ArticlesIntake of vitamin D and risk of type 1 diabetes: a birth-cohort study
Introduction
Exactly what causes the destruction of insulin secreting β cells in the pancreas, and thus the development of type 1 diabetes, remains unknown, though cytokines, T cells, and macrophages have all been implicated.1 In vitro, vitamin D acts as an immunosuppressive agent, reducing lymphocyte proliferation and cytokine production.2 Furthermore, in animals, the administration of vitamin D (1,25 (OH)2D3) seems to prevent development of type 1 diabetes.3, 4
Factors in infancy can affect the risk of development of diabetes in later life. The results of a large case-control study suggest that vitamin D supplementation during early childhood can prevent type 1 diabetes.5 Another study also found an inverse relation between maternal use of cod liver oil during pregnancy and the frequency of type 1 diabetes in their children.6 Our aim was to ascertain whether or not dietary supplementation with vitamin D in infancy could reduce the risk of type 1 diabetes.
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Participants
All women (n=12 055) living in Oulu and Lapland, northern Finland, whose pregnancy continued after the 24th week of gestation, and for whom the estimated date of delivery fell during 1966 were enrolled.7 Between the 24th and 28th week of gestation, the women were asked to fill in a questionnaire to obtain background information. A questionnaire about the birth and the status of the neonate was filled in by the attending midwife.7 12 058 children were born alive out of 12 231 births. 10 821 (91%
Results
9124 (88·0%) children were given vitamin D supplements regularly, and 1210 (11·7%) irregularly. 32 (0·3%) infants were not given vitamin D. Of those who received vitamin D regularly, 8582 (94%) had the recommended daily amount, and 434 (5%) and 71 (1%) received more or less than the recommended amount, respectively. In the first year of life, 216 (2%) children who took vitamin D had suspected rickets (table 1). Of these, dietary supplementation was irregular in 56 (26%), and 132 (61%) had
Discussion
Our results suggest that development of type 1 diabetes is associated with low intake of vitamin D and signs of rickets during the first year of life. In view of the fact that vitamin D acts as an immunosuppressive agent,2, 12 and that type 1 diabetes is believed to be an autoimmune disease,1 these findings are not surprising. To be classified as an autoimmune disease, the progress of the disorder must be slowed down or prevented by immunosuppressive therapy.13 We believe that vitamin D might
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