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.

The Alimini Lakes are two water bodies located in the south-eastern part of the Salento Peninsula. They are part of a complex hydrogeological system that includes various intercommunicating water bodies particularly sensitive to point and diffuse pollution. In consideration of the environmental and hygiene-health risks, from 1995 to 2014 the University of Salento and various public authorities, responsible for environmental quality in the Apulia region, conducted a series of monitoring activities to analyse the microbiological, toxicological and ecological quality of the waters throughout the hydrogeological system. The studies made it possible to: quantify the input of fresh water and nutrients to the lakes, revealing a greater environmental risk for Fontanelle as a result of the reduced exchange of waters; identify diffuse contamination of faecal origin linked to the anthropization of the surrounding area, which may have affected the stretch of sea near the mouth of the seaward channel and the underlying aquifer; highlight chemical and toxic risk factors arising from agricultural activities; and identify potential consequences for human health linked to the use of the waters (for domestic purposes, agriculture, recreation, etc.). However, the results of the investigations conducted revealed the gradual improvement of the quality of the waters in the two lakes and the hydrological networks that feed them.

CHRIS R. CARDWELL, PHD LARS C. STENE, PHD JOHNNY LUDVIGSSON, MD, PHD JOACHIM ROSENBAUER, MD, DIPL MATH ONDREJ CINEK, MD, PHD JANNET SVENSSON, PHD FRANCISCO PEREZ-BRAVO, PHD ANJUM MEMON, MBBS, DPHIL SUELY G. GIMENO, DPH EMMA J.K. WADSWORTH, PHD ELSA S. STROTMEYER, PHD MICHAEL J. GOLDACRE, FFPHM KATJA RADON, PHD LEE-MING CHUANG, MD, PHD ROGER C. PARSLOW, PHD AMANDA CHETWYND, PHD KYRIAKI KARAVANAKI, MD, PHD GIRTS BRIGIS, MD, PHD PAOLO POZZILLI, MBBS, MD BRONE URBONAIT _ E, MD, PHD EDITH SCHOBER, MD GABRIELE DEVOTI, MD SANDRA SIPETIC, MD, PHD GEIR JONER, MD, PHD CONSTANTIN IONESCU-TIRGOVISTE, MD, PHD CARINE E. DE BEAUFORT, MD, PHD KIRSTEN HARRILD, MSC VICTORIA BENSON, PHD ERKKI SAVILAHTI, MD, PHD ANNE-LOUISE PONSONBY, MBBS, PHD MONA SALEM, MD SAMIRA RABIEI, MSC CHRIS C. PATTERSON, PHD

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 <3 years compared with longer interbirth intervals (OR 0.82 [95% CI 0.72–0.93]). Adjustments for various potential confounders little altered this estimate. In conclusion, there was evidence of a 20% reduction in the risk of childhood diabetes in children born to mothers after interbirth intervals <3 years.

OBJECTIVE-To investigate if there is a reduced risk of type 1 diabetes in children breastfed or exclusively breastfed by performing a pooled analysis with adjustment for recognized confounders.RESEARCH DESIGN AND METHODS-Relevant studies were identified from literature searches using MEDLINE, Web of Science, and EMBASE. Authors of relevant studies were asked to provide individual participant data or conduct prespecified analyses. Meta-analysis techniques were used to combine odds ratios (ORs) and investigate heterogeneity between studies.RESULTS-Data were available from 43 studies including 9,874 patients with type 1 diabetes. Overall, there was a reduction in the risk of diabetes after exclusive breast-feeding for >2 weeks (20 studies; OR = 0.75, 95% CI 0.64-0.88), the association after exclusive breast-feeding for >3 months was weaker (30 studies; OR = 0.87, 95% CI 0.75-1.00), and no association was observed after (nonexclusive) breast-feeding for >2 weeks (28 studies; OR = 0.93, 95% CI 0.81-1.07) or >3 months (29 studies; OR = 0.88, 95% CI 0.78-1.00). These associations were all subject to marked heterogeneity (I-2 = 58, 76, 54, and 68%, respectively). In studies with lower risk of bias, the reduced risk after exclusive breast-feeding for >2 weeks remained (12 studies; OR = 0.86, 95% CI 0.75-0.99), and heterogeneity was reduced (I-2 = 0%). Adjustments for potential confounders altered these estimates very little.CONCLUSIONS-The pooled analysis suggests weak protective associations between exclusive breast-feeding and type 1 diabetes risk. However, these findings are difficult to interpret because of the marked variation in effect and possible biases (particularly recall bias) inherent in the included studies. Diabetes Care 35: 2215-2225, 2012

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.

BACKGROUNDThe 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.METHODSRelevant 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.RESULTSData 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 (I² = 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; I² = 23%).CONCLUSIONAlthough 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.

