Exposure to the Chinese famine in early life and the risk of hyperglycemia and type 2 diabetes in adulthood.
Exposure to the Chinese famine in early life and the risk of hyperglycemia and type 2 diabetes in adulthood.
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作者：
Li Y;He Y;Qi L;Jaddoe VW;Feskens EJ;Yang X;Ma G;Hu FB
营养不良的早期发育适应可能在2型糖尿病的易感性中发挥重要作用，特别是对于那些在以后的生活中经历“不匹配的丰富营养环境”的人。我们研究了在胎儿期和儿童期暴露于中国饥荒（1959-1961）与成年期高血糖和2型糖尿病风险的关系。我们使用的数据来自2002年中国国民营养与健康调查的7,874名农村成年人，他们出生于1954年至1964年，来自选定的社区。高血糖定义为空腹血糖≥6.1 mmol/l和/或2小时血糖≥7.8 mmol/l和/或既往临床诊断为2型糖尿病。在未暴露、胎儿暴露、儿童早期、儿童中期和儿童晚期暴露队列中，成人高血糖症的患病率分别为2.4%、5.7%、3.9%、3.4%和5.9%。在受严重影响的饥荒地区，与未暴露受试者相比，胎儿暴露受试者的高血糖风险增加（比值比= 3.92; 95% CI：1.64-9.39; P = 0.002）;在受影响不太严重的饥荒地区未观察到这种差异（比值比= 0.57; 95% CI：0.25-1.31; P = 0.185）。严重和不太严重的饥荒地区的优势比之间有显着差异（相互作用P = 0.001）。在受饥荒严重影响的地区，遵循富裕/西方饮食模式的胎儿暴露受试者（优势比= 7.63; 95%CI：2.41-24.1; P = 0.0005）或在晚年具有较高经济地位的人经历了显著升高的高血糖风险（优势比= 6.20; 95%CI：2.08-18.5; P = 0.001）。胎儿暴露于严重的中国饥荒会增加成年后患高血糖症的风险。这种关联似乎会因晚年营养丰富的环境而加剧。
Early developmental adaptations in response to undernutrition may play an essential role in susceptibility to type 2 diabetes, particularly for those experiencing a “mismatched rich nutritional environment” in later life. We examined the associations of exposure to the Chinese famine (1959–1961) during fetal life and childhood with the risk of hyperglycemia and type 2 diabetes in adulthood. We used the data for 7,874 rural adults born between 1954 and 1964 in selected communities from the cross-sectional 2002 China National Nutrition and Health Survey. Hyperglycemia was defined as fasting plasma glucose ≥6.1 mmol/l and/or 2-h plasma glucose ≥7.8 mmol/l and/or a previous clinical diagnosis of type 2 diabetes. Prevalences of hyperglycemia among adults in nonexposed, fetal exposed, early-childhood, mid-childhood, and late-childhood exposed cohorts were 2.4%, 5.7%, 3.9%, 3.4%, and 5.9%, respectively. In severely affected famine areas, fetal-exposed subjects had an increased risk of hyperglycemia compared with nonexposed subjects (odds ratio = 3.92; 95% CI: 1.64–9.39; P = 0.002); this difference was not observed in less severely affected famine areas (odds ratio = 0.57; 95% CI: 0.25–1.31; P = 0.185). The odds ratios were significantly different between groups from the severe and less severe famine areas (P for interaction = 0.001). In severely affected famine areas, fetal-exposed subjects who followed an affluent/Western dietary pattern (odds ratios = 7.63; 95% CI: 2.41–24.1; P = 0.0005) or who had a higher economic status in later life experienced a substantially elevated risk of hyperglycemia (odds ratios = 6.20; 95% CI: 2.08–18.5; P = 0.001). Fetal exposure to the severe Chinese famine increases the risk of hyperglycemia in adulthood. This association appears to be exacerbated by a nutritionally rich environment in later life.
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