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Seasonal trends in disease onset and autoimmune comorbidities were evaluated acoording to age at onset, birth season, and sex.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Distinct age and immunity-dependent seasonal patterns were identified. Early-onset T1DM showed no seasonal fluctuation, suggesting predominant genetic and immunological determinants. Conversely, late-onset T1DM demonstrated a clear autumn\u2013winter peak and was more frequent among children born in spring\u2013summer. The presence of multiple autoimmune disorders abolished this seasonality, implying that intense autoimmune activity may override environmental effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This 40-year cohort provides novel evidence that the relative contribution of environmental and immunogenetic factors in T1DM varies with age and immune burden. Environmental seasonality appears to play a greater role in later-onset disease, whereas early-onset and multi-autoimmune forms are driven by intrinsic immune mechanisms. These findings highlight the heterogeneity of T1DM pathogenesis and support the need for age- and immunity-specific strategies for prevention and early screening.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11845-026-04558-x","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T07:20:45Z","timestamp":1784704845000},"page":"2055-2063","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Attenuated Seasonality of Childhood Type 1 Diabetes with Increasing Autoimmune Comorbidities: A 40-year Cohort Study"],"prefix":"10.1007","volume":"195","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9049-2875","authenticated-orcid":false,"given":"Gulsum","family":"Ozen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0641-1321","authenticated-orcid":false,"given":"Angela","family":"Zanfardino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7659-9580","authenticated-orcid":false,"given":"Gulsah","family":"Ozen Acan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7020-5114","authenticated-orcid":false,"given":"Burak","family":"Acan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1070-4231","authenticated-orcid":false,"given":"Nadia","family":"Tinto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5305-6775","authenticated-orcid":false,"given":"Fernanda","family":"Iafusco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9410-5393","authenticated-orcid":false,"given":"Emanuele","family":"Miraglia del Giudice","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4584-2976","authenticated-orcid":false,"given":"Zehra","family":"Aycan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9398-3856","authenticated-orcid":false,"given":"Dario","family":"Iafusco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"4558_CR1","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1080\/14760584.2018.1548281","volume":"17","author":"H Hy\u00f6ty","year":"2018","unstructured":"Hy\u00f6ty H, Leon F, Knip M (2018) Developing a vaccine for T1DM by targeting coxsackie virus B. 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Stoppoloni\u201d of the University of Campania \u201cLuigi Vanvitelli,\u201d Naples, Italy.This study was conducted in accordance with the Declaration of Helsinki of 1975 (as revised in 2013) and was approved by the local ethics committee of the University of Campania (N prot:694 12.11.19 Comitato Etico Universita degli Studi della Campania \u2018\u2018Luigi Vanvitelli\u2019\u2019).","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}