Exposure to Environmental Factors in Drinking Water: Risk of Islet Autoimmunity and Type 1 Diabetes – The BABYDIAB Study

Abstract

Type 1 diabetes (T1D) is characterized by autoimmunity against pancreatic islets, and autoantibodies may be present for years before diagnosis. Environmental factors during early life, including drinking water, may play a role in pathogenesis of T1D. The German BABYDIAB study is a prospective observational study that followed newborn offspring of mothers or fathers with T1D from birth to 17 years of age. The present study was a nested case-control analysis, where subjects with islet autoimmunity were defined as cases (n=95), those without as controls (n=139). Drinking water quality was obtained from the German Water Supply Authorities for the participating families for the first year of the child's life. There was no significant association between water acidity or drinking water quality (concentration of minerals and elements) and islet autoimmunity risk. Increased progression to diabetes in islet autoantibody-positive children was associated with exposure to water with lower pH values (less than cohort median, 7.62; odds ratio [OR]: 2.5; 95% confidence interval [CI]: 1.1–5.7; p=0.03) but was not significant after correction for multiple comparisons. Concentrations of nitrate, nitrite, iron, aluminum, and manganese were not associated with risk of T1D progression. This is the first prospective study with water quality measured before the onset of islet autoimmunity and T1D. Consistent with a previous cross-sectional case–control study, we found an association between drinking water pH and the rate of T1D development in at-risk children. The association is marginal and requires validation in other prospective cohorts.

drinking water - type 1 diabetes - autoantibodies - islets - early life

References

• 1 Achenbach P, Bonifacio E, Koczwara K, Ziegler AG. Natural history of type 1 diabetes.  Diabetes. 2005;  54 ((Suppl 2)) S25-S31
• 2 Elfving M, Lindberg B, Lynch K, Ivarsson S-A, Lernmark A, Hampe CS. Epitope analysis of gad65 binding in both cord blood and at the time of clinical diagnosis of childhood type 1 diabetes.  Horm Metab Res. 2007;  39 790-796
• 3 Knip M, Akerblom HK. Early nutrition and later diabetes risk.  Adv Exp Med Biol. 2005;  569 142-150
• 4 Virtanen SM, Knip M. Nutritional risk of â cell autoimmunity and type 1 diabetes at a young age.  Am J Clin Nutr. 2003;  78 1053-1067
• 5 Knip M. Environmental triggers and determinants of beta-cell autoimmunity and type 1 diabetes.  Rev Endocr Metab Disord. 2003;  4 213-223
• 6 Akerblom HK, Vaarala O, Hyöty H, Ilonen J, Knip M. Environmental factors in the etiology of type 1 Diabetes.  Am J Med Genet. 2002;  115 18-29
• 7 Haglund B, Ryckenberg K, Selinus O, Dahlquist G. Evidence of a relationship between childhood-onset type I diabetes and low groundwater concentration of zinc.  Diabetes Care. 1996;  19 873-875
• 8 Stene LC, Hongve D, Magnus P, Ronningen KS, Joner G. Acidic drinking water and risk of childhood-onset type 1 diabetes.  Diabetes Care. 2002;  25 1534-1538
• 9 Zhao HX, Mold MD, Stenhouse EA, Bird SC, Wright DE, Demaine AG. et al . Drinking water composition and childhood-onset type 1 diabetes mellitus in Devon and Cornwall, England.  Diabet Med. 2001;  18 709-717
• 10 Kostraba JN, Gay EC, Rewers M, Hamman RF. Nitrate levels in community drinking waters and risk of IDDM. An ecological analysis.  Diabetes Care. 1992;  15 1505-1508
• 11 Parslow RC, MacKinney PA, Law GR, Staines A, Williams R, Bodansky HJ. Incidence of childhood diabetes mellitus in Yorkshire, northern England, is associated with nitrate in drinking water: an ecological analysis.  Diabetologia. 1997;  40 550-556
• 12 Ziegler AG, Hummel M, Schenker M, Bonifacio E. Autoantibody appearance and risk for development of childhood diabetes in offspring of parents with type 1 diabetes: the 2-year analysis of the German BABYDIAB Study.  Diabetes. 1999;  48 460-468
• 13 Schenker M, Hummel M, Ferber K, Walter M, Keller E, Albert ED. et al . Early expression and high prevalence of islet autoantibodies for DR3/4 heterozygous and DR4/4 homozygous offspring of parents with Type I diabetes: the German BABYDIAB study.  Diabetologia. 1999;  42 671-677
• 14 Huppmann M, Baumgarten A, Ziegler AG, Bonifacio E. Neonatal Bacille Calmette-Guerin vaccination and type 1 diabetes.  Diabetes Care. 2005;  28 1204-1206

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