Department of Clinical Sciences, Lund University, Malmo, Sweden.
Health Informatics Institute, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
Pediatr Diabetes. 2023;2023. doi: 10.1155/2023/3945064. Epub 2023 Feb 17.
BACKGROUND/OBJECTIVE: Growth and obesity have been associated with increased risk of islet autoimmunity (IA) and progression to type 1 diabetes. We aimed to estimate the effect of energy-yielding macronutrient intake on the development of IA through BMI.
Genetically at-risk children ( = 5,084) in Finland, Germany, Sweden, and the USA, who were autoantibody negative at 2 years of age, were followed to the age of 8 years, with anthropometric measurements and 3-day food records collected biannually. Of these, 495 (9.7%) children developed IA. Mediation analysis for time-varying covariates (BMI -score) and exposure (energy intake) was conducted. Cox proportional hazard method was used in sensitivity analysis.
We found an indirect effect of total energy intake (estimates: indirect effect 0.13 [0.05, 0.21]) and energy from protein (estimates: indirect effect 0.06 [0.02, 0.11]), fat (estimates: indirect effect 0.03 [0.01, 0.05]), and carbohydrates (estimates: indirect effect 0.02 [0.00, 0.04]) (kcal/day) on the development of IA. A direct effect was found for protein, expressed both as kcal/day (estimates: direct effect 1.09 [0.35, 1.56]) and energy percentage (estimates: direct effect 72.8 [3.0, 98.0]) and the development of GAD autoantibodies (GADA). In the sensitivity analysis, energy from protein (kcal/day) was associated with increased risk for GADA, hazard ratio 1.24 (95% CI: 1.09, 1.53), 0.042.
This study confirms that higher total energy intake is associated with higher BMI, which leads to higher risk of the development of IA. A diet with larger proportion of energy from protein has a direct effect on the development of GADA.
背景/目的：生长和肥胖与胰岛自身免疫（IA）风险增加和 1 型糖尿病进展相关。我们旨在通过 BMI 来估计能量产生的宏量营养素摄入对 IA 发展的影响。
芬兰、德国、瑞典和美国的遗传易感儿童（n=5084）在 2 岁时为自身抗体阴性，随访至 8 岁，每两年进行一次人体测量和 3 天的食物记录。其中，495 名（9.7%）儿童发生了 IA。对随时间变化的协变量（BMI 评分）和暴露（能量摄入）进行了中介分析。敏感性分析中使用了 Cox 比例风险方法。
我们发现总能量摄入（估计值：间接效应 0.13[0.05，0.21]）和蛋白质（估计值：间接效应 0.06[0.02，0.11]）、脂肪（估计值：间接效应 0.03[0.01，0.05]）和碳水化合物（估计值：间接效应 0.02[0.00，0.04]）（kcal/天）对 IA 发展有间接影响。我们发现蛋白质具有直接影响，既表现为 kcal/天（估计值：直接效应 1.09[0.35，1.56]）和能量百分比（估计值：直接效应 72.8[3.0，98.0]），并与 GAD 自身抗体（GADA）的发展相关。在敏感性分析中，蛋白质的能量（kcal/天）与 GADA 风险增加相关，风险比为 1.24（95%CI：1.09，1.53），P=0.042。
本研究证实，较高的总能量摄入与较高的 BMI 相关，而 BMI 又与 IA 发展的风险增加相关。高蛋白质能量摄入的饮食对 GADA 的发展有直接影响。
