早期生活饥荒暴露、理想心血管健康指标与糖尿病发病风险：来自 4C 研究的结果。

Early Life Famine Exposure, Ideal Cardiovascular Health Metrics, and Risk of Incident Diabetes: Findings From the 4C Study.

机构信息

Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

出版信息

Diabetes Care. 2020 Aug;43(8):1902-1909. doi: 10.2337/dc19-2325. Epub 2020 Jun 4.

DOI:10.2337/dc19-2325

PMID:32499384

Abstract

OBJECTIVE

We aim to investigate the impact of ideal cardiovascular health metrics (ICVHMs) on the association between famine exposure and adulthood diabetes risk.

RESEARCH DESIGN AND METHODS

This study included 77,925 participants from the China Cardiometabolic Disease and Cancer Cohort (4C) Study who were born around the time of the Chinese Great Famine and free of diabetes at baseline. They were divided into three famine exposure groups according to the birth year, including nonexposed (1963-1974), fetal exposed (1959-1962), and childhood exposed (1949-1958). Relative risk regression was used to examine the associations between famine exposure and ICVHMs on diabetes.

RESULTS

During a mean follow-up of 3.6 years, the cumulative incidence of diabetes was 4.2%, 6.0%, and 7.5% in nonexposed, fetal-exposed, and childhood-exposed participants, respectively. Compared with nonexposed participants, fetal-exposed but not childhood-exposed participants had increased risks of diabetes, with multivariable-adjusted risk ratios (RRs) (95% CIs) of 1.17 (1.05-1.31) and 1.12 (0.96-1.30), respectively. Increased diabetes risks were observed in fetal-exposed individuals with nonideal dietary habits, nonideal physical activity, BMI ≥24.0 kg/m, or blood pressure ≥120/80 mmHg, whereas significant interaction was detected only in BMI strata ( for interaction = 0.0018). Significant interactions have been detected between number of ICVHMs and famine exposure on the risk of diabetes ( for interaction = 0.0005). The increased risk was observed in fetal-exposed participants with one or fewer ICVHMs (RR 1.59 [95% CI 1.24-2.04]), but not in those with two or more ICVHMs.

CONCLUSIONS

The increased risk of diabetes associated with famine exposure appears to be modified by the presence of ICVHMs.

摘要

目的

本研究旨在探讨理想心血管健康指标（ICVHMs）对饥荒暴露与成年后患糖尿病风险之间关联的影响。

研究设计和方法

本研究纳入了来自中国心血管代谢疾病和癌症队列研究（4C 研究）的 77925 名参与者，他们出生于中国大饥荒时期，基线时无糖尿病。根据出生年份，他们被分为三组饥荒暴露组，包括未暴露组（1963-1974 年）、胎儿暴露组（1959-1962 年）和儿童暴露组（1949-1958 年）。采用相对危险度回归分析来检验饥荒暴露与 ICVHMs 对糖尿病的关联。

结果

在平均 3.6 年的随访期间，未暴露组、胎儿暴露组和儿童暴露组的糖尿病累积发病率分别为 4.2%、6.0%和 7.5%。与未暴露组相比，仅胎儿暴露组而非儿童暴露组患糖尿病的风险增加，多变量校正后的风险比（RR）（95%CI）分别为 1.17（1.05-1.31）和 1.12（0.96-1.30）。在具有非理想饮食习惯、非理想体力活动、BMI≥24.0kg/m2 或血压≥120/80mmHg 的胎儿暴露个体中观察到糖尿病风险增加，而仅在 BMI 分层中存在显著交互作用（ for interaction = 0.0018）。在 ICVHMs 与饥荒暴露对糖尿病风险的交互作用方面也检测到了显著交互作用（ for interaction = 0.0005）。在具有一个或更少 ICVHMs 的胎儿暴露参与者中观察到风险增加（RR 1.59 [95%CI 1.24-2.04]），但在具有两个或更多 ICVHMs 的参与者中未观察到这种情况。