Abstract
There are indications that the effect of environmental factors on the risk of type 1 diabetes mellitus (T1DM) is increasing over time. This can be documented by the rapid increase of T1DM incidence in genetically stable populations. Our aim was to study an association of T1DM with the variable factors of the perinatal period and of early infancy, using data from children born over a period of changing exposure to some of the studied factors. A case–control dataset was analysed, consisting of 868 diabetic children and 1,466 anonymous controls, mostly schoolmates of the children with T1DM. The data were collected using structured questionnaires completed by parents. After performing univariate analyses, the associations were analysed using multiple logistic regression adjusted for potential confounders, including the year of birth. The risk of T1DM decreased with increasing duration of breast-feeding, while no breast-feeding was associated with an increased T1DM risk, OR=1.93 [95% CI: 1.33–2.80], breast-feeding for more than 12 months was protective, OR=0.42 [95% CI: 0.22–0.81], both being relative to the reference category of breast-feeding for 1–3 months. A short duration of day-care attendance (none or less than 1 year) was weakly associated with the risk of T1DM, OR=1.65 [95% CI: 1.05–2.62]. No association was detected between T1DM and signs of prenatal infections, perinatal stress factors, birth size and weight, indicators of crowding or the presence of a domestic pet in the household. Short breast-feeding period and short attendance to day care is associated with the risk of T1DM in Czech children.
Similar content being viewed by others
Abbreviations
- 95% CI:
-
95% confidence interval
- OR:
-
Odds ratio
- T1DM:
-
Type 1 diabetes mellitus
References
EURODIAB ACE Study Group (2000) Variation and trends in incidence of childhood diabetes in Europe. Lancet 355:873–876
Bache I, Bock T, Volund A, Buschard K (1999) Previous maternal abortion, longer gestation, and younger maternal age decrease the risk of type 1 diabetes among male offspring. Diabetes Care 22:1063–1065
Dahlquist GG, Patterson C, Soltesz G; The EURODIAB Substudy 2 Study Group (1999) Perinatal risk factors for childhood type 1 diabetes in Europe. Diabetes Care 22:1698–1702
Green A, Patterson CC (2001) Trends in the incidence of childhood-onset diabetes in Europe 1989–1998. Diabetologia 44(Suppl 3):B3–B8
Kaila B, Taback SP (2001) The effect of day care exposure on the risk of developing type 1 diabetes: a meta-analysis of case–control studies. Diabetes Care 24:1353–1358
Knip M (2003) Cow's milk and the new trials for prevention of type 1 diabetes. J Endocrinol Invest 26:265–267
Marshall AL, Chetwynd A, Morris JA, Placzek M, Smith C, Olabi A, Thistlethwaite D (2004) Type 1 diabetes mellitus in childhood: a matched case control study in Lancashire and Cumbria, UK. Diabet Med 21:1035–1040
McKinney PA, Parslow R, Gurney K, Law G, Bodansky HJ, Williams DR (1997) Antenatal risk factors for childhood diabetes mellitus; a case–control study of medical record data in Yorkshire, UK. Diabetologia 40:933–939
McKinney PA, Parslow R, Gurney KA, Law GR, Bodansky HJ, Williams R (1999) Perinatal and neonatal determinants of childhood type 1 diabetes. A case–control study in Yorkshire, U.K. Diabetes Care 22:928–932
Norris JM, Barriga K, Klingensmith G, Hoffman M, Eisenbarth GS, Erlich HA, Rewers M (2003) Timing of initial cereal exposure in infancy and risk of islet autoimmunity. JAMA 290:1713–1720
Patterson CC, Carson DJ, Hadden DR (1996) Epidemiology of childhood IDDM in Northern Ireland 1989–1994: low incidence in areas with highest population density and most household crowding. Northern Ireland Diabetes Study Group. Diabetologia 39:1063–1069
Patterson CC, Carson DJ, Hadden DR, Waugh NR, Cole SK (1994) A case–control investigation of perinatal risk factors for childhood IDDM in Northern Ireland and Scotland. Diabetes Care 17:376–381
Rami B, Schneider U, Imhof A, Waldhor T, Schober E (1999) Risk factors for type I diabetes mellitus in children in Austria. Eur J Pediatr 158:362–366
Siemiatycki J, Colle E, Campbell S, Dewar RA, Belmonte MM (1989) Case–control study of IDDM. Diabetes Care 12:209–216
Staines A, Bodansky HJ, McKinney PA, Alexander FE, McNally RJ, Law GR, Lilley HE, Stephenson C, Cartwright RA (1997) Small area variation in the incidence of childhood insulin-dependent diabetes mellitus in Yorkshire, UK: links with overcrowding and population density. Int J Epidemiol 26:1307–1313
Stene LC, Barriga K, Norris JM, Hoffman M, Klingensmith G, Erlich HA, Eisenbarth GS, Rewers M (2003) Symptoms of common maternal infections in pregnancy and risk of islet autoimmunity in early childhood. Diabetes Care 26:3136–3141
Stene LC, Magnus P, Lie RT, Sovik O, Joner G (2001) Birth weight and childhood onset type 1 diabetes: population based cohort study. BMJ 322:889–892
Stene LC, Magnus P, Lie RT, Sovik O, Joner G (2003) No association between preeclampsia or cesarean section and incidence of type 1 diabetes among children: a large, population-based cohort study. Pediatr Res 54:487–490
Sumnik Z, Drevinek P, Lanska V, Malcova H, Vavrinec J, Cinek O (2004) Higher maternal age at delivery, and lower birth orders are associated with increased risk of childhood type 1 diabetes mellitus. Exp Clin Endocrinol Diabetes 112:294–297
Virtanen SM, Knip M (2003) Nutritional risk predictors of beta cell autoimmunity and type 1 diabetes at a young age. Am J Clin Nutr 78:1053–1067
Acknowledgements
The members of the Czech Childhood Diabetes Registry Study Group are acknowledged for an excellent collaboration and we also thank the participating families for their continuing support. We thank especially: S. Kolouskova, M. Snajderova, L. Brazdova, I. Titzova, M. Sykora, M. Svojsik, M. Machalkova, J. Bartosova, L. Tyce, H. Safarikova, J. Maly, P. Skala, V. Janstova, J. Kopriva, R. Machytka, E. Novakova, V. Kratochvil, A. Martiskova, L. Kocinova, P. Mikyska, H. Nemcova, M. Hromadkova, H. Strmenova, J. Soucek, P. Eichl, K. Fiklik, A. Benesova, A. Filakova, E. Hladakova, Z. Jezova, S. Pokorny, B. Cervickova, I. Velesikova, H. Vavrova, J. Fromel, M. Honkova, V. Prokop, J. Havlicek, Y. Ptoszkova, J. Klabochova, R. Zemanova, J. Berankova, J. Gayer, L. Zlamalova, J. Brozova, M. Imramovska, S. Hyckova, J. Skvor, M. Gregora, E. Senkyrova, V. Jamelska, P. Mokros, J. Matejkova, J. Bazant and M. Schubert. The study was supported by the Ministry of Education of the Czech Republic (grant MSM 0021620814) and a grant from the Czech Diabetes Society.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Malcova, H., Sumnik, Z., Drevinek, P. et al. Absence of breast-feeding is associated with the risk of type 1 diabetes: a case–control study in a population with rapidly increasing incidence. Eur J Pediatr 165, 114–119 (2006). https://doi.org/10.1007/s00431-005-0008-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00431-005-0008-9