Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
EBioMedicine. 2021 Oct;72:103633. doi: 10.1016/j.ebiom.2021.103633. Epub 2021 Oct 14.
Numerous dietary components have been linked to the development of islet autoimmunity (IA) and type 1 diabetes (T1D); however, no associations are firmly established. This systematic review and meta-analysis aimed to synthesize current knowledge on diet and incidence of IA and T1D.
Literature search was performed in Medline, Embase, and Cochrane Library, from inception until October 2020. Eligible studies had IA or T1D as outcome; any dietary exposure; case-control, cohort, or randomized controlled trial design; and hazard, risk, or odds ratios as measures of association. Summary relative risks (RR) and 95% confidence intervals (CI) were estimated with random-effects models. Certainty of evidence was assessed with GRADE. PROSPERO registration number: CRD42020212505.
Among 5935 identified records, 96 were eligible, and pooled estimates could be produced for 26 dietary factors. Evidence with moderate/high certainty indicated lower risk of T1D in relation to longer (≥6-12 vs <6-12 months, RR: 0⋅39, CI: 0⋅26-0⋅58, I=43%) and exclusive (≥2-3 vs <2-3 months, RR: 0⋅68, CI: 0⋅58-0⋅80, I=0%) breastfeeding, later introduction to gluten (3-6 vs <3-5 months, RR: 0⋅36, CI: 0⋅17-0⋅75, I=0%), cow's milk (≥2-3 vs <2-3 months, RR: 0⋅69, CI: 0⋅59-0⋅81, I=0%), and fruit (4-6 vs <4-5 months, RR: 0⋅47, CI: 0⋅25-0⋅86, I=0%). Higher childhood intake of cow's milk was associated with increased risk of both IA (per 2-3 portions/day, RR: 1⋅25, CI: 1⋅06-1⋅47, I=0%) and T1D (≥2-3 vs <2-3 glasses/day, RR: 1⋅81, CI: 1⋅12-2⋅91, I=31%). For the remaining dietary factors investigated, there was no association, or the evidence was of low certainty.
This study suggests that breastfeeding and late introduction of gluten, fruit, and cow's milk may reduce the risk of T1D, whereas high childhood cow's milk intake may increase it.
Swedish Research Council, Swedish Research Council for Health, Working Life and Welfare (FORTE), Novo Nordisk Foundation, and Swedish Diabetes Foundation.
许多饮食因素与胰岛自身免疫（IA）和 1 型糖尿病（T1D）的发展有关；然而，没有确定的关联。本系统评价和荟萃分析旨在综合目前关于饮食与 IA 和 T1D 发病率的知识。
在 Medline、Embase 和 Cochrane 图书馆中进行文献检索，从创建到 2020 年 10 月。合格的研究具有 IA 或 T1D 作为结局；任何饮食暴露；病例对照、队列或随机对照试验设计；以及危险、风险或优势比作为关联的度量。使用随机效应模型估计汇总相对风险（RR）和 95%置信区间（CI）。使用 GRADE 评估证据的确定性。PROSPERO 注册号：CRD42020212505。
在 5935 条确定的记录中，有 96 条符合条件，可对 26 种饮食因素进行汇总估计。具有中度/高度确定性的证据表明，与较短（≥6-12 个月与<6-12 个月，RR：0.39，CI：0.26-0.58，I=43%）和纯母乳喂养（≥2-3 个月与<2-3 个月，RR：0.68，CI：0.58-0.80，I=0%）、晚引入谷蛋白（3-6 个月与<3-5 个月，RR：0.36，CI：0.17-0.75，I=0%）、牛奶（≥2-3 个月与<2-3 个月，RR：0.69，CI：0.59-0.81，I=0%）和水果（4-6 个月与<4-5 个月，RR：0.47，CI：0.25-0.86，I=0%）有关。儿童期摄入更多的牛奶与 IA（每 2-3 份/天，RR：1.25，CI：1.06-1.47，I=0%）和 T1D（≥2-3 份/天与<2-3 杯/天，RR：1.81，CI：1.12-2.91，I=31%）的风险增加有关。对于其余调查的饮食因素，没有关联，或者证据的确定性较低。
本研究表明，母乳喂养和晚引入谷蛋白、水果和牛奶可能降低 T1D 的风险，而儿童期摄入大量牛奶可能增加其风险。
瑞典研究理事会、瑞典研究理事会促进健康、工作生活和福利（FORTE）、诺和诺德基金会和瑞典糖尿病基金会。
