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Background Lifestyles profoundly determine the quality of an individual’s health and life since his childhood. Many diseases in adulthood are avoidable if health-risk behaviors are identified and improved at an early stage of life. The aim of the present research was to characterize a cohort of children aged 6–8 years selected in order to perform an epidemiological molecular study (the MAPEC_LIFE study), investigate lifestyles of the children that could have effect on their health status, and assess possible association between lifestyles and socio-cultural factors. Methods A questionnaire composed of 148 questions was administered in two different seasons to parents of children attending 18 primary schools in five Italian cities (Torino, Brescia, Pisa, Perugia and Lecce) to obtain information regarding the criteria for exclusion from the study, demographic, anthropometric and health information on the children, as well as some aspects on their lifestyles and parental characteristics. The results were analyzed in order to assess the frequency of specific conditions among the different seasons and cities and the association between lifestyles and socio-economic factors. Results The final cohort was composed of 1,164 children (50.9 boys, 95.4% born in Italy). Frequency of some factors appeared different in terms of the survey season (physical activity in the open air, the ways of cooking certain foods) and among the various cities (parents’ level of education and rate of employment, sport, traffic near the home, type of heating, exposure to passive smoking, ways of cooking certain foods). Exposure to passive smoking and cooking fumes, obesity, residence in areas with heavy traffic, frequency of outdoor play and consumption of barbecued and fried foods were higher among children living in families with low educational and/or occupational level while children doing sports and consuming toasted bread were more frequent in families with high socio-economic level. Conclusions The socio-economic level seems to affect the lifestyles of children enrolled in the study including those that could cause health effects. Many factors are linked to the geographical area and may depend on environmental, cultural and social aspects of the city of residence.

Aims. To examine incidence and trends of Type 1 diabetes worldwide for the period 1990–1999. Methods. The incidence of Type 1 diabetes (per 100000/year) was analysed in children aged ≤ 14 years from 114 populations in 112 centres in 57 countries. Trends in the incidence of Type 1 diabetes were analysed by fitting Poisson regression models to the dataset. Results. A total of 43013 cases were diagnosed in the study populations of 84 million children. The age-adjusted incidence of Type 1 diabetes among 112 centres (114 populations) varied from 0.1 per 100000/year in China and Venezuela to 40.9 per 100000/year in Finland. The average annual increase in incidence calculated from 103 centres was 2.8% (95% CI 2.4–3.2%). During the years 1990–1994, this increase was 2.4% (95% CI 1.3–3.4%) and during the second study period of 1995–1999 it was slightly higher at 3.4% (95% CI 2.7– 4.3%). The trends estimated for continents showed statistically significant increases all over the world (4.0% in Asia, 3.2% in Europe and 5.3% in North America), except in Central America and the West Indies where the trend was a decrease of 3.6%. Only among the European populations did the trend in incidence diminish with age. Conclusions. The rising incidence of Type 1 diabetes globally suggests the need for continuous monitoring of incidence by using standardized methods in order to plan or assess prevention strategies.

Aims - Evaluation of the association among infectious diseases and other events pertaining to childhood medical history and type 1 diabetes. Methods - A case-control study was carried out, taking as cases 159 type 1 diabetic patients (0-29 years) recorded from 1988 to 2000 within the population registry of the Pavia province (North Italy). As controls 318 non diabetic subjects were matched by age and sex. A questionnaire was administered by standardised interviewers. Data were analysed by conditional logistic regression. Results - Viral childhood diseases (OR 4.29; 95%CI 1.57-11.74) and bottle feeding (OR 1.83; 95%CI 1.08-3.09) were directly associated to type 1 diabetes; an inverse association was found for vitamin D administration during lactation (0-14 years) (OR 0.31; 95%CI 0.11-0.86) and for history of scarlet fever in both sexes and age groups (OR 0.19; 95%CI 0.08-0.46). Conclusions - Most associations of the studied variables confirm already known findings. The significant inverse association of type 1 diabetes with scarlet fever history is a peculiar finding, whose meaning is still obscure, although it has been recently described that streptococcal A infections are regulated by HLA class II alleles.

