Wei Yuxia, Edstorp Jessica, Feychting Maria, Andersson Tomas, Carlsson Sofia
Institute of Environmental Medicine, Karolinska Institutet, Box 210, Stockholm S-171 77, Sweden.
Center for Occupational and Environmental Medicine, Region Stockholm, Solnavägen 4, Stockholm S-113 65, Sweden.
Lancet Reg Health Eur. 2023 Nov 4;36:100775. doi: 10.1016/j.lanepe.2023.100775. eCollection 2024 Jan.
Prenatal exposure to smoking is linked to a reduced risk of type 1 diabetes in children. We wanted to find out if the risk of adult-onset type 1 diabetes is reduced in individuals who are exposed to smoking prenatally or during adulthood.
We linked Swedish, nationwide registers and prospectively analyzed incidence of type 1 diabetes in relation to maternal smoking during pregnancy and adult smoking. Everyone was followed until age 30 or year 2019. We employed cohort and sibling design and used adjusted Cox regression and conditional logistic regression.
For analyses of maternal smoking there were 3,170,386 individuals (18,745 cases of type 1 diabetes) and for adult smoking 1,608,291 individuals (1274 cases). Prenatal exposure to smoking was associated with lower incidence of type 1 diabetes during childhood and young adulthood (age 20-24, Hazard ratio (HR) 0.76, 95% Confidence interval 0.67-0.87), but not at higher ages. The HR associated with adult smoking was estimated at 1.14 (CI 1.00-1.31) overall and 1.34 (CI 1.03-1.75) in those with family history of diabetes. In sibling analyses, the odds ratio (OR) of type 1 diabetes in relation to prenatal exposure was 0.71 (CI 0.62-0.81) in children and 1.06 (CI 0.75-1.51) in adults (age 19-30), while adult smoking conferred an OR of 1.59 (CI 1.08-2.35).
These findings indicate that a reduced risk conferred by tobacco exposure is limited to the prenatal period and type 1 diabetes developing during childhood. Adult smoking may be a risk factor for adult-onset type 1 diabetes, especially in people with family history of diabetes.
Swedish Research Councils, Swedish Diabetes and Novo Nordisk Foundations, China Scholarship Council.
产前暴露于吸烟环境与儿童患1型糖尿病的风险降低有关。我们想弄清楚，在产前或成年期暴露于吸烟环境的个体中，成年后患1型糖尿病的风险是否会降低。
我们将瑞典全国性登记数据进行关联，并前瞻性分析1型糖尿病的发病率与孕期母亲吸烟及成年后吸烟的关系。所有人均随访至30岁或2019年。我们采用队列研究和同胞设计，并使用调整后的Cox回归和条件逻辑回归。
分析孕期母亲吸烟情况时纳入了3170386人（18745例1型糖尿病病例），分析成年后吸烟情况时纳入了1608291人（1274例病例）。产前暴露于吸烟环境与儿童期和青年期（20 - 24岁）1型糖尿病发病率较低相关（风险比（HR）0.76，95%置信区间0.67 - 0.87），但在较高年龄阶段并非如此。成年后吸烟的总体风险比估计为1.14（置信区间1.00 - 1.31），在有糖尿病家族史的人群中为1.34（置信区间1.03 - 1.75）。在同胞分析中，儿童期1型糖尿病与产前暴露相关的比值比（OR）为0.71（置信区间0.62 - 0.81），成年期（19 - 30岁）为1.06（置信区间0.75 - 1.51），而成年后吸烟的比值比为1.59（置信区间1.08 - 2.35）。
这些研究结果表明，烟草暴露带来的风险降低仅限于产前时期以及儿童期发生的1型糖尿病。成年后吸烟可能是成年后患1型糖尿病的一个风险因素，尤其是在有糖尿病家族史的人群中。
瑞典研究理事会、瑞典糖尿病与诺和诺德基金会、中国国家留学基金管理委员会。
