Medical Research Council/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Diabetes Care. 2012 Jan;35(1):72-9. doi: 10.2337/dc11-0456. Epub 2011 Nov 18.
We examined associations of birth weight and weight gain in infancy and early childhood with type 2 diabetes (DM) risk in five cohorts from low- and middle-income countries.
Participants were 6,511 young adults from Brazil, Guatemala, India, the Philippines, and South Africa. Exposures were weight at birth, at 24 and 48 months, and adult weight, and conditional weight gain (CWG, deviation from expected weight gain) between these ages. Outcomes were adult fasting glucose, impaired fasting glucose or DM (IFG/DM), and insulin resistance homeostasis model assessment (IR-HOMA, three cohorts).
Birth weight was inversely associated with adult glucose and risk of IFG/DM (odds ratio 0.91[95% CI 0.84-0.99] per SD). Weight at 24 and 48 months and CWG 0-24 and 24-48 months were unrelated to glucose and IFG/DM; however, CWG 48 months-adulthood was positively related to IFG/DM (1.32 [1.22-1.43] per SD). After adjusting for adult waist circumference, birth weight, weight at 24 and 48 months and CWG 0-24 months were inversely associated with glucose and IFG/DM. Birth weight was unrelated to IR-HOMA, whereas greater CWG at 0-24 and 24-48 months and 48 months-adulthood predicted higher IR-HOMA (all P < 0.001). After adjusting for adult waist circumference, birth weight was inversely related to IR-HOMA.
Lower birth weight and accelerated weight gain after 48 months are risk factors for adult glucose intolerance. Accelerated weight gain between 0 and 24 months did not predict glucose intolerance but did predict higher insulin resistance.
我们在五个来自中低收入国家的队列中研究了出生体重和婴儿期及幼儿期体重增加与 2 型糖尿病（DM）风险的关系。
参与者为来自巴西、危地马拉、印度、菲律宾和南非的 6511 名年轻成年人。暴露因素为出生时、24 个月和 48 个月时的体重以及这些年龄之间的成人体重和条件体重增加（CWG，实际体重增加与预期体重增加的偏差）。结果为成人空腹血糖、空腹血糖受损或 DM（IFG/DM）和胰岛素抵抗稳态模型评估（IR-HOMA，三个队列）。
出生体重与成人血糖和 IFG/DM 风险呈负相关（每标准差 0.91[95%CI 0.84-0.99]）。24 个月和 48 个月时的体重以及 0-24 个月和 24-48 个月时的 CWG 与血糖和 IFG/DM 无关；然而，48 个月至成年期的 CWG 与 IFG/DM 呈正相关（每标准差 1.32[1.22-1.43]）。在调整成人腰围后，出生体重、24 个月和 48 个月时的体重以及 0-24 个月时的 CWG 与血糖和 IFG/DM 呈负相关。出生体重与 IR-HOMA 无关，而 0-24 个月和 24-48 个月以及 48 个月至成年期的 CWG 增加预测更高的 IR-HOMA（均 P<0.001）。在调整成人腰围后，出生体重与 IR-HOMA 呈负相关。
较低的出生体重和 48 个月后体重加速增加是成人葡萄糖耐量受损的危险因素。0-24 个月期间的体重加速增加与葡萄糖不耐受无关，但与更高的胰岛素抵抗有关。
