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Microbial exposure in infancy and subsequent appearance of type 1 diabetes mellitus-associated autoantibodies: a cohort study.

Abstract

IMPORTANCE

The role of microbial exposure during early life in the development of type 1 diabetes mellitus is unclear.

OBJECTIVE

To investigate whether animal contact and other microbial exposures during infancy are associated with the development of preclinical and clinical type 1 diabetes.

DESIGN, SETTING, AND PARTICIPANTS

A birth cohort of children with HLA antigen-DQB1-conferred susceptibility to type 1 diabetes was examined. Participants included 3143 consecutively born children at 2 hospitals in Finland between 1996 and 2004.

EXPOSURES

The following exposures during the first year of life were assessed: indoor and outdoor dogs and cats, farm animals, farming, visit to a stable, day care, and exposure to antibiotics during the first week of life.

MAIN OUTCOMES AND MEASURES

Clinical and preclinical type 1 diabetes were used as outcomes. The latter was defined as repeated positivity for islet-cell antibodies plus for at least 1 of 3 other diabetes-associated autoantibodies analyzed and/or clinical type 1 diabetes. The autoantibodies were analyzed at 3- to 12-month intervals since the birth of the child.

RESULTS

Children exposed to an indoor dog, compared with otherwise similar children without an indoor dog exposure, had a reduced odds of developing preclinical type 1 diabetes (adjusted odds ratio [OR], 0.47; 95% CI, 0.28-0.80; P = .005) and clinical type 1 diabetes (adjusted OR, 0.40; 95% CI, 0.14-1.14; P = .08). All of the other microbial exposures studied were not associated with preclinical or clinical diabetes: the odds ratios ranged from 0.74 to 1.58.

CONCLUSIONS AND RELEVANCE

Among the 9 early microbial exposures studied, only the indoor dog exposure during the first year of life was inversely associated with the development of preclinical type 1 diabetes. This finding needs to be confirmed in other populations.

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  • Authors+Show Affiliations

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    The National Institute for Health and Welfare, Nutrition Unit, Helsinki, Finland2Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland3The Science Center of Pirkanmaa Hospital District, Tampere, Finland4.

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    The National Institute for Health and Welfare, Nutrition Unit, Helsinki, Finland4School of Health Sciences, University of Tampere, Tampere, Finland.

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    School of Health Sciences, University of Tampere, Tampere, Finland.

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    Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland5University of Helsinki, Hjelt Institute, Helsinki, Finland.

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    The National Institute for Health and Welfare, Nutrition Unit, Helsinki, Finland3The Science Center of Pirkanmaa Hospital District, Tampere, Finland4School of Health Sciences, University of Tampere, Tampere, Finland.

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    Department of Statistics, Faculty of Mathematics and Natural Sciences, University of Turku, Turku, Finland.

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    The National Institute for Health and Welfare, Nutrition Unit, Helsinki, Finland.

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    Children's Hospital, University of Helsinki, and University Central Hospital, Helsinki, Finland8University of Helsinki, Diabetes and Obesity Research Program, Helsinki, Finland.

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    Department of Pediatrics, Faculty of Medicine, University of Turku, Turku, Finland.

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    Immunogenetics Laboratory, University of Turku, Turku, Finland11Department of Clinical Microbiology, Faculty of Health Sciences, University of Eastern Finland, Kuopio.

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    School of Medicine, University of Tampere, Tampere, Finland.

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    Department of Pediatrics, University of Oulu, Oulu, Finland.

    Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland7Children's Hospital, University of Helsinki, and University Central Hospital, Helsinki, Finland8University of Helsinki, Diabetes and Obesity Research.

