Hakola Leena, Miettinen Maija E, Syrjälä Essi, Åkerlund Mari, Takkinen Hanna-Mari, Korhonen Tuuli E, Ahonen Suvi, Ilonen Jorma, Toppari Jorma, Veijola Riitta, Nevalainen Jaakko, Knip Mikael, Virtanen Suvi M
Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland.
Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland.
JAMA Pediatr. 2019 Oct 1;173(10):953-960. doi: 10.1001/jamapediatrics.2019.2564.
Dietary proteins, such as gluten, have been suggested as triggers of the disease process in type 1 diabetes (T1D).
To study the associations of cereal, gluten, and dietary fiber intake with the development of islet autoimmunity (IA) and T1D.
DESIGN, SETTING, AND PARTICIPANTS: The prospective birth cohort Finnish Type 1 Diabetes Prediction and Prevention Study recruited children with genetic susceptibility to type 1 diabetes from September 1996 to September 2004 from 2 university hospitals in Finland and followed up every 3 to 12 months up to 6 years for diet, islet autoantibodies, and T1D. Altogether 6081 infants (78% of those invited) participated in the study. Dietary data were available for 5714 children (94.0%) and dietary and IA data were available for 5545 children (91.2%), of whom 3762 (68%) had data on islet autoantibodies up to age 6 years. Information on T1D was available for all children. Data were analyzed in 2018 and end point data were updated in 2015.
Each child's intake of cereals, gluten, and dietary fiber was calculated from repeated 3-day food records up to 6 years.
Islet autoimmunity was defined as repeated positivity for islet cell antibodies and at least 1 biochemical autoantibody of 3 analyzed, or T1D. Data on the diagnosis of T1D were obtained from Finnish Pediatric Diabetes Register.
Of 5545 children (2950 boys [53.2%]), 246 (4.4%) developed IA and of 5714 children (3033 boys [53.1%]), 90 (1.6%) developed T1D during the 6-year follow-up. Based on joint models, the intake of oats (hazard ratio [HR], 1.08; 95% CI, 1.03-1.13), wheat (HR, 1.09; 95% CI, 1.03-1.15), rye (HR, 1.13; 95% CI, 1.03-1.23), gluten-containing cereals (HR, 1.07; 95% CI, 1.03-1.11), gluten without avenin from oats (HR, 2.23; 95% CI, 1.40-3.57), gluten with avenin (HR, 2.06; 95% CI, 1.45-2.92), and dietary fiber (HR, 1.41; 95% CI, 1.10-1.81) was associated with the risk of developing IA (HRs for 1 g/MJ increase in intake). The intake of oats (HR, 1.10; 95% CI, 1.00-1.21) and rye (HR, 1.20; 95% CI, 1.03-1.41) was associated with the risk of developing T1D. After multiple testing correction, the associations with IA remained statistically significant.
A high intake of oats, gluten-containing cereals, gluten, and dietary fiber was associated with an increased risk of IA. Further studies are needed to confirm or rule out the findings and study potential mechanisms.
饮食中的蛋白质，如麸质，被认为是1型糖尿病（T1D）疾病进程的触发因素。
研究谷物、麸质和膳食纤维摄入量与胰岛自身免疫（IA）及T1D发生之间的关联。
设计、背景和参与者：前瞻性出生队列芬兰1型糖尿病预测与预防研究于1996年9月至2004年9月从芬兰的2所大学医院招募有1型糖尿病遗传易感性的儿童，并每3至12个月随访一次，长达6年，收集饮食、胰岛自身抗体和T1D相关信息。共有6081名婴儿（受邀者的78%）参与了该研究。5714名儿童（94.0%）有饮食数据，5545名儿童（91.2%）有饮食和IA数据，其中3762名（68%）在6岁时拥有胰岛自身抗体数据。所有儿童均有T1D相关信息。数据于2018年进行分析，终点数据于2015年更新。
根据长达6年的重复3天食物记录计算每个儿童的谷物、麸质和膳食纤维摄入量。
胰岛自身免疫定义为胰岛细胞抗体反复呈阳性，且所分析的3种生化自身抗体中至少有1种呈阳性，或患有T1D。T1D诊断数据来自芬兰儿科糖尿病登记处。
在5545名儿童（2950名男孩[53.2%]）中，246名（4.4%）发生了IA；在5714名儿童（3033名男孩[53.1%]）中，90名（1.6%）在6年随访期间发生了T1D。基于联合模型，燕麦摄入量（风险比[HR]，1.08；95%置信区间[CI]，1.03 - 1.13）、小麦摄入量（HR，1.09；95% CI，1.03 - 1.15）、黑麦摄入量（HR，1.13；95% CI，1.03 - 1.23）、含麸质谷物摄入量（HR，1.07；95% CI，1.03 - 1.11）、不含燕麦醇溶蛋白的麸质摄入量（HR，2.23；95% CI，1.40 - 3.57）、含燕麦醇溶蛋白的麸质摄入量（HR，2.06；95% CI，1.45 - 2.92）和膳食纤维摄入量（HR，1.41；95% CI，1.10 - 1.81）与发生IA的风险相关（摄入量每增加1 g/MJ的HR）。燕麦摄入量（HR，1.10；95% CI，1.00 - 1.21）和黑麦摄入量（HR，1.20；95% CI，1.03 - 1.41）与发生T1D的风险相关。经过多重检验校正后，与IA的关联仍具有统计学意义。
高摄入量的燕麦、含麸质谷物、麸质和膳食纤维与IA风险增加相关。需要进一步研究来证实或排除这些发现，并研究潜在机制。
