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. 2022 Aug 31;19(17):10880.
doi: 10.3390/ijerph191710880.

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

Justine Tanoey  1 , Christina Baechle  2 , Hermann Brenner  3 , Andreas Deckert  4 , Julia Fricke  5 , Kathrin Günther  6 , André Karch  7 , Thomas Keil  5   8   9 , Alexander Kluttig  10 , Michael Leitzmann  11 , Rafael Mikolajczyk  10 , Nadia Obi  1 , Tobias Pischon  12   13   14 , Tamara Schikowski  15 , Sabine M Schipf  16 , Matthias B Schulze  17   18 , Anja Sedlmeier  11 , Ilais Moreno Velásquez  12 , Katharina S Weber  19 , Henry Völzke  16 , Wolfgang Ahrens  6 , Sylvia Gastell  17 , Bernd Holleczek  3 , Karl-Heinz Jöckel  20 , Verena Katzke  21 , Wolfgang Lieb  19 , Karin B Michels  22 , Börge Schmidt  20 , Henning Teismann  7 , Heiko Becher  1
Affiliations

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

Justine Tanoey et al. Int J Environ Res Public Health. .

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.

Keywords: NAKO; adult-onset; autoimmune; delivery mode; late-onset; offspring; perinatal; sex.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
German National Cohort (GNC) type 1 diabetes case identification algorithm based on age at diagnosis and treatment with insulin.
Figure 2
Figure 2
Age at diagnosis and insulin therapy by sex among the German National Cohort participants with type 1 diabetes.
See this image and copyright information in PMC

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