OBJECTIVE This study investigates two-phase growth patterns in early life and their association with development of islet autoimmunity (IA) and type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS The Environmental Determinants of Diabetes in the Young (TEDDY) study followed 7,522 genetically high-risk children in Sweden, Finland, Germany, and the U.S. from birth for a median of 9.0 years (interquartile range 5.7-10.6) with available growth data. Of these, 761 (10.1%) children developed IA and 290 (3.9%) children were diagnosed with T1D. Bayesian two-phase piecewise linear mixed models with a random change point were used to estimate children's individual growth trajectories. Cox proportional hazards models were used to assess the effects of associated growth parameters on the risks of IA and progression to T1D. RESULTS A higher rate of weight gain in infancy was associated with increased IA risk (hazard ratio [HR] 1.09 [95% CI 1.02, 1.17] per 1 kg/year). A height growth pattern with a lower rate in infancy (HR 0.79 [95% CI 0.70, 0.90] per 1 cm/year), higher rate in early childhood (HR 1.48 [95% CI 1.22, 1.79] per 1 cm/year), and younger age at the phase transition (HR 0.76 [95% CI 0.58, 0.99] per 1 month) was associated with increased risk of progression from IA to T1D. A higher rate of weight gain in early childhood was associated with increased risk of progression from IA to T1D (HR 2.57 [95% CI 1.34, 4.91] per 1 kg/year) in children with first-appearing GAD autoantibody only. CONCLUSIONS Growth patterns in early life better clarify how specific growth phases are associated with the development of T1D.

中文翻译：

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生命早期的不同生长阶段与 1 型糖尿病风险相关：TEDDY 研究。


目的 本研究调查生命早期的两阶段生长模式及其与胰岛自身免疫 (IA) 和 1 型糖尿病 (T1D) 发展的关系。研究设计和方法 青少年糖尿病环境决定因素 (TEDDY) 研究对瑞典、芬兰、德国和美国的 7,522 名遗传高危儿童进行了自出生起中位 9.0 年（四分位数间距 5.7-10.6）的跟踪调查，增长数据。其中，761 名（10.1%）儿童患有 IA，290 名（3.9%）儿童被诊断为 T1D。使用具有随机变化点的贝叶斯两相分段线性混合模型来估计儿童的个体生长轨迹。 Cox 比例风险模型用于评估相关生长参数对 IA 风险和进展为 T1D 的影响。结果 婴儿期体重增加率较高与 IA 风险增加相关（每 1 kg/年的风险比 [HR] 1.09 [95% CI 1.02, 1.17]）。身高生长模式在婴儿期较低（HR 0.79 [95% CI 0.70, 0.90] 每 1 厘米/年），在幼儿期较高（HR 1.48 [95% CI 1.22, 1.79] 每 1 厘米/年） ，并且相变时的年龄较小（HR 0.76 [95% CI 0.58, 0.99]/1 个月）与从 IA 进展为 T1D 的风险增加相关。仅首次出现 GAD 自身抗体的儿童中，幼儿期体重增加率较高与从 IA 进展为 T1D 的风险增加相关（每 1 kg/年 HR 2.57 [95% CI 1.34, 4.91]）。结论 生命早期的生长模式可以更好地阐明特定的生长阶段与 T1D 的发展之间的关系。