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Birth Order, Caesarean Section, or Daycare Attendance in Relation to Child- and Adult-Onset Type 1 Diabetes: Results from the German National Cohort

Author

Listed:
  • Justine Tanoey

    (Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany)

  • Christina Baechle

    (Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research, Heinrich Heine University, 40225 Düsseldorf, Germany)

  • Hermann Brenner

    (Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany)

  • Andreas Deckert

    (Heidelberg Institute of Global Health, Heidelberg University Hospital, 69120 Heidelberg, Germany)

  • Julia Fricke

    (Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany)

  • Kathrin Günther

    (Leibniz Institute for Prevention Research and Epidemiology—BIPS, 28359 Bremen, Germany)

  • André Karch

    (Institute for Epidemiology and Social Medicine, Albert-Schweitzer-Campus 1, Building D3, 48149 Münster, Germany)

  • Thomas Keil

    (Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
    Institute of Clinical Epidemiology and Biometry, University of Würzburg, 97080 Würzburg, Germany
    State Institute of Health, Bavarian Health and Food Safety Authority, 91058 Erlangen, Germany)

  • Alexander Kluttig

    (Institute for Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany)

  • Michael Leitzmann

    (Department for Epidemiology and Preventive Medicine, Regensburg University Medical Center, 93053 Regensburg, Germany)

  • Rafael Mikolajczyk

    (Institute for Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany)

  • Nadia Obi

    (Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany)

  • Tobias Pischon

    (Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association, Molecular Epidemiology Research Group, 13125 Berlin, Germany
    Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association, Biobank Technology Platform, 13125 Berlin, Germany
    Charité—Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany)

  • Tamara Schikowski

    (Leibniz Research Institute for Environmental Medicine—IUF, 40225 Düsseldorf, Germany)

  • Sabine M. Schipf

    (Institute for Community Medicine, University Medicine Greifswald, 17489 Greifswald, Germany)

  • Matthias B. Schulze

    (German Institute of Human Nutrition Potsdam-Rehbruecke, 14558 Nuthetal, Germany
    Institute of Nutritional Science, University of Potsdam, 14558 Nuthetal, Germany)

  • Anja Sedlmeier

    (Department for Epidemiology and Preventive Medicine, Regensburg University Medical Center, 93053 Regensburg, Germany)

  • Ilais Moreno Velásquez

    (Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association, Molecular Epidemiology Research Group, 13125 Berlin, Germany)

  • Katharina S. Weber

    (Institute of Epidemiology, Kiel University, 24105 Kiel, Germany)

  • Henry Völzke

    (Institute for Community Medicine, University Medicine Greifswald, 17489 Greifswald, Germany)

  • Wolfgang Ahrens

    (Leibniz Institute for Prevention Research and Epidemiology—BIPS, 28359 Bremen, Germany)

  • Sylvia Gastell

    (German Institute of Human Nutrition Potsdam-Rehbruecke, 14558 Nuthetal, Germany)

  • Bernd Holleczek

    (Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany)

  • Karl-Heinz Jöckel

    (Institute of Medical Informatics, Biometry und Epidemiology, Essen University Hospital, 45147 Essen, Germany)

  • Verena Katzke

    (Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany)

  • Wolfgang Lieb

    (Institute of Epidemiology, Kiel University, 24105 Kiel, Germany)

  • Karin B. Michels

    (Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, 79110 Freiburg, Germany)

  • Börge Schmidt

    (Institute of Medical Informatics, Biometry und Epidemiology, Essen University Hospital, 45147 Essen, Germany)

  • Henning Teismann

    (Institute for Epidemiology and Social Medicine, Albert-Schweitzer-Campus 1, Building D3, 48149 Münster, Germany)

  • Heiko Becher

    (Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany)

Abstract

(1) Background: Global incidence of type 1 diabetes (T1D) is rising and nearly half occurred in adults. However, it is unclear if certain early-life childhood T1D risk factors were also associated with adult-onset T1D. This study aimed to assess associations between birth order, delivery mode or daycare attendance and type 1 diabetes (T1D) risk in a population-based cohort and whether these were similar for childhood- and adult-onset T1D (cut-off age 15); (2) Methods: Data were obtained from the German National Cohort (NAKO Gesundheitsstudie) baseline assessment. Self-reported diabetes was classified as T1D if: diagnosis age ≤ 40 years and has been receiving insulin treatment since less than one year after diagnosis. Cox regression was applied for T1D risk analysis; (3) Results: Analyses included 101,411 participants (100 childhood- and 271 adult-onset T1D cases). Compared to “only-children”, HRs for second- or later-born individuals were 0.70 (95% CI = 0.50–0.96) and 0.65 (95% CI = 0.45–0.94), respectively, regardless of parental diabetes, migration background, birth year and perinatal factors. In further analyses, higher birth order reduced T1D risk in children and adults born in recent decades. Caesarean section and daycare attendance showed no clear associations with T1D risk; (4) Conclusions: Birth order should be considered in both children and adults’ T1D risk assessment for early detection.

Suggested Citation

  • Justine Tanoey & Christina Baechle & Hermann Brenner & Andreas Deckert & Julia Fricke & Kathrin Günther & André Karch & Thomas Keil & Alexander Kluttig & Michael Leitzmann & Rafael Mikolajczyk & Nadia, 2022. "Birth Order, Caesarean Section, or Daycare Attendance in Relation to Child- and Adult-Onset Type 1 Diabetes: Results from the German National Cohort," IJERPH, MDPI, vol. 19(17), pages 1-14, August.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:17:p:10880-:d:903378
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    References listed on IDEAS

    as
    1. Paula Andrea Diaz-Valencia & Pierre Bougnères & Alain-Jacques Valleron, 2015. "Covariation of the Incidence of Type 1 Diabetes with Country Characteristics Available in Public Databases," PLOS ONE, Public Library of Science, vol. 10(2), pages 1-12, February.
    2. Yan Shao & Samuel C. Forster & Evdokia Tsaliki & Kevin Vervier & Angela Strang & Nandi Simpson & Nitin Kumar & Mark D. Stares & Alison Rodger & Peter Brocklehurst & Nigel Field & Trevor D. Lawley, 2019. "Stunted microbiota and opportunistic pathogen colonization in caesarean-section birth," Nature, Nature, vol. 574(7776), pages 117-121, October.
    3. Christopher J. Stewart & Nadim J. Ajami & Jacqueline L. O’Brien & Diane S. Hutchinson & Daniel P. Smith & Matthew C. Wong & Matthew C. Ross & Richard E. Lloyd & HarshaVardhan Doddapaneni & Ginger A. M, 2018. "Temporal development of the gut microbiome in early childhood from the TEDDY study," Nature, Nature, vol. 562(7728), pages 583-588, October.
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