Early-Life Exposure to the Chinese Famine of 1959-1961 and Type 2 Diabetes in Adulthood: A Systematic Review and Meta-Analysis.
Early-Life Exposure to the Chinese Famine of 1959-1961 and Type 2 Diabetes in Adulthood: A Systematic Review and Meta-Analysis.
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1959 - 1961年中国饥荒和成年后的2型糖尿病的早期暴露：系统评价和荟萃分析。
DOI：
10.3390/nu14142855
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发表时间：
2022-07-12
期刊：
影响因子：
5.9
通讯作者：
Lumey, L. H.
中科院分区：
文献类型：
--
作者：
Li, Chihua;Lumey, L. H.
关键词：
背景：快速增长的文献表明，1959年至1961年的中国饥荒导致了中国目前和未来的2型糖尿病(T2D)流行。这一结论可能为时过早，因为许多中国的饥荒研究在方法上存在重大问题。我们研究这些问题，展示它们如何偏向研究结果，并提出建议，以提高未来研究的质量。方法：我们在英文和中文数据库中检索了从2022年2月8日开始到2022年2月8日期间，中国孕期饥荒暴露与成人T2D之间的关系的研究。我们提取了T2D病例的信息，并研究了在饥荒期间(饥荒出生)、饥荒之前(饥荒前出生)和饥荒后(饥荒后出生)出生的个人的人口。我们使用随机效应模型比较了饥荒出生和几个对照组的T2D几率，包括饥荒后出生、饥荒前后出生和饥荒前出生。我们使用元回归来检验比较组之间的年龄差异对饥荒效应估计的影响，以及其他特征的作用，包括参与者的性别、年龄和T2D评估；饥荒强度；居住地；以及出版语言。还对潜在的异质性来源和研究质量进行了评估。结果：23项研究符合我们的纳入标准。样本大小从不到300人到超过36万人不等。所有研究都根据参与者的出生日期定义了饥荒暴露，18项研究比较了饥荒出生和饥荒后出生的婴儿，以估计饥荒对T2D的影响。在所有研究中，饥荒和饥荒后出生的婴儿年龄相差三岁或更长。对饥荒影响的估计因控制措施的选择而有所不同。以饥荒后出生作为对照，T2D在饥荒出生中的OR值为1.50(95%CI为1.34~1.68)，以饥荒前后出生为对照的OR值为1.12(95%CI为1.02~1.24)，以饥荒前出生为对照的OR值为0.89(95%CI为0.79~1.00)。Meta回归进一步表明，饥荒影响估计数增加了1.05倍以上，饥荒出生和对照之间被忽略的年龄差异每增加一年。其他新发现的方法问题包括饥荒强度评估不佳，饥荒研究的研究环境不合适，以及混乱的调整不佳。解释：目前对中国出生前接触饥荒与成人T2D之间正相关关系的估计主要是由于饥荒出生和饥荒后出生之间的年龄差异不受控制。需要使用更严格的方法进行研究，包括年龄平衡控制和稳健的饥荒强度测量，以量化饥荒暴露与中国目前的T2D模式的关联程度。
Background: The fast-growing literature suggests that the Chinese famine of 1959–1961 drives current and future type 2 diabetes (T2D) epidemics in China. This conclusion may be premature, as many Chinese famine studies have major methodological problems. We examine these problems, demonstrate how they bias the study results, and formulate recommendations to improve the quality of future studies. Methods: We searched English and Chinese databases for studies that examined the relationship between prenatal exposure to the Chinese famine and adult T2D from inception to 8 February 2022. We extracted information on T2D cases and study populations of individuals born during the famine (famine births), before the famine (prefamine births), and after the famine (postfamine births). We used random-effects models to compare the odds of T2D in famine births to several control groups, including postfamine births, combined pre- and postfamine births, and prefamine births. We used meta-regressions to examine the impacts of age differences between comparison groups on famine effect estimates and the role of other characteristics, including participant sex, age, and T2D assessments; famine intensity; residence; and publication language. Potential sources of heterogeneity and study quality were also evaluated. Results: Twenty-three studies met our inclusion criteria. The sample sizes ranged from less than 300 to more than 360,000 participants. All studies defined the famine exposure based on the participants’ dates of birth, and 18 studies compared famine births and postfamine births to estimate famine effects on T2D. The famine and postfamine births had an age difference of three years or more in all studies. The estimates of the famine effect varied by the selection of controls. Using postfamine births as controls, the OR for T2D among famine births was 1.50 (95% CI 1.34–1.68); using combined pre- and postfamine births as controls, the OR was 1.12 (95% CI 1.02–1.24); using prefamine births as controls, the OR was 0.89 (95% CI 0.79–1.00). The meta-regressions further showed that the famine effect estimates increased by over 1.05 times with each one-year increase in ignored age differences between famine births and controls. Other newly identified methodological problems included the poorly assessed famine intensity, unsuitable study settings for famine research, and poor confounding adjustment. Interpretation: The current estimates of a positive relationship between prenatal exposure to the Chinese famine and adult T2D are mainly driven by uncontrolled age differences between famine births and postfamine births. Studies with more rigorous methods, including age-balanced controls and robust famine intensity measures, are needed to quantify to what extent the famine exposure is related to current T2D patterns in China.
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