Background: Type 1 diabetes is an autoimmune disease. Genetics as well as environmental factors seem to play a role in the pathogenesis of type 1 diabetes. Aims: We sought to investigate the possible relationship between migration from Sardinia to a low incidence area of type 1 diabetes (Lombardy) and the prevalence of autoantibody positivity. Methods: We enrolled 554 Sardinian immigrants and 226 of their offspring. All subjects underwent a complete anamnestic evaluation. Fasting blood glucose, HbA1c, GADA and IA-2 were measured in all study participants. Additionally, the presence of risk haplotypes (HLA-DR3 –DR4 and DQB1/0302) was determined. After a seven-year follow-up, high genetic risk and/or autoantibody positivity subjects were re-evaluated. Results: Among Sardinian immigrants, the prevalence of type 1 diabetes was 0.9%, while in the offspring group, the prevalence was 0.4%. After removing type 1 diabetic patients, the GADA prevalence was 2.4% in the immigrant group and 3.8% among their offspring. Among Sardinian immigrants, the IA-2 prevalence was 0.7%, while all offspring were IA-2 negative. After a seven-year follow-up, 85.7% of GADA-positive migrants had persistent GADA positivity. Two GADA-negative offspring subjects turned positive. None of the study participants developed diabetes during the follow-up. Conclusions: The present study showed a higher prevalence of GADA positivity within Sardinian immigrants at high genetic risk; GADA positivity may represent the first detectable phase of type 1 diabetes. After a seven-year follow-up, none of the high genetic/antibody risk group subjects developed type 1 diabetes. However, it seems reasonable to strictly control high-risk individuals in order to diagnose subclinical diabetes.

OBJECTIVE to describe the prevalence of smokers among 13- 18-years-old students in Lombardy and to evaluate some related motives. DESIGN a survey has been carried out with anonymous questionnaires, distributed at the beginning of the school year 2005-2006. SETTING the study involved 3,593 classes of the third year of middle school and 2,893 classes of the second and the fifth year of high school, sampled among all the schools of Lombardy. PARTICIPANTS the study interested 11,494 students aged either 13, 15 or 18. MAIN OUTCOME MEASURES the prevalence of habitual smokers was 6%, 26.5% and 33.2%. RESULTS a higher percentage of smokers report to have low school performances and to receive more than 15 euros as weekly tip. The number of smokers among family components and friends always appears higher for smoker students. Unemployed fathers and working mothers were higher among smokers. Both parents of smoker students have a lower educational level. CONCLUSION an organized and systematic regional surveillance could highlight some characteristics of smoking habit among young students useful to set health education programs and to evaluate the efficacy of interventions already being carried out. Besides, it could enhance the awareness of the problem.

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.

The objective of the study was to evaluate the association between infectious diseases and other events pertaining to childhood medical history and type 1 diabetes. 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. 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 correlated to type 1 diabetes; an inverse correlation 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). Most associations of the studied variables confirm already known findings. The significant inverse correlation of type 1 diabetes with scarlet fever history is a peculiar finding, the meaning of which is still obscure, although it has been recently described that streptococcal A infections are regulated by HLA class II alleles.

Aims To examine incidence and trends of Type 1 diabetes worldwide for the period 1990-1999.Methods The incidence of Type 1 diabetes (per 100 000/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 43 013 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 100 000/year in China and Venezuela to 40.9 per 100 000/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.

The aim of this paper was to evaluate the relationship between socioeconomic indicators (education, occupation and residence) and short-term CHD mortality in an Italian population sample. Socioeconomic indicators and major CHD risk factors (BMI, SBP, DBP, TOT-CH, HDL-CH and TRIG) were measured in 15,315 males aged 40-69 years; mortality data by cause were collected for the next six years. CHD mortality risk ratio (RR) in the different educational and occupational levels and by residence was computed by Cox proportional hazards models. The association between socioeconomic indicators and CHD risk factors was explored by covariance and logistic regression analysis. After six years, 632 men died, 181 of whom because of coronary fatalities. No association with educational level was found for CHD mortality (RR = 1.00 high, 0.69 intermediate, 0.92 low), nor did occupational level show a significant association. Urban vs rural residence (RR = 1.00) showed a RR for CHD mortality of 1.35. Adjustment for bio-behavioral risk factors did not change the above results; only mortality for CHD of urban vs rural residents increased (RR = 1.63, p < 0.003). By considering the interaction between schooling and occupation, it was found that education appropriated to occupational level was a protective factor. The study does not indicate any association between education/occupational level and CHD mortality in male RIFLE population samples. The mean level of major CHD risk factors within different educational/occupational levels supports these results. Status incongruity as well as residence in an urban environment proved to be risk conditions for CHD mortality.