Diabetologia

, Volume 60, Issue 11, pp 2226–2230 | Cite as

Immigration to Israel during childhood is associated with diabetes at adolescence: a study of 2.7 million adolescents

  • Alon Peled
  • Barak Gordon
  • Gilad Twig
  • Joseph Mendlovic
  • Estela Derazne
  • Michal Lisnyansky
  • Itamar Raz
  • Arnon Afek
Short Communication

Abstract

Aims/hypothesis

Immigration studies can shed light on diabetes pathogenesis and risk factors. To this end, we investigated the association between age at immigration and diabetes occurrence at adolescence among immigrants to Israel.

Methods

We analysed cross-sectional data on 2,721,767 Jewish adolescents assessed for mandatory military service at approximately 17 years of age between 1967 and 2014. The study population comprised 430,176 immigrants with origins in Ethiopia, former USSR, Middle East and North Africa (ME/NA) and western countries. ORs for diabetes were calculated for men and women, grouped according to age at immigration, with Israel-born participants as controls. Unadjusted and fully adjusted models were made to account for possible confounders. Additionally, the study population was stratified by origin and each immigrant group was referenced to Israel-born participants of the same origin.

Results

There was a graded decrease in OR for diabetes across the study groups in the fully adjusted model. Immigrants arriving at age 0–5 years had comparable OR for diabetes to the Israeli-born reference group; those arriving at age 6–11 years had an OR of 0.82 (95% CI 0.70, 0.97; p = 0.017) and recent immigrants, arriving at age 12–19 years, had the lowest OR of 0.65 (95% CI 0.54, 0.77; p < 0.0001). When age at immigration was treated as a continuous variable, there was an adjusted risk for occurrence of diabetes of 0.97 (95% CI 0.96, 0.99; p = 0.001) for every year increment. The lower risk for diabetes among recent immigrants persisted in the unadjusted model and persisted when the study sample was stratified by sex and origin, except for immigrants arriving from ME/NA. Notably, Ethiopians born in Israel had a sixfold higher diabetes crude prevalence than Ethiopian immigrants arriving after the age of 5 years.

Conclusions/interpretation

Immigrants of different ethnic groups arriving earlier in childhood lose their protection against diabetes at adolescence, relative to children born in Israel. This is perhaps due to environmental and lifestyle changes, especially those beginning at an early age.

Keywords

Adolescent Childhood Diabetes mellitus Environmental exposure Ethnic groups Immigration and emigration Lifestyle Pathogenesis Risk factors 

Abbreviations

IDF

Israeli Defense Forces

ME/NA

Middle East and North Africa

Notes

Data availability

The datasets analysed during the current study are not publicly available due to IDF restrictions.

Funding

This research was supported by a grant from the office of the Israeli chief scientist.

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript.

Contribution statement

AP, BG, GT, AA and ED contributed to the conception and design of the study. AP and BG contributed to acquisition, analysis and interpretation of data. ED contributed to acquisition of data and performed statistical analysis. GT, AA, JM, IR and ML contributed to interpretation of data. AP and BG drafted the manuscript and GT, AA, JM, IR, ML and ED critically revised it for important intellectual content. All authors provided final approval of the version to be published. BG and AA are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Supplementary material

125_2017_4399_MOESM1_ESM.pdf (438 kb)
ESM 1(PDF 438 kb)

