Microbial Exposure in Infancy and Subsequent Appearance of Type 1 Diabetes Mellitus–Associated Autoantibodies: A Cohort Study | Allergy and Clinical Immunology | JAMA Pediatrics | JAMA Network
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Original Investigation
August 2014

Microbial Exposure in Infancy and Subsequent Appearance of Type 1 Diabetes Mellitus–Associated Autoantibodies: A Cohort Study

Author Affiliations
  • 1The National Institute for Health and Welfare, Nutrition Unit, Helsinki, Finland
  • 2Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
  • 3The Science Center of Pirkanmaa Hospital District, Tampere, Finland
  • 4School of Health Sciences, University of Tampere, Tampere, Finland
  • 5University of Helsinki, Hjelt Institute, Helsinki, Finland
  • 6Department of Statistics, Faculty of Mathematics and Natural Sciences, University of Turku, Turku, Finland
  • 7Children’s Hospital, University of Helsinki, and University Central Hospital, Helsinki, Finland
  • 8University of Helsinki, Diabetes and Obesity Research Program, Helsinki, Finland
  • 9Department of Pediatrics, Faculty of Medicine, University of Turku, Turku, Finland
  • 10Immunogenetics Laboratory, University of Turku, Turku, Finland
  • 11Department of Clinical Microbiology, Faculty of Health Sciences, University of Eastern Finland, Kuopio
  • 12School of Medicine, University of Tampere, Tampere, Finland
  • 13Department of Pediatrics, University of Oulu, Oulu, Finland
  • 14Folkhälsan Research Center, Helsinki, Finland
JAMA Pediatr. 2014;168(8):755-763. doi:10.1001/jamapediatrics.2014.296

Importance  The role of microbial exposure during early life in the development of type 1 diabetes mellitus is unclear.

Objective  To investigate whether animal contact and other microbial exposures during infancy are associated with the development of preclinical and clinical type 1 diabetes.

Design, Setting, and Participants  A birth cohort of children with HLA antigen–DQB1–conferred susceptibility to type 1 diabetes was examined. Participants included 3143 consecutively born children at 2 hospitals in Finland between 1996 and 2004.

Exposures  The following exposures during the first year of life were assessed: indoor and outdoor dogs and cats, farm animals, farming, visit to a stable, day care, and exposure to antibiotics during the first week of life.

Main Outcomes and Measures  Clinical and preclinical type 1 diabetes were used as outcomes. The latter was defined as repeated positivity for islet-cell antibodies plus for at least 1 of 3 other diabetes-associated autoantibodies analyzed and/or clinical type 1 diabetes. The autoantibodies were analyzed at 3- to 12-month intervals since the birth of the child.

Results  Children exposed to an indoor dog, compared with otherwise similar children without an indoor dog exposure, had a reduced odds of developing preclinical type 1 diabetes (adjusted odds ratio [OR], 0.47; 95% CI, 0.28-0.80; P = .005) and clinical type 1 diabetes (adjusted OR, 0.40; 95% CI, 0.14-1.14; P = .08). All of the other microbial exposures studied were not associated with preclinical or clinical diabetes: the odds ratios ranged from 0.74 to 1.58.

Conclusions and Relevance  Among the 9 early microbial exposures studied, only the indoor dog exposure during the first year of life was inversely associated with the development of preclinical type 1 diabetes. This finding needs to be confirmed in other populations.