Day Care Attendance and Risk of Type 1 Diabetes: A Meta-Analysis and Systematic Review.

IF 24.7 1区医学 Q1 PEDIATRICS JAMA Pediatrics Pub Date : 2024-11-04 DOI:10.1001/jamapediatrics.2024.4361

Susanna Tall, Suvi M Virtanen, Mikael Knip

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Abstract

Importance: A meta-analysis published in 2001 suggested that exposure to infections measured by day care attendance may be important in the pathogenesis of type 1 diabetes. Several new studies on the topic have since been published.

Objective: To investigate the association between day care attendance and risk of type 1 diabetes and to include all available literature up to March 10, 2024.

Data sources: Data from PubMed and Web of Science were used and supplemented by bibliographies of the retrieved articles and searched for studies assessing the association between day care attendance and risk of type 1 diabetes.

Study selection: Studies that reported a measure of association between day care attendance and risk of type 1 diabetes were included.

Data extraction and synthesis: Details, including exposure and outcome assessment and adjustment for confounders, were extracted from the included studies. The multivariable association with the highest number of covariates, lowest number of covariates, and unadjusted estimates and corresponding 95% CIs were extracted. DerSimonian and Laird random-effects meta-analyses were performed and yielded conservative confidence intervals around relative risks.

Main outcomes and measures: The principal association measure was day care attendance vs no day care attendance and risk of type 1 diabetes.

Results: Seventeen articles including 22 observational studies of 100 575 participants were included in the meta-analysis. Among the participants, 3693 had type 1 diabetes and 96 882 were controls. An inverse association between day care attendance and risk of type 1 diabetes was found (combined odds ratio, 0.68; 95% CI, 0.58-0.79; P < .001; adjusted for all available confounders). When the 3 cohort studies included were analyzed separately, the risk of type 1 diabetes was 15% lower in the group attending day care; however, the difference was not statistically significant (odds ratio, 0.85; 95% CI, 0.59-1.12; P = .37).

Conclusions and relevance: These results demonstrated that day care attendance appears to be associated with a reduced risk of type 1 diabetes. Increased contacts with microbes in children attending day care compared with children who do not attend day care may explain these findings. However, further prospective cohort studies are needed to confirm the proposed association.

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参加日托与罹患 1 型糖尿病的风险：元分析和系统回顾

重要性：2001 年发表的一项荟萃分析表明，通过日托机构的出勤率来衡量是否受到感染，可能对 1 型糖尿病的发病机制有重要影响。此后，又有几项新的相关研究发表：调查日间护理出席率与 1 型糖尿病风险之间的关联，并纳入截至 2024 年 3 月 10 日的所有可用文献：数据来源：我们使用了 PubMed 和 Web of Science 的数据，并对检索到的文章的参考书目进行了补充，以搜索评估日托出席率与 1 型糖尿病风险之间关联的研究：数据提取与综合：从纳入的研究中提取详细信息，包括暴露和结果评估以及混杂因素调整。数据提取：从纳入的研究中提取了包括暴露和结果评估以及混杂因素调整在内的详细信息，并提取了具有最多协变因素、最少协变因素以及未调整估计值和相应 95% CI 的多变量关联。进行了 DerSimonian 和 Laird 随机效应荟萃分析，得出了相对风险的保守置信区间：主要结果和测量方法：主要的关联测量方法是参加日托与不参加日托与 1 型糖尿病风险的关系：荟萃分析纳入了 17 篇文章，包括 22 项观察性研究，共有 100 575 名参与者。其中，3693 人患有 1 型糖尿病，96882 人为对照组。研究发现，参加日托与罹患 1 型糖尿病的风险呈反向关系（综合几率比为 0.68；95% CI 为 0.58-0.79；P 结论及意义：这些结果表明，参加日托似乎与降低罹患 1 型糖尿病的风险有关。与不参加日托的儿童相比，参加日托的儿童与微生物的接触增加，这可能是这些发现的原因。不过，还需要进一步的前瞻性队列研究来证实所提出的关联。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JAMA Pediatrics PEDIATRICS-

CiteScore

31.60

自引率

1.90%

发文量

357

期刊介绍： JAMA Pediatrics, the oldest continuously published pediatric journal in the US since 1911, is an international peer-reviewed publication and a part of the JAMA Network. Published weekly online and in 12 issues annually, it garners over 8.4 million article views and downloads yearly. All research articles become freely accessible online after 12 months without any author fees, and through the WHO's HINARI program, the online version is accessible to institutions in developing countries. With a focus on advancing the health of infants, children, and adolescents, JAMA Pediatrics serves as a platform for discussing crucial issues and policies in child and adolescent health care. Leveraging the latest technology, it ensures timely access to information for its readers worldwide.