References

  1. 1.
    Blumenfeld O, Dichtiar R, Shohat T (2014) Trends in the incidence of type 1 diabetes among Jews and Arabs in Israel. Pediatr Diabetes 15:422–427CrossRefPubMedGoogle Scholar
  2. 2.
    Patterson CC, Dahlquist GG, Gyürüs E, Green A, Soltész G, EURODIAB Study Group (2009) Incidence trends for childhood type 1 diabetes in Europe during 1989–2003 and predicted new cases 2005–20: a multicentre prospective registration study. Lancet 373:2027–2033CrossRefPubMedGoogle Scholar
  3. 3.
    Rewers M, Ludvigsson J (2016) Environmental risk factors for type 1 diabetes. Lancet 387:2340–2348CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Neu A, Willasch A, Ehehalt S, Kehrer M, Hub R, Ranke M (2001) Diabetes incidence in children of different nationalities: an epidemiological approach to the pathogenesis of diabetes. Diabetologia 44(Suppl 3):B21–B26CrossRefPubMedGoogle Scholar
  5. 5.
    Söderström U, Åman J, Hjern A (2012) Being born in Sweden increases the risk for type 1 diabetes—a study of migration of children to Sweden as a natural experiment. Acta Paediatr 101:73–77CrossRefPubMedGoogle Scholar
  6. 6.
    Oilinki T, Otonkoski T, Ilonen J, Knip M, Miettinen P (2012) Prevalence and characteristics of diabetes among Somali children and adolescents living in Helsinki, Finland. Pediatr Diabetes 13:176–180CrossRefPubMedGoogle Scholar
  7. 7.
    Twig G, Yaniv G, Levine H et al (2016) Body-mass index in 2.3 million adolescents and cardiovascular death in adulthood. N Engl J Med 374:2430–2440CrossRefPubMedGoogle Scholar
  8. 8.
    Lamb MM, Frederiksen B, Seifert JA, Kroehl M, Rewers M, Norris JM (2015) Sugar intake is associated with progression from islet autoimmunity to type 1 diabetes: the Diabetes Autoimmunity Study in the Young. Diabetologia 58:2027–2034CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Meydan C, Afek A, Derazne E et al (2013) Population-based trends in overweight and obesity: a comparative study of 2 148 342 Israeli male and female adolescents born 1950–1993. Pediatric Obes 8:98–111CrossRefGoogle Scholar
  10. 10.
    Meydan C, Twig G, Derazne E et al (2014) The immigration effect on obesity and overweight in Israeli Jewish male adolescents born 1970–1993. Ann Epidemiol 24:424–431CrossRefPubMedGoogle Scholar
  11. 11.
    Zung A, Elizur M, Weintrob N et al (2004) Type 1 diabetes in Jewish Ethiopian immigrants in Israel: HLA class II immunogenetics and contribution of new environment. Hum Immunol 65:1463–1468CrossRefPubMedGoogle Scholar
  12. 12.
    Alemu S, Dessie A, Seid E et al (2009) Insulin-requiring diabetes in rural Ethiopia: should we reopen the case for malnutrition-related diabetes? Diabetologia 52:1842–1845CrossRefPubMedGoogle Scholar
  13. 13.
    Sepa A, Wahlberg J, Vaarala O, Frodi A, Ludvigsson J (2005) Psychological stress may induce diabetes-related autoimmunity in infancy. Diabetes Care 28:290–295CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Alon Peled
    • 1
    • 2
  • Barak Gordon
    • 1
    • 3
  • Gilad Twig
    • 1
    • 3
    • 4
    • 5
    • 6
  • Joseph Mendlovic
    • 7
    • 8
  • Estela Derazne
    • 1
    • 3
  • Michal Lisnyansky
    • 1
  • Itamar Raz
    • 9
  • Arnon Afek
    • 1
    • 7
  1. 1.Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  2. 2.Rishon LezionIsrael
  3. 3.Medical Corps, Israeli Defense Forces, Tel Hashomer BaseTel HashomerIsrael
  4. 4.Department of MedicineSheba Medical CenterTel HashomerIsrael
  5. 5.Dr. Pinchas Bornstein Talpiot Medical Leadership ProgramSheba Medical CenterTel HashomerIsrael
  6. 6.Institute of Endocrinology, Sheba Medical CenterTel HashomerIsrael
  7. 7.Ministry of HealthJerusalemIsrael
  8. 8.Shaare Zedek Medical CenterJerusalemIsrael
  9. 9.Diabetes Research CenterHadassah Hebrew University Medical CenterJerusalemIsrael

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