Glucose tolerance in adults after prenatal exposure to famine
Glucose tolerance in adults after prenatal exposure to famine
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DOI：
10.1016/s0140-6736(97)07244-9
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发表时间：
1998-01-17
期刊：
影响因子：
168.9
通讯作者：
Bleker, OP
中科院分区：
文献类型：
--
作者：
Ravelli, ACJ;van der Meulen, JHP;Bleker, OP
背景 子宫内生长缓慢与 2 型（非胰岛素依赖型）糖尿病和成年后糖耐量受损有关。人类没有直接证据表明妊娠期间母体营养会影响胰岛素-葡萄糖代谢。我们调查了 1944-45 年荷兰饥荒期间出生的人的葡萄糖耐量。方法 我们纳入了 1943 年 11 月 1 日至 1947 年 2 月 28 日之间出生在阿姆斯特丹的 702 人，我们对他们有详细的产前和出生记录。我们将妊娠期间任何阶段暴露于饥荒的参与者（暴露参与者）与那些在饥荒前一年出生或在饥荒后一年受孕的参与者（非暴露参与者）的葡萄糖和胰岛素对标准口服葡萄糖负荷的反应进行了比较。发现暴露参与者中标准葡萄糖负荷后 2 小时，血糖浓度增加（p = 0.006），并且在中后期暴露的男性和女性中血糖浓度最高 妊娠。非暴露参与者的平均 2 小时葡萄糖浓度为 5.8 mmol/L；妊娠晚期暴露的参与者的浓度高出 0.5 mmol/L (95% Cl 0.1-0.9)，妊娠中期暴露的参与者浓度高出 0.4 mmol/L (0-0.8)，妊娠早期暴露的参与者浓度高出 0.1 mmol/L (-0.4 至 0.6)。体重较低的母亲所生的瘦婴儿的参与者体内浓度最高，而在成年后肥胖的暴露于饥荒的人群中浓度尤其高。产前暴露于饥荒与空腹胰岛素原 (p=0.05) 和 2 小时胰岛素浓度 (p=0.04) 增加有关，这表明与胰岛素抵抗有关。 解释 产前暴露于饥荒，尤其是在妊娠后期，是 与成人葡萄糖耐量降低有关。子宫内营养不良可能会导致胰岛素-葡萄糖代谢的永久性变化，即使对胎儿生长的影响很小。饥荒对葡萄糖耐量的影响对于肥胖者尤其重要。
Background Reduced growth in utero is associated with type 2 (non-insulin-dependent) diabetes and impaired glucose tolerance in adult life. There is no direct evidence in human beings that maternal nutrition during gestation affects insulin-glucose metabolism. We investigated glucose tolerance in people born around the time of famine in the Netherlands during 1944-45.Methods We included 702 people born between Nov 1, 1943, and Feb 28, 1947, in Amsterdam, for whom we had detailed prenatal and birth records. We compared glucose and insulin responses to a standard oral glucose load in participants exposed to famine at any stage during gestation (exposed participants) with those who were born in the year before or conceived in the year after the famine (non-ex posed participants).Findings Glucose concentrations were increased 2 h after a standard glucose load among exposed participants (p=0.006), and were highest in men and women exposed during mid and late gestation. Mean 2 h glucose concentration among non-exposed participants was 5.8 mmol/L; concentrations were 0.5 mmol/L (95% Cl 0.1-0.9) higher among participants exposed during late gestation, 0.4 mmol/L (0-0.8) higher among those exposed during mid gestation, and 0.1 mmol/L (-0.4 to 0.6) among those exposed during early gestation. Participants born as thin babies to mothers with low bodyweights had the highest concentrations and concentrations were especially high among people exposed to famine who became obese as adults, Prenatal exposure to famine was related to increased fasting proinsulin (p=0.05) and 2 h insulin concentrations (p=0.04), which suggests an association with insulin resistance.Interpretation Prenatal exposure to famine, especially during late gestation, is linked to decreased glucose tolerance in adults. Poor nutrition in utero may lead to permanent changes in insulin-glucose metabolism, even if the effect on fetal growth is small. This effect of famine on glucose tolerance is especially important in people who become obese.