Birthweight, body-mass index in middle age, and incident coronary heart disease
Birthweight, body-mass index in middle age, and incident coronary heart disease
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DOI：
10.1016/s0140-6736(96)03482-4
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发表时间：
1996-11-30
期刊：
影响因子：
168.9
通讯作者：
Smith, GD
中科院分区：
文献类型：
--
作者：
Frankel, S;Elwood, P;Smith, GD
背景：一些研究表明，胎儿发育（如出生体重）与后来的冠心病之间存在关系。这项研究调查这种关系是否主要是早期生活暴露的后果，或可以最好地解释在早期生活和adultory.Methods的影响之间的相互作用，在Caerphilly，南威尔士州，包括1258名男子，年龄在45-59岁的初步筛选，谁能够提供出生体重数据。这些男性来自最初的2512名男性队列，自1979年以来，通过一系列检查获得了他们的健康相关行为、冠心病发病率和危险因素的信息。主要的结局措施是致命性和非致命性冠心病在10 years of follow-up.Findings高出生体重与较低的冠心病风险在随访期间：冠心病46例出生体重最低三分位数的男性为44例（11.6%），中间三分位数的男性为44例（12.0%），最高三分位数的男性为38例（9.1%）（p=0.03）。按体重指数（BMI）对队列进行分层显示了显著的相互作用，出生体重与冠心病风险之间的负相关仅限于BMI最高三分位数的男性（年龄校正的相互作用检验p=0.048，完全校正的p=0.012）。在最高BMI三分位数中，最低出生体重三分位数的男性中有19例（16.4%）发生冠心病，中间三分位数的男性中有13例（12.6%），最高三分位数的男性中有13例（7.5%）（p=0.0005）。这些协会并没有改变很大的调整年龄，父亲的社会阶层，自己的社会阶层，婚姻状况，纤维蛋白原和胆固醇浓度，收缩压，和smokinghistory.Interpretation之间的关联出生体重和冠心病的风险不能解释与儿童或成年社会经济地位的协会。成年期冠心病的传统危险因素也不能解释这种联系。然而，出生体重和BMI之间存在重要的相互作用，因此与低出生体重相关的冠心病风险增加仅限于成年后BMI高的人。冠心病的风险似乎是由早年和晚年暴露的综合影响来定义的。
Background Several studies have shown a relation between fetal development, as shown by birthweight, and later coronary heart disease. This study investigated whether this relation is predominantly the consequence of early life exposures, or can best be explained in terms of an interaction between influences in early life and in adulthood.Methods This prospective study in Caerphilly, South Wales, included 1258 men, aged 45-59 at initial screening, who were able to provide birthweight data. These men are from an initial cohort of 2512 men, from whom information has been obtained in a series of examinations since 1979 on health-related behaviours, incidence of coronary heart disease, and risk factors. The main outcome measure was fatal and non-fatal coronary heart disease during 10 years of follow-up.Findings Higher birthweight was related to lower risk of coronary heart disease during the follow-up period: coronary heart disease occurred in 46 (11.6%) men in the lowest birthweight tertile, 44 (12.0%) of those in the middle tertile, and 38 (9.1%) of those in the highest tertile (p=0.03). Stratification of the cohort by body-mass index (BMI) revealed a significant interaction such that the inverse association between birthweight and risk of coronary heart disease was restricted to men in the top tertile of BMI (interaction test p=0.048 adjusted for age, and p=0.012 fully adjusted). Within the top BMI tertile, coronary heart disease occurred in 19 (16.4%) of men in the lowest birthweight tertile, 13 (12.6%) of those in the middle tertile, and 13 (7.5%) of those in the highest tertile (p=0.0005). These associations were not changed substantially by adjustment for age, father's social class, own social class, marital status, fibrinogen and cholesterol concentrations, systolic blood pressure, and smoking history.Interpretation The association between birthweight and risk of coronary heart disease cannot be explained by associations with childhood or adulthood socioeconomic status. Nor do conventional risk factors for coronary heart disease in adulthood account for the association. However, there is an important interaction between birthweight and BMI such that the increased risk of coronary heart disease associated with low birthweight is restricted to people who have high BMI in adulthood. Risk of coronary heart disease seems to be defined by the combined effect of early-life and later-life exposures.