title: High birth weights but not excessive weight gain prior to manifestation are related to earlier onset of diabetes in childhood: 'accelerator hypothesis' revisited.
abstract: OBJECTIVE
  Aim of this study was to test Wilkin's 'accelerator hypothesis': whether excessive weight gain accelerates the onset of type 1 diabetes.
  
  
  METHODS
  Anthropometric birth data of 1117 children who developed diabetes between 1988 and April 2013 were compared with those of a sex, age, and gestational age matched, contemporary regional control group (n = 54 344). Cases were divided into three manifestation groups (G1:0-4.9 yr, G2:5-9.9 yr, and G3: 10-20 yr). Furthermore, growth data of 540 children with diabetes were compared with controls (n = 134 249) in pre-, peri-, and post-onset intervals (interval: 1-6). Also, correlation of age at onset and body mass index (BMI) standard deviation score (SDS) at this point of time were examined.
  
  
  RESULTS
  Cases had significantly higher SDSs for birth weight when compared with controls (boys: p = 0.007, girls: p = 0.002). Children with early manifestation had the highest mean of birth weight SDS (G1>G2>G3), (p = 0.22, adjusted r(2) = 0.001). BMI SDS trend curves of cases are slightly higher compared with those of the healthy controls. This was only significant in years after diagnosis (interval 6, p < 0.000). Cases did not show excessive weight gain in any of the examined intervals before the onset of diagnosis (interval 1-3). One year after diagnosis, we found an inverse correlation between age at diagnosis and BMI SDS at diabetes manifestation. The youngest children at diagnosis (G1) had the lowest BMI SDS at manifestation and vice versa (G1<G2<G3, p = 0.06).
  
  
  CONCLUSIONS
  Our data do not support the 'accelerator hypothesis'. There was no sign of excessive weight gain before manifestation. Discrepant results from other studies could be due to non-age-adjusted controls.
authors.affiliation: Department of Woman and Child Health, Centre of Paediatric Research, Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany.
authors.forename: Veronika
authors.initials: V
authors.lastname: Kuchlbauer
authors.forename: Mandy
authors.initials: M
authors.lastname: Vogel
authors.forename: Ruth
authors.initials: R
authors.lastname: Gausche
authors.forename: Thomas
authors.initials: T
authors.lastname: Kapellen
authors.forename: Ulrike
authors.initials: U
authors.lastname: Rothe
authors.forename: Christian
authors.initials: C
authors.lastname: Vogel
authors.forename: Roland
authors.initials: R
authors.lastname: Pfäffle
authors.forename: Wieland
authors.initials: W
authors.lastname: Kiess
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001724:Birth Weight / Q000502:physiology*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D005320:Fetal Macrosomia / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008962:Models, Theoretical; D015430:Weight Gain / Q000502:physiology*; D055815:Young Adult
keywords: BMI; accelerator hypothesis; body mass index; type 1 diabetes mellitus; weight gain