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ARE THERE COMMON FACTORS AFFECTING TYPE-1 DIABETES AND ASTHMA? (p 607)
February 21, 2001The occurrence of asthma and type-1 diabetes may be positively associated with each other at a population level, conclude authors of a research letter in this week's issue of THE LANCET.
Asthma and type-1 diabetes are immune-mediated atopic diseases with wide variations in occurrence worldwide, and there are indications of increasing trends in many countries. Studies dating back at least to the 1930s have shown that atopic diseases occur less often than expected in children with diabetes, and vice versa. The balance between T-helper 1/ T-helper 2 (Th1/Th2) immune responses provides a possible explanation for this observation. Type-1 diabetes is mediated by Th 1 responses whereas atopic diseases are mediated by Th 2 responses. The Th1/Th2 paradigm predicts a negative association between the diseases because Th1 and Th2 responses are mutually inhibitory.
Lars Stene and Per Nafstad from Aker University Hospital and the National Institute of Public Health, Oslo, Norway, analysed published data on the prevalence of wheeze (as a measure of asthma) in the past 12 months in children aged 13-14 years. They also looked at published data on frequency of type-1 diabetes in children aged 0-15 years. They aimed to investigate the relation between the occurrence of the two diseases at the population level. Diabetes data from Europe from 1989 to 1994 and outside Europe from 1971 to 1991 were used to generate two sets of data. Data for both disorders were available for 16 countries in Europe and 12 countries outside Europe. The investigators calculated the correlation between the frequency of both diseases; the results showed a positive association between the occurrence of type-1 diabetes and symptoms of asthma across countries, both in Europe and elsewhere. There was a tendency for high rates of both diseases in affluent countries, especially in English-speaking countries.
Lars Stene comments: "Our observation does not refute the hypothesis that Th1/Th2 balance plays a part in development of either disease. However, we think that general shifts in the Th1/Th2 balance at the population level are unlikely to be a major explanation of the change in frequency of both atopic diseases and type 1 diabetes. Our data indicate that factors affecting the proportion of individuals susceptible to inflammatory diseases, such as asthma and type-1 diabetes, may cluster in countries. The susceptibility might be attributable to genetic make-up, early environmental exposures, or both, priming individuals for later susceptibility to inflammatory disease".
Contact: Dr Lars Stene, Aker Diabetes Research Centre, Aker University Hospital, N-0514 Oslo, Norway; T) +47 2 204 2399; F) +47 2 204 2351; E) lars.christian.stene@folkehelsa.no
Lancet
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