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- Title
Dietary Intake and Body Mass Index Influence the Risk of Islet Autoimmunity in Genetically At-Risk Children: A Mediation Analysis Using the TEDDY Cohort.
- Authors
Andrén Aronsson, Carin; Tamura, Roy; Vehik, Kendra; Uusitalo, Ulla; Yang, Jimin; Haller, Michael J.; Toppari, Jorma; Hagopian, William; McIndoe, Richard A.; Rewers, Marian J.; Ziegler, Anette-G.; Akolkar, Beena; Krischer, Jeffrey P.; Norris, Jill M.; Virtanen, Suvi M.; Elding Larsson, Helena
- Abstract
Background/Objective. Growth and obesity have been associated with increased risk of islet autoimmunity (IA) and progression to type 1 diabetes. We aimed to estimate the effect of energy-yielding macronutrient intake on the development of IA through BMI. Research Design and Methods. Genetically at-risk children (n = 5,084) in Finland, Germany, Sweden, and the USA, who were autoantibody negative at 2 years of age, were followed to the age of 8 years, with anthropometric measurements and 3-day food records collected biannually. Of these, 495 (9.7%) children developed IA. Mediation analysis for time-varying covariates (BMI z-score) and exposure (energy intake) was conducted. Cox proportional hazard method was used in sensitivity analysis. Results. We found an indirect effect of total energy intake (estimates: indirect effect 0.13 [0.05, 0.21]) and energy from protein (estimates: indirect effect 0.06 [0.02, 0.11]), fat (estimates: indirect effect 0.03 [0.01, 0.05]), and carbohydrates (estimates: indirect effect 0.02 [0.00, 0.04]) (kcal/day) on the development of IA. A direct effect was found for protein, expressed both as kcal/day (estimates: direct effect 1.09 [0.35, 1.56]) and energy percentage (estimates: direct effect 72.8 [3.0, 98.0]) and the development of GAD autoantibodies (GADA). In the sensitivity analysis, energy from protein (kcal/day) was associated with increased risk for GADA, hazard ratio 1.24 (95% CI: 1.09, 1.53), p = 0.042. Conclusions. This study confirms that higher total energy intake is associated with higher BMI, which leads to higher risk of the development of IA. A diet with larger proportion of energy from protein has a direct effect on the development of GADA.
- Subjects
UNITED States; SWEDEN; FINLAND; GERMANY; ENERGY density; CONFIDENCE intervals; FOOD consumption; ANTHROPOMETRY; TYPE 1 diabetes; NUTRITIONAL requirements; ISLANDS of Langerhans; RISK assessment; DESCRIPTIVE statistics; FACTOR analysis; RESEARCH funding; BODY mass index; PROPORTIONAL hazards models; DISEASE risk factors; CHILDREN
- Publication
Pediatric Diabetes, 2023, p1
- ISSN
1399-543X
- Publication type
Article
- DOI
10.1155/2023/3945064