    Source

    JAMA pediatrics 168:8 2014 Aug pg 755-63

    MeSH

    Animals
    Anti-Infective Agents
    Autoantibodies
    Autoimmunity
    Cats
    Child, Preschool
    Diabetes Mellitus, Type 1
    Dogs
    Environmental Exposure
    Female
    Finland
    Genetic Predisposition to Disease
    HLA Antigens
    Humans
    Hygiene
    Infant
    Infant, Newborn
    Islets of Langerhans
    Male
    Microbiota
    Risk Factors
    Surveys and Questionnaires

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    24957949

    Citation

    Virtanen, Suvi M., et al. "Microbial Exposure in Infancy and Subsequent Appearance of Type 1 Diabetes Mellitus-associated Autoantibodies: a Cohort Study." JAMA Pediatrics, vol. 168, no. 8, 2014, pp. 755-63.
    Virtanen SM, Takkinen HM, Nwaru BI, et al. Microbial exposure in infancy and subsequent appearance of type 1 diabetes mellitus-associated autoantibodies: a cohort study. JAMA Pediatr. 2014;168(8):755-63.
    Virtanen, S. M., Takkinen, H. M., Nwaru, B. I., Kaila, M., Ahonen, S., Nevalainen, J., ... Knip, M. (2014). Microbial exposure in infancy and subsequent appearance of type 1 diabetes mellitus-associated autoantibodies: a cohort study. JAMA Pediatrics, 168(8), pp. 755-63. doi:10.1001/jamapediatrics.2014.296.
    Virtanen SM, et al. Microbial Exposure in Infancy and Subsequent Appearance of Type 1 Diabetes Mellitus-associated Autoantibodies: a Cohort Study. JAMA Pediatr. 2014;168(8):755-63. PubMed PMID: 24957949.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Microbial exposure in infancy and subsequent appearance of type 1 diabetes mellitus-associated autoantibodies: a cohort study. AU - Virtanen,Suvi M, AU - Takkinen,Hanna-Mari, AU - Nwaru,Bright I, AU - Kaila,Minna, AU - Ahonen,Suvi, AU - Nevalainen,Jaakko, AU - Niinistö,Sari, AU - Siljander,Heli, AU - Simell,Olli, AU - Ilonen,Jorma, AU - Hyöty,Heikki, AU - Veijola,Riitta, AU - Knip,Mikael, PY - 2014/6/25/entrez PY - 2014/6/25/pubmed PY - 2014/12/15/medline SP - 755 EP - 63 JF - JAMA pediatrics JO - JAMA Pediatr VL - 168 IS - 8 N2 - IMPORTANCE: The role of microbial exposure during early life in the development of type 1 diabetes mellitus is unclear. OBJECTIVE: To investigate whether animal contact and other microbial exposures during infancy are associated with the development of preclinical and clinical type 1 diabetes. DESIGN, SETTING, AND PARTICIPANTS: A birth cohort of children with HLA antigen-DQB1-conferred susceptibility to type 1 diabetes was examined. Participants included 3143 consecutively born children at 2 hospitals in Finland between 1996 and 2004. EXPOSURES: The following exposures during the first year of life were assessed: indoor and outdoor dogs and cats, farm animals, farming, visit to a stable, day care, and exposure to antibiotics during the first week of life. MAIN OUTCOMES AND MEASURES: Clinical and preclinical type 1 diabetes were used as outcomes. The latter was defined as repeated positivity for islet-cell antibodies plus for at least 1 of 3 other diabetes-associated autoantibodies analyzed and/or clinical type 1 diabetes. The autoantibodies were analyzed at 3- to 12-month intervals since the birth of the child. RESULTS: Children exposed to an indoor dog, compared with otherwise similar children without an indoor dog exposure, had a reduced odds of developing preclinical type 1 diabetes (adjusted odds ratio [OR], 0.47; 95% CI, 0.28-0.80; P = .005) and clinical type 1 diabetes (adjusted OR, 0.40; 95% CI, 0.14-1.14; P = .08). All of the other microbial exposures studied were not associated with preclinical or clinical diabetes: the odds ratios ranged from 0.74 to 1.58. CONCLUSIONS AND RELEVANCE: Among the 9 early microbial exposures studied, only the indoor dog exposure during the first year of life was inversely associated with the development of preclinical type 1 diabetes. This finding needs to be confirmed in other populations. SN - 2168-6211 UR - https://www.unboundmedicine.com/medline/citation/24957949/Microbial_exposure_in_infancy_and_subsequent_appearance_of_type_1_diabetes_mellitus_associated_autoantibodies:_a_cohort_study_ L2 - https://jamanetwork.com/journals/jamapediatrics/fullarticles/10.1001/jamapediatrics.2014.296 DB - PRIME DP - Unbound Medicine ER -