Kibirige M, Metcalf B, Renuka R, Wilkin T J
Department of Child Health, James Cook University Hospital, Middlesbrough, UK.
Diabetes Care. 2003 Oct;26(10):2865-70. doi: 10.2337/diacare.26.10.2865.
Previous reports have predicted greater risk of type 1 diabetes among people who were heavier as young children. The Accelerator Hypothesis predicts earlier onset in heavier people, without necessarily a change in risk, and views type 1 and type 2 diabetes as the same disorder of insulin resistance, set against different genetic backgrounds. Insulin resistance is a function of fat mass, and increasing body weight in the industrialized world has been accompanied by earlier presentation (i.e., acceleration) of type 2 diabetes. We wanted to establish whether increasing body weight was also associated with the earlier presentation of type 1 diabetes, as the Accelerator Hypothesis would predict.
The relationships between fatness and age at diagnosis were examined in context of birth weight, weight change since birth, weight at diagnosis, BMI at diagnosis, and BMI 12 months later in 94 children aged 1-16 years (49 boys and 45 girls) presenting for management of acute-onset type 1 diabetes.
BMI standard deviation score (SDS) at diagnosis, weight SDS change since birth, and BMI SDS 12 months later were all inversely related to age at presentation (r = -0.39 to -0.40, P < 0.001). The boys were significantly fatter than the girls (BMI SDS 0.56 vs. -0.08, respectively; P = 0.006) and presented with diabetes at a significantly younger age (6.74 vs. 8.32 years, respectively; P < 0.05). The sex difference in age at diagnosis, however, disappeared when corrected for BMI (P = 0.31), suggesting that fatness or something related to it was the responsible factor.
The data are consistent with the hypothesis that the age at presentation of type 1 diabetes is associated with fatness. The implications for prevention of type 1 diabetes may be important.
既往报告预测，幼儿期体重较重者患1型糖尿病的风险更高。加速假说预测，体重较重者发病更早，但风险不一定改变，且将1型和2型糖尿病视为胰岛素抵抗的同一种疾病，只是遗传背景不同。胰岛素抵抗是脂肪量的函数，在工业化国家，体重增加伴随着2型糖尿病的更早出现（即加速）。我们想确定体重增加是否也与1型糖尿病的更早出现有关，正如加速假说所预测的那样。
在94名1 - 16岁（49名男孩和45名女孩）因急性起病的1型糖尿病前来就诊的儿童中，研究了肥胖与诊断年龄之间的关系，研究内容包括出生体重、出生后体重变化、诊断时体重、诊断时体重指数（BMI）以及诊断后12个月的BMI。
诊断时的BMI标准差评分（SDS）、出生后体重SDS变化以及诊断后12个月的BMI SDS均与发病年龄呈负相关（r = -0.39至 -0.40，P < 0.001）。男孩比女孩明显更胖（BMI SDS分别为0.56和 -0.08；P = 0.006），且患糖尿病的年龄明显更小（分别为6.74岁和8.32岁；P < 0.05）。然而，校正BMI后，诊断年龄的性别差异消失（P = 0.31），这表明肥胖或与之相关的因素是责任因素。
数据与1型糖尿病发病年龄与肥胖有关的假说一致。这对1型糖尿病的预防可能具有重要意义。
