Department of Epidemiology and Health Statistics, School of Public Health, No. 81 Meishan Road, Hefei, 230032 Anhui, China.
Department of Epidemiology and Health Statistics, School of Public Health, No. 81 Meishan Road, Hefei, 230032 Anhui, China; Center for Evidence-Based Practice, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032 Anhui, China.
Clin Nutr. 2020 Jun;39(6):1717-1723. doi: 10.1016/j.clnu.2019.08.002. Epub 2019 Aug 10.
The association between famine exposure and type 2 diabetes (T2DM) remains controversial. A meta-analysis was performed to clarify the relation of famine exposure to T2DM risk in detail.
A systematic literature search was performed in PubMed, Cochrane library, Web of Science, China National Knowledge Infrastructure (CNKI), Sinomed (CBM), Wanfang Data Knowledge Service Platform and China Science and Technology Journal VIP Database. The articles were limited to be available in English or Chinese before 10 April 2019. The pooled relative risk (RR) with 95% confidence interval (CI) was used to estimate the effect of famine exposure on T2DM. The I square value (I) was used to assess heterogeneity, and the random effects model (REM) was adopted as the pooling method.
This meta-analysis included 24 published articles with 1,660,385 subjects. A significant association of famine exposure with increased risk of T2DM was observed (RR = 1.433, 95% CI: 1.101-1.865). The pooled RRs were different in terms of publication year, location, study design, sample size, famine duration and definition of diabetes (criteria). Longer the famine exposure experienced, greater the effect of famine exposure on T2DM would be. Compared to WHO criteria, studies of which diabetes diagnosed by ADA criteria and other criteria might more likely to find this association. Compared to moderate famine exposure, the pooled RR in severe famine was statistically significant. Furthermore, the pooled RR adjusted for the most confounders in females was 1.517 (95% CI: 1.018-2.261). In terms of period of famine exposure, compared to adult exposure, people who exposure famine in fetal, childhood, and adolescent were likely to be diabetes.
Famine exposure may increase the risk of T2DM. The risk may vary with famine duration, definition of diabetes, gender and period of famine exposure.
饥荒暴露与 2 型糖尿病（T2DM）之间的关系仍存在争议。本研究通过荟萃分析详细阐明了饥荒暴露与 T2DM 风险之间的关系。
通过检索 PubMed、Cochrane 图书馆、Web of Science、中国知网（CNKI）、中国生物医学文献数据库（Sinomed，CBM）、万方数据知识服务平台和维普中文科技期刊数据库，检索时限均截止至 2019 年 4 月 10 日，收集有关饥荒暴露与 T2DM 风险关系的研究。文献语种限定为英文或中文。采用合并相对危险度（RR）及其 95%可信区间（CI）评估饥荒暴露与 T2DM 风险的关联强度，采用 I 平方（I 2 ）检验评估异质性，采用随机效应模型（REM）进行合并分析。
本研究共纳入 24 项研究，包含 1660385 例研究对象。荟萃分析结果显示，饥荒暴露与 T2DM 风险增加显著相关（RR=1.433，95%CI：1.101-1.865）。按发表年份、地点、研究设计、样本量、饥荒持续时间和糖尿病定义（标准）进行分层分析，RR 值存在差异。随着饥荒暴露时间的延长，饥荒暴露对 T2DM 的影响越大。与 WHO 标准相比，采用 ADA 标准和其他标准诊断糖尿病的研究更可能发现这种关联。与中度饥荒暴露相比，严重饥荒暴露的合并 RR 有统计学意义。此外，调整女性中大多数混杂因素后，合并 RR 为 1.517（95%CI：1.018-2.261）。按饥荒暴露时期分层，与成人暴露相比，胎儿期、儿童期和青春期暴露于饥荒的人群发生糖尿病的风险更高。
饥荒暴露可能会增加 T2DM 的发病风险。这种风险可能与饥荒持续时间、糖尿病定义、性别和饥荒暴露时期有关。
