Exposure to the 1959-1961 Chinese famine and risk of non-communicable diseases in later life: A life course perspective.
Exposure to the 1959-1961 Chinese famine and risk of non-communicable diseases in later life: A life course perspective.
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DOI：
10.1371/journal.pgph.0002161
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发表时间：
2023
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儿童营养不良和晚年非传染性疾病是主要的全球健康问题。文献表明，儿童时期营养不良/饥荒会对健康产生直接和长期的不利影响。然而，许多研究存在理论和方法上的局限性。为了补充文献并克服其中的一些局限性，我们采用了生命历程的观点，并使用了更强大的方法。我们调查了1959-1961年中国饥荒暴露与晚年NCD之间的关联，以及这种关联是否取决于：暴露时的生命阶段，饥荒严重程度和性别。我们对一项大规模、具有全国代表性的纵向研究--中国健康与养老纵向研究（2011-2018年，11,094名参与者）进行了二次数据分析。我们使用自我报告的经历测量饥荒暴露/严重程度，使用暴露时的年龄测量生命阶段，使用NCD数量测量健康状况。我们进行了泊松增长曲线模型。我们得到了三个发现。首先，与未暴露的参与者相比，18岁之前暴露的参与者在晚年患非传染性疾病的风险更高，特别是如果在子宫内暴露（IRR = 1.90，95% CI [1.70，2.12]，p <0.001）和生命的“前1，000天”（IRR = 1.86，95% CI [1.73，2.00]，p < .001;对于0-6个月组，IRR = 1.95，95% CI [1.67，2.29]，p < .001）。其次，中度和重度暴露的参与者的饥饿效应相似（IRR = 1.18，95% CI [1.09，1.28]，p < .001和IRR = 1.24，95% CI [1.17，1.32]，p < .001）。第三，饥饿效应在女性和男性之间没有差异（IRR = 0.98，95% CI [0.90，1.07]，p = 0.703）。在人的生命历程中，胎儿期和“头1 000天”是一个特别敏感的时期，如果在这一时期出现营养不良/饥荒，就会对非传染性疾病产生明显的长期影响。然而，这扇窗户一直打开到成年。这突出表明，需要加大对预防和治疗儿童/青少年营养不良的投资，以应对晚年的非传染性疾病。
Child undernutrition and later-life non-communicable diseases (NCDs) are major global health issues. Literature suggests that undernutrition/famine exposure in childhood has immediate and long-term adverse health consequences. However, many studies have theoretical and methodological limitations. To add to the literature and overcome some of these limitations, we adopted a life course perspective and used more robust methods. We investigated the association between exposure to the 1959–1961 Chinese famine and later-life NCDs and if this association depends on: life stage at exposure, famine severity, and sex. We conducted a secondary data analysis of a large-scale, nationally representative, longitudinal study—the China Health and Retirement Longitudinal Study (2011–2018, 11,094 participants). We measured famine exposure/severity using self-reported experience, life stage using age at exposure, and health using the number of NCDs. We performed Poisson growth curve models. We obtained three findings. First, compared with unexposed participants, those exposed before age 18 had a higher risk of later-life NCDs, particularly if exposed in-utero (IRR = 1.90, 95% CI [1.70, 2.12], p < .001) and in the “first 1,000 days” of life (IRR = 1.86, 95% CI [1.73, 2.00], p < .001; for 0–6 months group, IRR = 1.95, 95% CI [1.67, 2.29], p < .001). Second, the famine effects among participants moderately and severely exposed were similar (IRR = 1.18, 95% CI [1.09, 1.28], p < .001 and IRR = 1.24, 95% CI [1.17, 1.32], p < .001). Third, the famine effects did not differ between females and males (IRR = 0.98, 95% CI [0.90, 1.07], p = .703). In an individual’s life course, in-utero and the “first 1,000 days” are a particularly sensitive time period with marked long-term implications for NCDs if undernutrition/famine is experienced in this period. However, this window remains open until young adulthood. This highlights the need to invest more in preventing and treating child/adolescent undernutrition to tackle later-life NCDs.