Short interbirth interval has been associated with maternal complications and childhood autism and leukemia, possibly due to deficiencies in maternal micronutrients at conception or increased exposure to sibling infections. A possible association between interbirth interval and subsequent risk of childhood type 1 diabetes has not been investigated. A secondary analysis of 14 published observational studies of perinatal risk factors for type 1 diabetes was conducted. Risk estimates of diabetes by category of interbirth interval were calculated for each study. Random effects models were used to calculate pooled odds ratios (ORs) and investigate heterogeneity between studies. Overall, 2,787 children with type 1 diabetes were included. There was a reduction in the risk of childhood type 1 diabetes in children born to mothers after interbirth intervals

Czech Republic Ministry of Education Department of Health of Taiwan Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Swedish Child Diabetes Foundation NHS National Coordinating Centre for Research Capacity Development UK Australian National Health and Medical Research Council (NHMRC) Research Council of Norway German Research Foundation Ministry for Science and Technological Development of Serbia European Commission Health Information Strand Diabetes UK Northern Ireland Department of Health and Social Services Background the incidence rates of childhood onset type 1 diabetes are almost universally increasing across the globe but the aetiology of the disease remains largely unknown. We investigated whether birth order is associated with the risk of childhood diabetes by performing a pooled analysis of previous studies.Methods Relevant studies published before January 2010 were identified from MEDLINE, Web of Science and EMBASE. Authors of studies provided individual patient data or conducted pre-specified analyses. Meta-analysis techniques were used to derive combined odds ratios (ORs), before and after adjustment for confounders, and investigate heterogeneity.Results Data were available for 6 cohort and 25 case-control studies, including 11 955 cases of type 1 diabetes. Overall, there was no evidence of an association prior to adjustment for confounders. After adjustment for maternal age at birth and other confounders, a reduction in the risk of diabetes in second- or later born children became apparent [fully adjusted OR = 0.90 95% confidence interval (CI) 0.83-0.98; P = 0.02] but this association varied markedly between studies (I(2) = 67%). An a priori subgroup analysis showed that the association was stronger and more consistent in children < 5 years of age (n = 25 studies, maternal age adjusted OR = 0.84 95% CI 0.75, 0.93; I(2) = 23%).Conclusion Although the association varied between studies, there was some evidence of a lower risk of childhood onset type 1 diabetes with increasing birth order, particularly in children aged < 5 years. This finding could reflect increased exposure to infections in early life in later born children. Queens Univ Belfast, Ctr Publ Hlth, Sch Med Dent & Biomed Sci, Belfast BT12 6BJ, Antrim, North Ireland Norwegian Inst Publ Hlth, Div Epidemiol, Oslo, Norway Oslo Univ Hosp, Oslo Diabet Res Ctr, Oslo, Norway Univ Oslo, Inst Hlth Management & Hlth Econ, Oslo, Norway Univ Western Australia, Telethon Inst Child Hlth Res, Ctr Child Hlth Res, Perth, WA 6009, Australia Univ Notre Dame, Inst Hlth & Rehabil Res, Fremantle, Australia Charles Univ Prague, Sch Med 2, Prague, Czech Republic Univ Dusseldorf, Leibniz Inst, Inst Biometr & Epidemiol, German Diabet Ctr, Dusseldorf, Germany Linkoping Univ, Dept Paediat, Linkoping, Sweden Linkoping Univ, Diabet Res Ctr, Linkoping, Sweden Glostrup Univ Hosp, Dept Pediat, Glostrup, Denmark Univ Oxford, Dept Publ Hlth, Oxford, England Med Univ Vienna, Dept Epidemiol, Vienna, Austria Med Univ Silesia, Dept Pediat Endocrinol & Diabet, Katowice, Poland Universidade Federal de São Paulo, Dept Prevent Med, São Paulo, Brazil Natl Taiwan Univ Hosp, Dept Internal Med, Taipei 100, Taiwan Univ Sydney, Kolling Inst Med Res, Sydney, NSW 2006, Australia Univ Leeds, Paediat Epidemiol Grp, Leeds, W Yorkshire, England Cardiff Univ, Ctr Occupat & Hlth Psychol, Cardiff, S Glam, Wales Univ Lancaster, Dept Math & Stat, Lancaster, England Riga Stradins Univ, Dept Publ Hlth & Epidemiol, Riga, Latvia Kaunas Univ Med, Inst Endocrinol, Kaunas, Lithuania Univ Belgrade, Sch Med, Inst Epidemiol, Belgrade, Serbia Med Univ Vienna, Dept Paediat, Vienna, Austria Univ Lecce, Dept Social Sci & Commun, I-73100 Lecce, Italy N Paulescu Inst Diabet, Nutr & Metab Dis Clin, Bucharest, Romania Pediat Clin, Luxembourg, Luxembourg Childrens Diabet Ctr, Sofia, Bulgaria Rigshosp, Bartholin Inst, DK-2100 Copenhagen, Denmark Hosp LMU Munich, Inst Occupat & Environm Med, Munich, Germany Hosp LMU Munich, Outpatient Clin Occupat & Environm Med, Munich, Germany Sir Charles Gairdner Hosp, Perth, WA, Australia Universidade Federal de São Paulo, Dept Prevent Med, São Paulo, Brazil Czech Republic Ministry of Education: MSM 0021620814 Department of Health of Taiwan: DOH 90-TD1028 FAPESP: 94/0943-0 Australian National Health and Medical Research Council (NHMRC): 457302 German Research Foundation: HE 234/1-1 Ministry for Science and Technological Development of Serbia: 145084 European Commission Health Information Strand: 2007115 Web of Science

