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Analgesic antipyretic use among young children in the TEDDY study : No association with islet autoimmunity

Lundgren, Markus LU ; Steed, Leigh Johnson; Tamura, Roy N.; Jonsdottir, Berglind LU ; Gesualdo, Patricia; Crouch, Claire Cowen; Sjöberg, Maija; Hansson, Gertie LU ; Hagopian, William A. and Ziegler, Anette-G, et al. (2017) In BMC Pediatrics 17(1).
Abstract

Background: The use of analgesic antipyretics (ANAP) in children have long been a matter of controversy. Data on their practical use on an individual level has, however, been scarce. There are indications of possible effects on glucose homeostasis and immune function related to the use of ANAP. The aim of this study was to analyze patterns of analgesic antipyretic use across the clinical centers of The Environmental Determinants of Diabetes in the Young (TEDDY) prospective cohort study and test if ANAP use was a risk factor for islet autoimmunity. Methods: Data were collected for 8542 children in the first 2.5 years of life. Incidence was analyzed using logistic regression with country and first child status as independent variables.... (More)

Background: The use of analgesic antipyretics (ANAP) in children have long been a matter of controversy. Data on their practical use on an individual level has, however, been scarce. There are indications of possible effects on glucose homeostasis and immune function related to the use of ANAP. The aim of this study was to analyze patterns of analgesic antipyretic use across the clinical centers of The Environmental Determinants of Diabetes in the Young (TEDDY) prospective cohort study and test if ANAP use was a risk factor for islet autoimmunity. Methods: Data were collected for 8542 children in the first 2.5 years of life. Incidence was analyzed using logistic regression with country and first child status as independent variables. Holm's procedure was used to adjust for multiplicity of intercountry comparisons. Time to autoantibody seroconversion was analyzed using a Cox proportional hazards model with cumulative analgesic use as primary time dependent covariate of interest. For each categorization, a generalized estimating equation (GEE) approach was used. Results: Higher prevalence of ANAP use was found in the U.S. (95.7%) and Sweden (94.8%) compared to Finland (78.1%) and Germany (80.2%). First-born children were more commonly given acetaminophen (OR 1.26; 95% CI 1.07, 1.49; p = 0.007) but less commonly Non-Steroidal Anti-inflammatory Drugs (NSAID) (OR 0.86; 95% CI 0.78, 0.95; p = 0.002). Acetaminophen and NSAID use in the absence of fever and infection was more prevalent in the U.S. (40.4%; 26.3% of doses) compared to Sweden, Finland and Germany (p < 0.001). Acetaminophen or NSAID use before age 2.5 years did not predict development of islet autoimmunity by age 6 years (HR 1.02, 95% CI 0.99-1.09; p = 0.27). In a sub-analysis, acetaminophen use in children with fever weakly predicted development of islet autoimmunity by age 3 years (HR 1.05; 95% CI 1.01-1.09; p = 0.024). Conclusions: ANAP use in young children is not a risk factor for seroconversion by age 6 years. Use of ANAP is widespread in young children, and significantly higher in the U.S. compared to other study sites, where use is common also in absence of fever and infection.

