Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany.
Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, Munich, Germany.
Diabetologia. 2024 Apr;67(4):670-678. doi: 10.1007/s00125-023-06079-z. Epub 2024 Jan 12.
AIMS/HYPOTHESIS: The aim of this study was to determine whether BMI in early childhood was affected by the COVID-19 pandemic and containment measures, and whether it was associated with the risk for islet autoimmunity.
Between February 2018 and May 2023, data on BMI and islet autoimmunity were collected from 1050 children enrolled in the Primary Oral Insulin Trial, aged from 4.0 months to 5.5 years of age. The start of the COVID-19 pandemic was defined as 18 March 2020, and a stringency index was used to assess the stringency of containment measures. Islet autoimmunity was defined as either the development of persistent confirmed multiple islet autoantibodies, or the development of one or more islet autoantibodies and type 1 diabetes. Multivariate linear mixed-effect, linear and logistic regression methods were applied to assess the effect of the COVID-19 pandemic and the stringency index on early-childhood BMI measurements (BMI as a time-varying variable, BMI at 9 months of age and overweight risk at 9 months of age), and Cox proportional hazard models were used to assess the effect of BMI measurements on islet autoimmunity risk.
The COVID-19 pandemic was associated with increased time-varying BMI (β = 0.39; 95% CI 0.30, 0.47) and overweight risk at 9 months (β = 0.44; 95% CI 0.03, 0.84). During the COVID-19 pandemic, a higher stringency index was positively associated with time-varying BMI (β = 0.02; 95% CI 0.00, 0.04 per 10 units increase), BMI at 9 months (β = 0.13; 95% CI 0.01, 0.25) and overweight risk at 9 months (β = 0.23; 95% CI 0.03, 0.43). A higher age-corrected BMI and overweight risk at 9 months were associated with increased risk for developing islet autoimmunity up to 5.5 years of age (HR 1.16; 95% CI 1.01, 1.32 and HR 1.68, 95% CI 1.00, 2.82, respectively).
CONCLUSIONS/INTERPRETATION: Early-childhood BMI increased during the COVID-19 pandemic, and was influenced by the level of restrictions during the pandemic. Controlling for the COVID-19 pandemic, elevated BMI during early childhood was associated with increased risk for childhood islet autoimmunity in children with genetic susceptibility to type 1 diabetes.
目的/假设：本研究旨在确定儿童早期 BMI 是否受到 COVID-19 大流行和遏制措施的影响，以及它是否与胰岛自身免疫的风险相关。
2018 年 2 月至 2023 年 5 月，从参与初级口服胰岛素试验的 1050 名年龄在 4.0 个月至 5.5 岁的儿童中收集 BMI 和胰岛自身免疫数据。将 COVID-19 大流行的开始定义为 2020 年 3 月 18 日，并使用严格指数评估遏制措施的严格程度。胰岛自身免疫定义为持续确认存在多种胰岛自身抗体，或存在一种或多种胰岛自身抗体和 1 型糖尿病。应用多变量线性混合效应、线性和逻辑回归方法评估 COVID-19 大流行和严格指数对儿童早期 BMI 测量（BMI 作为时变变量、9 个月时的 BMI 和 9 个月时的超重风险）的影响，应用 Cox 比例风险模型评估 BMI 测量对胰岛自身免疫风险的影响。
COVID-19 大流行与时间变化的 BMI（β=0.39；95%CI 0.30，0.47）和 9 个月时的超重风险（β=0.44；95%CI 0.03，0.84）增加有关。在 COVID-19 大流行期间，严格指数越高，时间变化的 BMI（β=0.02；95%CI 0.00，0.04 每增加 10 个单位）、9 个月时的 BMI（β=0.13；95%CI 0.01，0.25）和 9 个月时的超重风险（β=0.23；95%CI 0.03，0.43）越高。校正年龄后的 BMI 较高和 9 个月时的超重风险与 5.5 岁时发生胰岛自身免疫的风险增加相关（HR 1.16；95%CI 1.01，1.32 和 HR 1.68，95%CI 1.00，2.82）。
结论/解释：儿童早期 BMI 在 COVID-19 大流行期间增加，并受到大流行期间限制水平的影响。在控制 COVID-19 大流行的情况下，儿童早期 BMI 升高与具有 1 型糖尿病遗传易感性的儿童的儿童期胰岛自身免疫风险增加有关。
