Akerblom H K, Knip M
The Children's Hospital, University of Helsinki, Finland.
Diabetes Metab Rev. 1998 Mar;14(1):31-67. doi: 10.1002/(sici)1099-0895(199803)14:1<31::aid-dmr201>3.0.co;2-a.
Various environmental triggers, e.g. certain viruses and dietary factors, are thought to initiate the autoimmune process, leading to the destruction of pancreatic beta-cells and consequent Type 1 diabetes. A genetic predisposition is another prerequisite allowing the autoimmune process to progress. Twin studies, major geographical variations in incidence rates, temporal trends in the incidence and findings in migrant studies indicate that environmental factors play a crucial role in the development of Type 1 diabetes. In the present review the major focus is on dietary factors, and among them particularly the possible role of cow's milk proteins. The cow's milk and Type 1 diabetes hypothesis was developed more than 10 years ago, and the issue is still not settled. Among viral infections, enteroviruses are today the most interesting group of viruses in this respect, as recent prospective studies indicate that these viruses may trigger and potentiate existing beta-cell autoimmunity. Among toxins, particularly N-nitroso compounds are of potential interest, as they are probably involved in the aetiology of some cases. Finally, psychosocial factors and the interaction between genetic predisposition and environmental factors are briefly discussed.
多种环境触发因素，如某些病毒和饮食因素，被认为会引发自身免疫过程，导致胰腺β细胞被破坏，进而引发1型糖尿病。遗传易感性是自身免疫过程进展的另一个先决条件。双胞胎研究、发病率的主要地理差异、发病率的时间趋势以及移民研究的结果表明，环境因素在1型糖尿病的发展中起着至关重要的作用。在本综述中，主要关注的是饮食因素，其中尤其关注牛奶蛋白的可能作用。牛奶与1型糖尿病的假说早在10多年前就已提出，而这个问题至今仍未解决。在病毒感染中，肠道病毒是目前在这方面最受关注的病毒组，因为最近的前瞻性研究表明，这些病毒可能引发并增强现有的β细胞自身免疫。在毒素中，特别是N-亚硝基化合物具有潜在的研究价值，因为它们可能与某些病例的病因有关。最后，简要讨论了心理社会因素以及遗传易感性与环境因素之间的相互作用。
