Jensen Elizabeth T, Bertoni Alain G, Crago Osa L, Rotter Jerome I, Chen Yii-Der I, Wood Alexis, Rich Stephen S, Goodarzi Mark O
Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
Institute for Translational Genomics and Population Sciences, The Lundquist Institute for Biomedical Innovation and Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA 90502, USA.
J Endocr Soc. 2022 May 4;6(7):bvac072. doi: 10.1210/jendso/bvac072. eCollection 2022 Jul 1.
The present study was designed to evaluate if mode of delivery at birth is associated with body mass index (BMI) and glucose homeostasis traits in later life, controlling for possible confounders, including maternal history of diabetes. Data were obtained through a racially diverse, prospective cohort study of nondiabetic, older adults, the Microbiome and Insulin Longitudinal Evaluation Study (MILES). We used generalized linear models to estimate the association between mode of delivery and glycemic status, BMI (kg/m), waist circumference (cm), fasting glucose, fasting insulin, insulin secretion, insulin sensitivity, and insulin clearance. Further, we estimated the direct and indirect effects of cesarean delivery on glucose and insulin-related traits, as mediated by BMI status. Relative to vaginal delivery, cesarean delivery was associated with a significantly higher BMI (adjusted beta [aβ] 3.53 kg/m; 95% CI 0.15, 6.91) and fasting glucose (aβ 5.12; 95% CI 0.01, 10.23), a 14% decrease in insulin sensitivity (aβ -0.14; 95% CI -0.28, -0.01), and a 58% increased risk (adjusted relative risk [aRR] 1.58; 95% CI 1.08, 2.31) for prediabetes/diabetes. Associations were mediated in part by BMI, with the strongest evidence observed for glycemic status (proportion mediated 22.6%; = .03), fasting insulin (proportion mediated 58.0%; = .05), and insulin sensitivity index (proportion mediated 45.9%; = .05). Independent of mediation, a significant direct effect of cesarean delivery on glycemic status was observed (aRR 1.88; 95% CI 1.16, 2.60). Cesarean delivery may lead to reduced insulin sensitivity and, ultimately, increased risk for developing prediabetes and diabetes.
本研究旨在评估出生时的分娩方式是否与成年后期的体重指数（BMI）及葡萄糖稳态特征相关，并对包括母亲糖尿病史在内的可能混杂因素进行控制。数据来自一项针对非糖尿病老年人的种族多样化前瞻性队列研究——微生物组与胰岛素纵向评估研究（MILES）。我们使用广义线性模型来估计分娩方式与血糖状态、BMI（kg/m）、腰围（cm）、空腹血糖、空腹胰岛素、胰岛素分泌、胰岛素敏感性及胰岛素清除率之间的关联。此外，我们还估计了剖宫产通过BMI状态对葡萄糖及胰岛素相关特征产生的直接和间接影响。相对于阴道分娩，剖宫产与显著更高的BMI（校正β值[aβ]为3.53 kg/m；95%置信区间为0.15，6.91）和空腹血糖（aβ为5.12；95%置信区间为0.01，10.23）、胰岛素敏感性降低14%（aβ为 -0.14；95%置信区间为 -0.28，-0.01）以及糖尿病前期/糖尿病风险增加58%（校正相对风险[aRR]为1.58；95%置信区间为1.08，2.31）相关。这些关联部分由BMI介导，在血糖状态方面观察到的证据最为有力（介导比例为22.6%；P = 0.03）、空腹胰岛素（介导比例为58.0%；P = 0.05）和胰岛素敏感性指数（介导比例为45.9%；P = 0.05）。独立于中介作用之外，还观察到剖宫产对血糖状态有显著的直接影响（aRR为1.88；95%置信区间为1.16，2.60）。剖宫产可能会导致胰岛素敏感性降低，并最终增加患糖尿病前期和糖尿病的风险。
