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Epidemiology/Health Services/Psychosocial Research

In Utero Dietary Exposures and Risk of Islet Autoimmunity in Children

  1. Carolyn M. Fronczak, MSPH1,
  2. Anna E. Barón, PHD1,
  3. H. Peter Chase, MD2,
  4. Colleen Ross, MS1,
  5. Heather L. Brady, RD, MS1,
  6. Michelle Hoffman, RN1,
  7. George S. Eisenbarth, MD, PHD2,
  8. Marian Rewers, MD, PHD2 and
  9. Jill M. Norris, MPH, PHD1
  1. 1Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, Colorado
  2. 2The Barbara Davis Center for Childhood Diabetes, University of Colorado Health Sciences Center, Denver, Colorado
  1. Address correspondence and reprint requests to Jill M. Norris, MPH, PhD, Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, 4200 East Ninth Ave., Box B119, Denver, CO 80262. E-mail: jill.norris{at}uchsc.edu
Diabetes Care 2003 Dec; 26(12): 3237-3242. https://doi.org/10.2337/diacare.26.12.3237
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Article Figures & Tables

Tables

  • Table 1—

    Demographic and pregnancy characteristics and risk of IA in offspring

    CharacteristicAffectedUnaffectedUnadjusted HR (95% CI)Wald χ2P
    n16206
    Age at last follow-up (years)*4.3 ± 1.94.0 ± 1.4NA†NA†
    Child’s sex (% male)7 (43.7)101 (49.0)0.87 (0.32–2.33)0.779
    Child’s ethnicity (% non-Hispanic Caucasian)15 (93.7)152 (73.8)5.29 (0.7–40.06)0.133
    Maternal age at delivery (years)31.3 ± 6.029.7 ± 5.81.26 (0.8–1.96)‡0.331
    Maternal education at delivery (% ≤12 years)4 (25.0)48 (23.3)1.09 (0.35–3.39)0.878
    Income at delivery (% <$30,000/year)§4 (26.7)48 (23.8)1.04 (0.33–3.28)0.942
    Birth weight (g)§3,122.9 ± 564.93,286.4 ± 527.70.74 (0.47–1.18)‡0.238
    Pre- or post-term delivery§2 (13.3)69 (33.7)0.31 (0.07–1.37)0.148
    Cesarean delivery1 (6.2)43 (20.9)0.27 (0.04–2.04)0.226
    Breast-fed <3 months§6 (37.5)66 (32.3)1.3 (0.47–3.56)0.619
    GDM3 (18.8)3 (1.5)9.64 (2.74–33.97)0.006
    First-degree type 1 diabetic relative6 (37.5)62 (30.1)1.71 (0.62–4.75)0.302
    HLA-DR3/4, DQ8 genotype14 (87.5)129 (62.6)3.17 (0.72–14.01)0.166
    • Data are means ± SD or n (%) unless otherwise indicated.

    • ↵* For affected, average age at first positive test for IA is 2.5 ± 1.7 years;

    • ↵† outcome determined by difference in age of affected subject at first positive visit and age at last negative visit;

    • ↵‡ HR associated with incremental values: maternal age = 5 years, birth weight = 500 g;

    • ↵§ missing observations include income: one in the affected group (6.2%) and four (1.9%) in the unaffected group, birth weight: one from the unaffected group (0.5%), pre- or post-term delivery: one in each affected (6.2%) and unaffected group (0.5%), and breast-feeding duration: two missing observations from unaffected group (1.0%).

  • Table 2—

    Maternal dietary exposures during pregnancy and risk of IA in offspring

    Parameters (mean daily intake)AffectedUnaffectedUnadjusted HR (95% CI)Wald χ2P
    n16206
    Vitamin D intake via food (IU)167.6252.30.49 (0.26–0.94)*0.059
    Vitamin D intake via supplements (IU)
     ≥40013 (81.3)116 (56.3)3.09 (0.88–10.83)0.107
    EPA and DHA (ω-3 fatty acids) (g)
     ≥0.109 (56.3)137 (66.5)0.64 (0.24–1.71)0.380
    Linolenic acid (ω-3 fatty acid) (g)1.41.31.16 (0.75–1.80)*0.503
    Arachidonic acid (ω-6 fatty acid) (g)0.130.140.88 (0.5–1.56)*0.672
    Linoleic acid (ω-6 fatty acid) (g)†
     <7.924 (25.0)71 (34.5)1.0 (referent)
     7.92–11.788 (50.0)66 (32.0)2.01 (0.55–7.37)0.274
     >11.784 (25.0)69 (33.5)1.04 (0.26–4.16)0.955
    Ratio of ω-6 total:ω-3 total7.97.81.13 (0.70–1.83)*0.624
    Caloric intake (kcal)†
     <1,718.885 (31.2)68 (33.0)1.0 (referent)
     1,718.88–2,491.049 (56.2)67 (32.5)1.61 (0.54–4.82)0.405
     >2,491.042 (12.5)71 (34.5)0.37 (0.07–1.93)0.258
    • Data are n (%) unless otherwise indicated.

    • ↵* HR represent risk for an SD difference in intake: SD vitamin D = 155.6 IU; SD linolenic acid = 0.69 g; SD arachidonic acid = 0.08 g; SD ratio ω-6 total to ω-3 total = 2.00;

    • ↵† categorized as tertiles because variable did not meet the assumption of log linearity.

  • Table 3—

    Multivariate survival analysis examining maternal vitamin D intake via food during pregnancy and risk of IA and persistent IA

    Risk factors*IA adjusted HR (95% CI)Wald χ2PPersistent IA adjusted HR (95% CI)Wald χ2P
    n1611
    Vitamin D intake via food (IU)0.37 (0.17–0.78)0.0200.58 (0.27–1.28)†0.205
    First-degree type 1 diabetic relative5.15 (1.45–18.28)0.0216.74 (1.62–28.03)0.031
    HLA-DR 3/4, DQ8 genotype9.79 (1.69–56.83)0.0299.14 (1.50–55.85)0.054
    GDM7.78 (1.83–33.03)0.0112.05 (0.22–19.02)0.528
    Child’s ethnicity (% non-Hispanic Caucasian)6.97 (0.88–55.46)0.088Not calculable‡NA
    • ↵* All variables entered into model simultaneously;

    • ↵† HR represents risk for a 155.6 IU SD difference in intake;

    • ↵‡ all affected were non-Hispanic Caucasian.

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In Utero Dietary Exposures and Risk of Islet Autoimmunity in Children
Carolyn M. Fronczak, Anna E. Barón, H. Peter Chase, Colleen Ross, Heather L. Brady, Michelle Hoffman, George S. Eisenbarth, Marian Rewers, Jill M. Norris
Diabetes Care Dec 2003, 26 (12) 3237-3242; DOI: 10.2337/diacare.26.12.3237

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In Utero Dietary Exposures and Risk of Islet Autoimmunity in Children
Carolyn M. Fronczak, Anna E. Barón, H. Peter Chase, Colleen Ross, Heather L. Brady, Michelle Hoffman, George S. Eisenbarth, Marian Rewers, Jill M. Norris
Diabetes Care Dec 2003, 26 (12) 3237-3242; DOI: 10.2337/diacare.26.12.3237
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