a CAPHRI Research Institute and Department of Complex Genetics , Maastricht University , Maastricht , The Netherlands.
b Tisch Cancer Institute , Icahn School of Medicine at Mount Sinai , New York City , NY , USA.
Crit Rev Toxicol. 2018 Oct;48(9):789-795. doi: 10.1080/10408444.2018.1541073. Epub 2018 Dec 27.
The incidence rates of a wide range of diseases and conditions have increased over the last decades. There is controversy over the origin of these increases, whether they are caused by exposure to compounds thought to have an effect on the endocrine system, the "endocrine disruption theory", or whether some other factor is responsible. In this analysis, the authors take a closer look at the role that changes in reproductive factors have played in this respect. They apply the relative risks of age at first pregnancy and parity or family size to a set of Dutch demographic data from 1955 and 2015 and calculate the percentage of disease increase explained. The decrease in parity over the last decades explains an increase of 26% in testicular cancer. The combination of decrease in parity and increase in maternal age at first pregnancy explains an increase of 34% in hypospadias prevalence. This combination of decreased parity and increased maternal age at pregnancy explains an increase of 24% in childhood obesity prevalence. The authors further point to a perhaps even more profound effect of the trend toward smaller families. This trend has led to an estimated doubling of the proportion of children born from subfertile couples. Since children born from subfertile couples are more likely to be preterm or of low birth weight, the incidence of these conditions must have increased as well. Low birth weight and preterm delivery are risk factors for a wide range of diseases and conditions. The changes in human reproduction over the last decades have had a profound impact on the incidence of a range of diseases and conditions in the next generation and thus provide a sound explanation for a substantial portion of the reported increases. Key messages The incidence rates of a wide range of diseases and conditions have increased in the Western societies over the last decades. Many have argued that these increases are attributable to compounds thought to have effects on the human endocrine system: the endocrine disruption theory This analysis shows, however, that human reproductive factors such as maternal age at first pregnancy and parity explain substantial proportions of the reported increases.
在过去的几十年里，许多疾病和病症的发病率都有所上升。对于这些上升的原因，存在争议，有人认为是由于接触到那些被认为会影响内分泌系统的化合物所致，即“内分泌干扰理论”；也有人认为可能是其他因素在起作用。在这项分析中，作者更深入地研究了生殖因素变化在这方面所起的作用。他们将首次生育年龄和生育次数或家庭规模的相对风险应用于 1955 年至 2015 年的一组荷兰人口数据，并计算了由此解释的疾病发病率上升的百分比。过去几十年生育率的下降解释了睾丸癌发病率上升 26%的原因。生育率下降和首次生育母亲年龄增加的组合解释了尿道下裂发病率上升 34%的原因。生育率下降和孕妇年龄增加的组合解释了儿童肥胖症发病率上升 24%的原因。作者还进一步指出，较小家庭规模的趋势可能产生更深远的影响。这种趋势导致了由生育能力低下的夫妇所生子女比例估计增加了一倍。由于生育能力低下的夫妇所生的孩子更有可能早产或体重过轻，因此这些疾病的发病率也必然有所上升。低出生体重和早产是多种疾病和病症的风险因素。过去几十年人类生殖的变化对下一代多种疾病和病症的发病率产生了深远的影响，因此为报告发病率上升的很大一部分提供了合理的解释。 要点 在过去几十年里，西方社会中许多疾病和病症的发病率都有所上升。 许多人认为，这些上升归因于那些被认为会影响人体内分泌系统的化合物：内分泌干扰理论。 然而，这项分析表明，产妇首次生育年龄和生育次数等生殖因素解释了报告发病率上升的很大一部分。