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keywords
Analgesics, Islet autoimmunity, Prospective studies, Type 1 diabetes
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BMC Pediatrics
volume
17
issue
1
publisher
BioMed Central
external identifiers
  • scopus:85019465441
  • wos:000401666800002
ISSN
1471-2431
DOI
10.1186/s12887-017-0884-y
language
English
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yes
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6a59c413-936c-4908-8bed-26b4774b1f84
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2017-07-03 16:13:20
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2017-09-18 11:37:18
@article{6a59c413-936c-4908-8bed-26b4774b1f84,
  abstract     = {<p>Background: The use of analgesic antipyretics (ANAP) in children have long been a matter of controversy. Data on their practical use on an individual level has, however, been scarce. There are indications of possible effects on glucose homeostasis and immune function related to the use of ANAP. The aim of this study was to analyze patterns of analgesic antipyretic use across the clinical centers of The Environmental Determinants of Diabetes in the Young (TEDDY) prospective cohort study and test if ANAP use was a risk factor for islet autoimmunity. Methods: Data were collected for 8542 children in the first 2.5 years of life. Incidence was analyzed using logistic regression with country and first child status as independent variables. Holm's procedure was used to adjust for multiplicity of intercountry comparisons. Time to autoantibody seroconversion was analyzed using a Cox proportional hazards model with cumulative analgesic use as primary time dependent covariate of interest. For each categorization, a generalized estimating equation (GEE) approach was used. Results: Higher prevalence of ANAP use was found in the U.S. (95.7%) and Sweden (94.8%) compared to Finland (78.1%) and Germany (80.2%). First-born children were more commonly given acetaminophen (OR 1.26; 95% CI 1.07, 1.49; p = 0.007) but less commonly Non-Steroidal Anti-inflammatory Drugs (NSAID) (OR 0.86; 95% CI 0.78, 0.95; p = 0.002). Acetaminophen and NSAID use in the absence of fever and infection was more prevalent in the U.S. (40.4%; 26.3% of doses) compared to Sweden, Finland and Germany (p &lt; 0.001). Acetaminophen or NSAID use before age 2.5 years did not predict development of islet autoimmunity by age 6 years (HR 1.02, 95% CI 0.99-1.09; p = 0.27). In a sub-analysis, acetaminophen use in children with fever weakly predicted development of islet autoimmunity by age 3 years (HR 1.05; 95% CI 1.01-1.09; p = 0.024). Conclusions: ANAP use in young children is not a risk factor for seroconversion by age 6 years. Use of ANAP is widespread in young children, and significantly higher in the U.S. compared to other study sites, where use is common also in absence of fever and infection.</p>},
  articleno    = {127},
  author       = {Lundgren, Markus and Steed, Leigh Johnson and Tamura, Roy N. and Jonsdottir, Berglind and Gesualdo, Patricia and Crouch, Claire Cowen and Sjöberg, Maija and Hansson, Gertie and Hagopian, William A. and Ziegler, Anette-G and Rewers, Marian J. and Lernmark, Åke and Toppari, Jorma and She, Jin-Xiong and Akolkar, Beena and Krischer, Jeffrey P. and Haller, Michael J. and Elding Larsson, Helena and Bautista, Kimberly and Baxter, Judith and Bedoy, Ruth and Felipe-Morales, Daniel and Driscoll, Kimberly and Frohnert, Brigitte I. and Hoffman, Michelle and Karban, Rachel and Liu, Edwin and Norris, Jill and Samper-Imaz, Adela and Steck, Andrea K and Waugh, Kathleen and Wright, Hali and Simell, Olli G. and Adamsson, Annika and Ahonen, Suvi and Hyöty, Heikki and Ilonen, Jorma and Jokipuu, Sanna and Kallio, Tiina and Karlsson, Leena and Kähönen, Miia and Knip, Mikael and Kovanen, Lea and Koreasalo, Mirva and Kurppa, Kalle and