School of Public Health, North China University of Science and Technology, Tangshan, China.
Department of Neurosurgery, Affiliated Hospital of North China University of Science and Technology, Tangshan, China.
Eur J Neurol. 2021 Apr;28(4):1244-1252. doi: 10.1111/ene.14661. Epub 2020 Dec 19.
Epidemiological studies have reported an association between famine exposure and increased risk of cardiovascular disease. However, it is unclear whether fetal exposure to the Great Chinese Famine of 1959 to 1961 was associated with risk of ischemic stroke in midlife.
A total of 17,787 participants of the Kailuan study, who were free of cardiovascular disease and cancer at baseline (2006) were enrolled in the study. All participants were divided into three groups: unexposed (born between 1 October 1962 and 30 September 1964, used as the reference group in current analyses), fetal exposure (born between 1 October 1959 and 30 September 1961), and early childhood exposure (born between 1 October 1956 and 30 September 1958). Incident ischemic stroke cases between 2006 and 2017 were confirmed by review of medical records. Cox proportional hazards regression was applied to analyze the effect of fetal famine exposure on ischemic stroke risk.
During the mean (10.4 ± 2.2) years of follow-up, 547 incident ischemic stroke cases were identified. After adjustment for potential confounders, the hazard ratio (HR) for ischemic stroke was 1.45, and the 95% confidence interval (CI) was 1.14, 1.84 for fetal famine-exposed compared with unexposed individuals. Similar associations were observed in men (adjusted HR: 1.40; 95% CI: 1.08, 1.80) and overweight individuals (adjusted HR: 1.56; 95% CI: 1.18, 2.07), but not in their counterparts. The results of the early childhood-exposed group were similar to the above.
Our findings support an association between fetal malnutrition and higher risk of ischemic stroke in adulthood.
流行病学研究报告称，饥荒暴露与心血管疾病风险增加之间存在关联。然而，目前尚不清楚 1959 年至 1961 年中国大饥荒期间胎儿暴露是否与中年时期发生缺血性中风的风险相关。
共纳入了 17787 名参加开滦研究的参与者，他们在基线（2006 年）时无心血管疾病和癌症。所有参与者被分为三组：未暴露组（出生于 1962 年 10 月 1 日至 1964 年 9 月 30 日，当前分析中用作参考组）、胎儿暴露组（出生于 1959 年 10 月 1 日至 1961 年 9 月 30 日）和幼儿暴露组（出生于 1956 年 10 月 1 日至 1958 年 9 月 30 日）。通过审查病历来确认 2006 年至 2017 年期间发生的缺血性中风病例。应用 Cox 比例风险回归分析胎儿饥荒暴露对缺血性中风风险的影响。
在平均（10.4±2.2）年的随访期间，共确定了 547 例缺血性中风事件。在校正潜在混杂因素后，与未暴露组相比，胎儿饥荒暴露组发生缺血性中风的风险比（HR）为 1.45，95%置信区间（CI）为 1.14 至 1.84。在男性（校正 HR：1.40；95%CI：1.08 至 1.80）和超重个体（校正 HR：1.56；95%CI：1.18 至 2.07）中也观察到类似的关联，但在其对应组中则不然。幼儿暴露组的结果与上述结果相似。
我们的研究结果支持胎儿营养不良与成年后患缺血性中风风险增加之间存在关联。
