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Incidence trends and environmental determinants of type 1 diabetes in Lithuania and Sweden
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Variation of diabetes incidence over time in countries with different incidence levels and socio-economic conditions, and in an age span beyond the childhood years, may give clues for diabetes causes.

Materials: Data from prospective type 1 diabetes registers in Sweden and Lithuania in children (0-14 years) and young adults (15-34 and 15-39 years, respectively). Number of infections recorded in health care booklets (117 cases; 270 controls); interview about the dietary intake one-year before the diagnosis and routinely recorded growth data (99 cases; 180 controls).

Results: The incidence of type 1 diabetes in Sweden and Lithuania differed most in the younger age groups, 28.9 and 7.5/100,000/year in 0-14-year group, respectively. During 1983-2000 incidence increased in 0-14-year old children in both countries, but the pattern of change differed. During 1983-1998 the incidence increased in Swedish children, but tended to decrease in young adults, with no increase in the age group below 35 years, indicating that the increase of childhood diabetes may be due to a shift towards a younger age at diagnosis. Within a low-incidence country Lithuania there was an urban-rural gradient of incidence, especially in the younger age groups, that seemed to follow poverty distribution: incidence in the 0-39-year group was 7.1, 9.0 and 8.8/100,000/year in rural areas, towns and cities, respectively, p<0.001.

Exposure to one or more non-specific infection during the first half-year of life reduced diabetes risk: odds ratios (95%-CI) in 0-14 and 5-14-year groups were (0.60; 0.37-0.98) and (0.47; 0.26-0.87), respectively. Higher energy intake and weight-for-age were independent diabetes risk factors: odds ratios for medium and high levels of energy were 1.33 (0.52-3.42) and 5.23 (1.67-16.38), and for weight-for-age 3.20 (1.30-7.88) and 3.09 (1.16-8.22), respectively. High intake of carbohydrates, disaccharides and sucrose in particular, increased diabetes risk independently of the high intake of energy.

Conclusion: Environmental factors associated with socio-economic conditions in childhood may be important for the occurrence of type 1 diabetes. Lack of exposure to microbial antigens early in life, higher intake of energy and more rapid growth may contribute to the increase of childhood-onset diabetes observed in many countries.

Place, publisher, year, edition, pages
Umeå: Umeå university , 2003. , 70 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 853
Keyword [en]
Pediatrics, type 1 diabetes mellitus, epidemiology, childhood, incidence, secular trend, case-control study, risk factors, infections, energy, weight
Keyword [sv]
Pediatrik
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
URN: urn:nbn:se:umu:diva-114ISBN: 91-7305-519-0 (print)OAI: oai:DiVA.org:umu-114DiVA: diva2:140357
Public defence
2003-10-03, Major Groove, 6L (mikrobiologi), Umeå, 09:00
Opponent
Supervisors
Available from: 2003-10-01 Created: 2003-10-01 Last updated: 2012-08-08Bibliographically approved
List of papers
1. Time trend of childhood type 1 diabetes incidence in Lithuania and Sweden, 1983-2000
Open this publication in new window or tab >>Time trend of childhood type 1 diabetes incidence in Lithuania and Sweden, 1983-2000
2004 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 93, no 11, 1519-1524 p.Article in journal (Refereed) Published
Abstract [en]

AIM: To compare the time trend of childhood type 1 diabetes over an 18-y period in Lithuania and Sweden--countries with different incidence levels and different socio-economic conditions. METHODS: Percent average incidence change per year between 1983 and 2000, based on 8031 Swedish and 1100 Lithuanian cases in the age group 0-14 y, was calculated using Poisson regression. RESULTS: Average age- and sex-standardized incidence/100 000/y was 28.9 (95% CI: 28.2-29.5) in Sweden and 7.5 (95% CI: 7.1-8.0) in Lithuania. Between 1983 and 2000, the average increase per year was 2.2% in Sweden (95% CI: 1.7-2.6) and 2.3% in Lithuania (95% CI: 1.1-3.5), but the latter trend depended on an increase during the last few years of the period, and only for girls. In Sweden, incidence increased significantly in all age groups, but more so in the younger groups (3.0%, 2.2% and 1.7% per year in 0-4, 5-9 and 10-14-y age groups, respectively), while in Lithuania a significant increase was found only in the 10-14-y age group (3.0%). In Sweden, a trend towards a younger age at diagnosis was indicated for both boys and girls when comparing 1983-1991 and 1992-2000, whereas in Lithuania, the changes in age distribution over time were small, with an opposite tendency for boys. CONCLUSION: Incidence variability over time differed considerably in the two countries in the region of the Baltic Sea, suggesting a complex effect of environmental risk factors, some of which may be associated with wealth and socio-economic conditions.

Keyword
Type 1 diabetes, time trend, childhood
National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-16427 (URN)10.1111/j.1651-2227.2004.tb02640.x (DOI)15513583 (PubMedID)
Available from: 2008-01-12 Created: 2008-01-12 Last updated: 2017-12-14Bibliographically approved
2. The incidence of Type 1 diabetes has not increased but shifted to a younger age at diagnosis in the 0-34 years group in Sweden 1983 to 1998
Open this publication in new window or tab >>The incidence of Type 1 diabetes has not increased but shifted to a younger age at diagnosis in the 0-34 years group in Sweden 1983 to 1998
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2002 In: Diabetologia, ISSN 0012-186X, Vol. 45, no 6, 783-791 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:umu:diva-2386 (URN)
Available from: 2003-10-01 Created: 2003-10-01Bibliographically approved
3. Incidence of Type 1 Diabetes in Lithuanians aged 0-39 Years Varies by the Urban-Rural setting, and the Time Change Differs for Men and Women During 1991-2000
Open this publication in new window or tab >>Incidence of Type 1 Diabetes in Lithuanians aged 0-39 Years Varies by the Urban-Rural setting, and the Time Change Differs for Men and Women During 1991-2000
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2003 In: Diabetes Care, ISSN 0149-5992, Vol. 26, no March, 671-676 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:umu:diva-2387 (URN)
Available from: 2003-10-01 Created: 2003-10-01Bibliographically approved
4. Infections and risk of Type I (insulin-dependent) diabetes mellitus in Lithuanian children
Open this publication in new window or tab >>Infections and risk of Type I (insulin-dependent) diabetes mellitus in Lithuanian children
2000 In: Diabetologia, ISSN 0012-186X, Vol. 43, no 10, 1229-1234 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:umu:diva-2388 (URN)
Available from: 2003-10-01 Created: 2003-10-01Bibliographically approved
5. Diet, growth and the risk for insulin-dependent diabetes mellitus in childhood
Open this publication in new window or tab >>Diet, growth and the risk for insulin-dependent diabetes mellitus in childhood
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(English)Manuscript (Other academic)
Identifiers
urn:nbn:se:umu:diva-2389 (URN)
Available from: 2003-10-01 Created: 2003-10-01 Last updated: 2010-10-13Bibliographically approved

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