Latvaaho, Tiina and Lönnrot, Maria and Mäntymäki, Elina and Multasuo, Katja and Mykkänen, Juha and Niininen, Tiina and Niinistö, Sari and Nyblom, Mia and Rajala, Petra and Rautanen, Jenna and Riikonen, Anne and Riikonen, Mika and Rouhiainen, Jenni and Romo, Minna and Simell, Tuula and Simell, Ville and Stenius, Aino and Leppänen, Maria and Vainionpää, Sini and Varjonen, Eeva and Veijola, Riitta and Virtanen, Suvi M and Vähä-Mäkilä, Mari and Åkerlund, Mari and Lindfors, Katri and Schatz, Desmond and Hopkins, Diane and Thomas, Jamie and Adams, Janey and Silvis, Katherine and Gardiner, Melissa and McIndoe, Richard and Sharma, Ashok and Williams, Joshua W and Young, Gabriela and Anderson, Stephen W. and Jacobsen, Laura Mary and Beyerlein, Andreas and Bonifacio, Ezio and Hummel, Michael and Hummel, Sandra and Foterek, Kristina and Janz, Nicole and Kersting, Mathilde and Knopff, Annette and Koletzko, Sibylle and Peplow, Claudia and Roth, Roswith and Scholz, Marlon and Stock, Joanna and Warncke, Katharina and Wendel, Lorena and Winkler, Christiane and Agardh, Daniel and Aronsson, Carin Andrén and Ask, Maria and Bremer, Jenny and Carlsson, Ulla Marie and Cilio, Corrado and Ericson-Hallström, Emelie and Fransson, Lina and Gard, Thomas and Gerardsson, Joanna and Bennet, Rasmus and Hansen, Monica and Hyberg, Susanne and Johansen, Fredrik and Lindström, Marielle and Månsson-Martinez, Maria and Markan, Maria and Melin, Jessica and Mestan, Zeliha and Ottosson, Karin and Rahmati, Kobra and Ramelius, Anita and Salami, Falastin and Sibthorpe, Sara and Sjöberg, Birgitta and Swartling, Ulrica and Amboh, Evelyn Tekum and Törn, Carina and Wallin, Anne and Wimar, Åsa and Åberg, Sofie and Michael Killian, Killian and Skidmore, Jennifer and Carson, Josephine and Dalzell, Maria and Dunson, Kayleen and Hervey, Rachel and Johnson, Corbin and Lyons, Rachel and Meyer, Arlene and Mulenga, Denise and Tarr, Alexander and Uland, Morgan and Willis, John and Becker, Dorothy and Franciscus, Margaret and Ellen, Mary and Smith, Mary Ellen Dalmagro Elias and Daftary, Ashi and Klein, Mary Beth and Yates, Chrystal and Abbondondolo, Michael and Austin-Gonzalez, Sarah and Avendano, Maryouri and Baethke, Sandra and Brown, Rasheedah and Burkhardt, Brant R. and Butterworth, Martha and Clasen, Joanna and Cuthbertson, David and Christopher Eberhard, Eberhard and Fiske, Steven W. and Garcia, Dena and Garmeson, Jennifer and Gowda, Veena and Heyman, Kathleen and Laras, Francisco Perez and Lee, Hye-Seung and Liu, Shu and Liu, Xiang and Lynch, Kristian and Malloy, Jamie and McCarthy, Cristina and Meulemans, Steven and Parikh, Hemang and Shaffer, Chris and Smith, Laura and Smith, Susan and Sulman, Noah and Uusitalo, Ulla and Vehik, Kendra and Vijayakandipan, Ponni and Wood, Keith and Yang, Jimin and Lori Ballard, R. D. and Hadley, David and Mcleod, Wendy and Yu, Liping and Miao, Dongmei and Bingley, Polly J and Williams, Alistair and Chandler, Kyla and Rokni, Saba and Williams, Claire L. and Wyatt, Rebecca and George, Gifty and Grace, Sian and Erlich, Henry and Mack, Steven J. and Fear, Anna Lisa and Ke, Sandra and Mulholland, Niveen and Rich, Stephen and Chen, Wei-Min and Onengut-Gumuscu, Suna and Farber, Emily and Pickin, Rebecca Roche and Davis, Jordan and Gallo, Dan and Bonnie, Jessica and Campolieto, Paul and Bourcier, Kasia and Briese, Thomas and Johnson, Suzanne Bennett and Triplett, Eric W},
  issn         = {1471-2431},
  keyword      = {Analgesics,Islet autoimmunity,Prospective studies,Type 1 diabetes},
  language     = {eng},
  month        = {05},
  number       = {1},
  publisher    = {BioMed Central},
  series       = {BMC Pediatrics},
  title        = {Analgesic antipyretic use among young children in the TEDDY study : No association with islet autoimmunity},
  url          = {http://dx.doi.org/10.1186/s12887-017-0884-y},
  volume       = {17},
  year         = {2017},
}