Center for Data Science in Health and Medicine, Peking University, Beijing, China.
Department of Epidemiology and Biostatistics, Peking University Health Science Center, Beijing, China.
Heart. 2020 Feb;106(3):213-220. doi: 10.1136/heartjnl-2019-315750. Epub 2019 Nov 8.
To comprehensively examine the potential impacts of prenatal experience of the Chinese Great Famine on chronic disease risks in the middle age.
This study included 92 284 participants aged 39-51 years from China Kadoorie Biobank born around the famine period and without major chronic diseases at baseline. We categorised participants into non-famine births (born between 1 October 1956 and 30 September 1958, and 1 October 1962 and 30 September 1964) and famine births (born between 1 October 1959 and 30 September 1961). The outcomes were incident cardiovascular disease, cancer and respiratory system disease. Cox regression was used to estimate adjusted HR and 95% CI for famine exposure. Subgroup analyses were performed according to baseline characteristics.
During a median 10.1 years of follow-up, we identified 4626 incident ischaemic heart disease (IHD) cases, 7332 cerebrovascular disease cases, 3111 cancer cases and 16 081 respiratory system disease cases. In the whole population, prenatal famine exposure was not statistically associated with the risks of developing any chronic diseases in adulthood. However, for urban participants, compared with non-famine births, famine births had a higher risk of cerebrovascular disease (HR 1.18; 95% CI 1.09 to 1.28); such association was not shown for rural participants (p for interaction <0.001). Also, we observed the associations of prenatal famine exposure with IHD (HR 1.15; 95% CI 1.05 to 1.26) and cerebrovascular disease (HR 1.13; 95% CI 1.05 to 1.21) in participants with lower physical activity level, but not in those with higher ones (all p for interaction=0.003).
Our findings indicate that prenatal exposure to the Chinese famine might be associated with an increased cardiovascular risk and such risk may be modified by adult lifestyle.
全面考察中国大饥荒期间胎儿期经历对中年期慢性疾病风险的潜在影响。
本研究纳入了中国慢性病前瞻性研究（CKB）中的 92284 名年龄在 39-51 岁的参与者，他们均出生于饥荒时期且基线时无重大慢性疾病。我们将参与者分为非饥荒出生（1956 年 10 月 1 日至 1958 年 9 月 30 日和 1962 年 10 月 1 日至 1964 年 9 月 30 日期间出生）和饥荒出生（1959 年 10 月 1 日至 1961 年 9 月 30 日期间出生）。结局为心血管疾病、癌症和呼吸系统疾病的发病情况。采用 Cox 回归估计暴露于饥荒与调整后的 HR（95%CI）。根据基线特征进行亚组分析。
在中位 10.1 年的随访期间，我们共发现 4626 例缺血性心脏病（IHD）病例、7332 例脑血管病病例、3111 例癌症病例和 16081 例呼吸系统疾病病例。在整个人群中，胎儿期暴露于饥荒与成年后患任何慢性疾病的风险并无统计学关联。然而，对于城市参与者，与非饥荒出生相比，饥荒出生患脑血管病的风险更高（HR 1.18；95%CI 1.09-1.28）；但农村参与者中未见这种关联（p 交互<0.001）。此外，我们还发现，在体力活动水平较低的参与者中，胎儿期暴露于饥荒与 IHD（HR 1.15；95%CI 1.05-1.26）和脑血管病（HR 1.13；95%CI 1.05-1.21）的发病风险相关，但在体力活动水平较高的参与者中则无这种关联（p 交互=0.003）。
我们的研究结果表明，胎儿期暴露于中国饥荒可能与心血管疾病风险增加相关，且这种风险可能会受到成年期生活方式的影响。