OBJECTIVE The aim if the study was to investigate whether children born to older mothers have an increased risk of type 1 diabetes by performing a pooled analysis of previous studies using individual patient data to adjust for recognized confounders. RESEARCH DESIGN AND METHODS Relevant studies published before June 2009 were identified from MEDLINE, Web of Science, and EMBASE. Authors of studies were contacted and asked to provide individual patient data or conduct prespecified analyses. Risk estimates of type 1 diabetes by maternal age were calculated for each study, before and after adjustment for potential confounders. Meta-analysis techniques were used to derive combined odds ratios and to investigate heterogeneity among studies. RESULTS Data were available for 5 cohort and 25 case-control studies, including 14,724 cases of type 1 diabetes. Overall, there was, on average, a 5% (95% CI 2–9) increase in childhood type 1 diabetes odds per 5-year increase in maternal age (P = 0.006), but there was heterogeneity among studies (heterogeneity I2 = 70%). In studies with a low risk of bias, there was a more marked increase in diabetes odds of 10% per 5-year increase in maternal age. Adjustments for potential confounders little altered these estimates. CONCLUSIONS There was evidence of a weak but significant linear increase in the risk of childhood type 1 diabetes across the range of maternal ages, but the magnitude of association varied between studies. A very small percentage of the increase in the incidence of childhood type 1 diabetes in recent years could be explained by increases in maternal age.

AIMS/HYPOTHESIS: The aim of this study was to investigate the evidence of an increased risk of childhood-onset type 1 diabetes in children born by Caesarean section by systematically reviewing the published literature and performing a meta-analysis with adjustment for recognised confounders. METHODS: After MEDLINE, Web of Science and EMBASE searches, crude ORs and 95% CIs for type 1 diabetes in children born by Caesarean section were calculated from the data reported in each study. Authors were contacted to facilitate adjustments for potential confounders, either by supplying raw data or calculating adjusted estimates. Meta-analysis techniques were then used to derive combined ORs and to investigate heterogeneity between studies. RESULTS: Twenty studies were identified. Overall, there was a significant increase in the risk of type 1 diabetes in children born by Caesarean section (OR 1.23, 95% CI 1.15-1.32, p < 0.001). There was little evidence of heterogeneity between studies (p = 0.54). Seventeen authors provided raw data or adjusted estimates to facilitate adjustments for potential confounders. In these studies, there was evidence of an increase in diabetes risk with greater birthweight, shorter gestation and greater maternal age. The increased risk of type 1 diabetes after Caesarean section was little altered after adjustment for gestational age, birth weight, maternal age, birth order, breast-feeding and maternal diabetes (adjusted OR 1.19, 95% CI 1.04-1.36, p = 0.01). CONCLUSIONS/INTERPRETATION: This analysis demonstrates a 20% increase in the risk of childhood-onset type 1 diabetes after Caesarean section delivery that cannot be explained by known confounders.