Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL
Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL.
Diabetes Care. 2020 Mar;43(3):556-562. doi: 10.2337/dc19-1670. Epub 2020 Jan 2.
This study investigates two-phase growth patterns in early life and their association with development of islet autoimmunity (IA) and type 1 diabetes (T1D).
The Environmental Determinants of Diabetes in the Young (TEDDY) study followed 7,522 genetically high-risk children in Sweden, Finland, Germany, and the U.S. from birth for a median of 9.0 years (interquartile range 5.7-10.6) with available growth data. Of these, 761 (10.1%) children developed IA and 290 (3.9%) children were diagnosed with T1D. Bayesian two-phase piecewise linear mixed models with a random change point were used to estimate children's individual growth trajectories. Cox proportional hazards models were used to assess the effects of associated growth parameters on the risks of IA and progression to T1D.
A higher rate of weight gain in infancy was associated with increased IA risk (hazard ratio [HR] 1.09 [95% CI 1.02, 1.17] per 1 kg/year). A height growth pattern with a lower rate in infancy (HR 0.79 [95% CI 0.70, 0.90] per 1 cm/year), higher rate in early childhood (HR 1.48 [95% CI 1.22, 1.79] per 1 cm/year), and younger age at the phase transition (HR 0.76 [95% CI 0.58, 0.99] per 1 month) was associated with increased risk of progression from IA to T1D. A higher rate of weight gain in early childhood was associated with increased risk of progression from IA to T1D (HR 2.57 [95% CI 1.34, 4.91] per 1 kg/year) in children with first-appearing GAD autoantibody only.
Growth patterns in early life better clarify how specific growth phases are associated with the development of T1D.
本研究调查了生命早期的两阶段生长模式及其与胰岛自身免疫（IA）和 1 型糖尿病（T1D）发展的关系。
糖尿病的环境决定因素在年轻人（TEDDY）研究中，从出生开始，瑞典、芬兰、德国和美国的 7522 名遗传高风险儿童接受了中位时间为 9.0 年（四分位距 5.7-10.6）的随访，并且有可用的生长数据。其中，761 名（10.1%）儿童发生了 IA，290 名（3.9%）儿童被诊断为 T1D。采用具有随机变化点的贝叶斯两阶段分段线性混合模型来估计儿童的个体生长轨迹。Cox 比例风险模型用于评估相关生长参数对 IA 风险和进展为 T1D 的影响。
婴儿期体重增加速度越快，IA 风险越高（每增加 1kg/年，风险比 [HR] 为 1.09 [95%CI 1.02, 1.17]）。婴儿期生长速度较慢（HR 为 0.79 [95%CI 0.70, 0.90]，每增加 1cm/年）、幼儿期生长速度较快（HR 为 1.48 [95%CI 1.22, 1.79]，每增加 1cm/年）、相转变年龄较小（HR 为 0.76 [95%CI 0.58, 0.99]，每增加 1 个月）的身高增长模式与从 IA 进展为 T1D 的风险增加相关。仅在首次出现谷氨酸脱羧酶自身抗体的儿童中，幼儿期体重增加速度较快（HR 为 2.57 [95%CI 1.34, 4.91]，每增加 1kg/年）与从 IA 进展为 T1D 的风险增加相关。
生命早期的生长模式更清楚地说明了特定生长阶段如何与 T1D 的发展相关。
