因素無法解釋我們的結果。
  
  他指出,我們不認為是嬰兒體重數值直接影響了這些案例的風險,而是一些還需要研究的其他因素。長久以來的理論認為,與胰島素阻抗性有關,但是這難以在嬰兒進行測量,特別是像我們這種大範圍研究。
  
  他們指出,可用來解釋其研究結果的一般機轉是,生長快速增加了β細胞分泌胰島素的需求,在體外試驗中,β細胞積極分泌胰島素更容易造成細胞激素損傷。
  
  他們也推測,或許是某些相關的腸道菌群或發炎情況可用來解釋研究結果。
  
  資料來源: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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