Verge C F, Howard N J, Irwig L, Simpson J M, Mackerras D, Silink M
Ray Williams Institute for Pediatric Endocrinology, Royal Alexandra Hospital for Children, Sydney, Australia.
Diabetes Care. 1994 Dec;17(12):1381-9. doi: 10.2337/diacare.17.12.1381.
To identify environmental factors involved in the etiology of insulin-dependent diabetes mellitus (IDDM).
An estimated 90% of all incident cases of IDDM in patients 0-14 years of age in New South Wales, Australia, were ascertained over 18 months. For each IDDM patient, two age- and sex-matched control subjects were randomly selected from the population. Past environmental exposures were determined with a questionnaire completed by the parents. Response rates were 92% for the IDDM patients (217 of 235) and 55% for the control subjects (258 of 470). The relative risk associated with each exposure was estimated with the odds ratio (OR) adjusted for confounding factors using multiple logistic regression.
The introduction of cow's milk-based infant formula into the diet before 3 months of age was associated with an increased risk (OR 1.52, 95% confidence interval [CI] 1.04-2.24). Exclusive breast-feeding for > or = 3 months was associated with a protective effect (OR 0.66, 95% CI 0.45-0.97). High dietary intake of cow's milk protein in the 12 months before the onset of diabetic symptoms was also associated with an increased risk (OR 1.84, 95% CI 1.12-3.00). A recent infection (during the 3 months before onset of diabetic symptoms) was more common in the patients than the control subjects (OR 2.92, 95% CI 1.96-4.35), as was day care attendance before the age of 3 (OR 1.73, 95% CI 1.00-3.00). When two age-groups, defined by the median age at onset of diabetes, were compared, the associations with early infant-feeding were stronger among the younger group (< 9.2 years), and associations with recent diet and recent infection were stronger among the older group (> or = 9.2 years).
These results indicate an increased risk of IDDM associated with early dietary exposure to cow's milk-containing formula, short duration of exclusive breast-feeding, high intake of cow's milk protein in the recent diet, recent infection, and early attendance at day care.
确定与胰岛素依赖型糖尿病（IDDM）病因相关的环境因素。
在18个月的时间里，确定了澳大利亚新南威尔士州0至14岁IDDM患者中估计90%的新发病例。对于每例IDDM患者，从人群中随机选取两名年龄和性别匹配的对照对象。通过父母填写的问卷来确定过去的环境暴露情况。IDDM患者的回复率为92%（235例中的217例），对照对象的回复率为55%（470例中的258例）。使用多元逻辑回归对混杂因素进行调整后，用优势比（OR）估计每种暴露相关的相对风险。
在3个月龄前将以牛奶为基础的婴儿配方奶粉引入饮食与风险增加相关（OR 1.52，95%置信区间[CI] 1.04 - 2.24）。纯母乳喂养≥3个月与保护作用相关（OR 0.66，95% CI 0.45 - 0.97）。糖尿病症状出现前12个月内牛奶蛋白的高膳食摄入量也与风险增加相关（OR 1.84，95% CI 1.12 - 3.00）。近期感染（在糖尿病症状出现前3个月内）在患者中比对照对象更常见（OR 2.92，95% CI 1.96 - 4.35），3岁前入托情况也是如此（OR 1.73，95% CI 1.00 - 3.00）。当比较按糖尿病发病年龄中位数定义的两个年龄组时，与早期婴儿喂养的关联在较年轻组（<9.2岁）中更强，与近期饮食和近期感染的关联在较年长组（≥9.2岁）中更强。
这些结果表明，IDDM风险增加与早期饮食中接触含牛奶配方奶粉、纯母乳喂养时间短、近期饮食中牛奶蛋白摄入量高、近期感染以及早期入托有关。
