Reviews in Endocrine and Metabolic Disorders

, Volume 7, Issue 3, pp 149–162 | Cite as

Environmental factors in the development of Type 1 diabetes

  • Hui Peng
  • William Hagopian


Environmental factors appear to play an important role in the pathogenesis of childhood-onset type 1 diabetes (T1D). The most important factors are thought to be infectious, dietary, perinatal, and psychosocial. Enteroviruses (especially Coxsackie B virus), breastfeeding, the early presence or lack of certain foods, birth weight, childhood over-nutrition, maternal islet autoimmunity, and negative stress events have been shown to be related to the prevalence of T1D. However, clear conclusions to date are limited because most studies lacked power to detect exposure/disease associations, were not prospective or long-term, did not start in infancy, had imprecise or infrequent exposure estimates, had confounding exposures, and failed to account for genetic susceptibility. In addition to the identification of specific antigenic triggers, several more general hypotheses, including the accelerator and hygiene hypotheses, are testable approaches worth pursuing.


Autoimmunity Infectious Dietary Perinatal Psychosocial Nutrition Gene-environment 



(type 1 diabetes)


(human enterovirus)


(human leukocyte antigen)


(glutamic acid decarboxylase)



We acknowledge the support of the TEDDY consurtium by NIDDK, NIAID, and JDRF (DK063829) and support of our population-based T1D studies by the Hussman Foundation.


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Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Pacific Northwest Research InstituteSeattleUSA
  2. 2.Dept. of MedicineUniv. of WashingtonSeattleUSA

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