Non‐genetic risk determinants for type 1 (insulin‐dependent) diabetes mellitus in childhood

Abstract

Using the prospective Hungarian childhood diabetes register, a nationwide case-control study was carried out to investigate the possible role of various non-genetic factors as risk determinants for type 1 diabetes in childhood. A questionnaire (covering family characteristics, social status, fetal and perinatal events, breast-feeding habits, infectious diseases and stressful life events) was sent by mail to all incident diabetic children in 1990 (n = 163) and to two referent children (for each diabetic child), matched for age, sex and county. Diabetic children had a tendency to have mothers > 35 years of age (odds ratio (OR) = 3.52; 95% confidence intervals (CI) 0.74-16.79), a lower proportion of their mothers had higher education (OR = 1.69; 95% CI 0.95-3.0) and these children tended to move home more frequently (OR = 1.99; 95% CI 0.97-4.1). Although the duration of exclusive breast feeding was similar in both groups, the proportion of diabetic children who received no breast milk tended to be higher (OR = 1.76; 95% CI 0.91-3.4). A higher proportion of diabetic children reported non-specific infections (OR = 2.94; 95% CI 1.19-7.21) and the number of stressful life events was higher in diabetic children aged 10-14 years (OR = 3.9; 95% CI 1.14-13.27). As the risk determinants for childhood insulin-dependent diabetes mellitus identified in our low-risk population appear to be similar to those detected in the genetically different, high-risk Swedish population, our study strongly supports an etiological role for these non-genetic risk factors in IDDM.

Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: a meta-analysis of observational studies

“…The more general MEDLINE search identified a further eight articles [33][34][35][36][37][38][39][40], and review of reference lists revealed another two articles [41,42].…”

“…Three articles [25,26,28] reported the same data. A study [33] was excluded because no raw data were presented in the paper or available from the authors. Another study was excluded as it contained fewer than 15 cases [29].…”

Birthweight and the risk of childhood-onset type 1 diabetes: a meta-analysis of observational studies using individual patient data

“…A study from Denmark (with 839 cases) reported no significant difference in birthweight between cases and controls. Finally, two other studies, one from Hungary [29] and one from USA [40], reported little evidence of a difference, but contained relatively few cases (163 and 103, respectively). …”

“…For instance, per 500 g increase in birthweight, there was a 4% (OR Other studies In five of the studies identified by our searches [29,30,33,35,40] the required data could not be obtained from authors (or extracted from the published reports). In a Swedish study [30] (with 4,584 cases of type 1 diabetes) we were able to estimate results from a figure, but only using a different reference category (of 3.0 to 4.0 kg).…”

Socioeconomic conditions and type 1 diabetes in childhood in North Rhine–Westphalia, Germany

“…In Germany, as in other European countries, the growing social inequality among children is a serious problem [6]. Epidemiological studies on the association between social status and type 1 diabetes in children have reported conflicting results, finding positive [7][8][9][10][11][12][13][14][15][16][17], inverse [18][19][20][21][22][23][24][25] or no associations [26][27][28]. Likewise, the results of studies on the relation with population density and with urban versus rural areas are contradictory [10,13,14,17,19,29,30].…”