Cheng Mengling, Sommet Nicolas, Kerac Marko, Jopp Daniela S, Spini Dario
Swiss Centre of Expertise in Life Course Research, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland.
Centre for Maternal Adolescent Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, United Kingdom.
PLOS Glob Public Health. 2023 Aug 16;3(8):e0002161. doi: 10.1371/journal.pgph.0002161. eCollection 2023.
Child undernutrition and later-life non-communicable diseases (NCDs) are major global health issues. Literature suggests that undernutrition/famine exposure in childhood has immediate and long-term adverse health consequences. However, many studies have theoretical and methodological limitations. To add to the literature and overcome some of these limitations, we adopted a life course perspective and used more robust methods. We investigated the association between exposure to the 1959-1961 Chinese famine and later-life NCDs and if this association depends on: life stage at exposure, famine severity, and sex. We conducted a secondary data analysis of a large-scale, nationally representative, longitudinal study-the China Health and Retirement Longitudinal Study (2011-2018, 11,094 participants). We measured famine exposure/severity using self-reported experience, life stage using age at exposure, and health using the number of NCDs. We performed Poisson growth curve models. We obtained three findings. First, compared with unexposed participants, those exposed before age 18 had a higher risk of later-life NCDs, particularly if exposed in-utero (IRR = 1.90, 95% CI [1.70, 2.12], p < .001) and in the "first 1,000 days" of life (IRR = 1.86, 95% CI [1.73, 2.00], p < .001; for 0-6 months group, IRR = 1.95, 95% CI [1.67, 2.29], p < .001). Second, the famine effects among participants moderately and severely exposed were similar (IRR = 1.18, 95% CI [1.09, 1.28], p < .001 and IRR = 1.24, 95% CI [1.17, 1.32], p < .001). Third, the famine effects did not differ between females and males (IRR = 0.98, 95% CI [0.90, 1.07], p = .703). In an individual's life course, in-utero and the "first 1,000 days" are a particularly sensitive time period with marked long-term implications for NCDs if undernutrition/famine is experienced in this period. However, this window remains open until young adulthood. This highlights the need to invest more in preventing and treating child/adolescent undernutrition to tackle later-life NCDs.
儿童营养不良和成年后非传染性疾病（NCDs）是全球主要的健康问题。文献表明，儿童时期的营养不良/饥荒暴露会对健康产生即时和长期的不良后果。然而，许多研究存在理论和方法上的局限性。为了丰富文献并克服其中一些局限性，我们采用了生命历程视角并使用了更可靠的方法。我们研究了1959 - 1961年中国饥荒暴露与成年后非传染性疾病之间的关联，以及这种关联是否取决于：暴露时的生命阶段、饥荒严重程度和性别。我们对一项大规模、具有全国代表性的纵向研究——中国健康与养老追踪调查（2011 - 2018年，11,094名参与者）进行了二次数据分析。我们使用自我报告的经历来衡量饥荒暴露/严重程度，使用暴露时的年龄来衡量生命阶段，使用非传染性疾病的数量来衡量健康状况。我们进行了泊松增长曲线模型分析。我们得到了三个发现。第一，与未暴露的参与者相比，18岁之前暴露的参与者成年后患非传染性疾病的风险更高，特别是在子宫内暴露（发病率比值比[IRR] = 1.90，95%置信区间[CI][1.70, 2.12]，p <.001）以及在生命的“前1000天”暴露（IRR = 同类型的蛋白质）的情况下（IRR = 1.86，95% CI[1.73, 2.00]，p <.001；对于0 - 6个月组，IRR = 1.95，95% CI[1.67, 2.29]，p <.001）。第二，中度和重度暴露参与者的饥荒影响相似（IRR = 1.18，95% CI[1.09, 1.28]，p <.001和IRR = 1.24，95% CI[1.17, 1.32]，p <.001）。第三，女性和男性的饥荒影响没有差异（IRR = 0.98，95% CI[0.90, 1.07]，p =.703）。在个体的生命历程中，子宫内和“前1000天”是一个特别敏感的时期，如果在此期间经历营养不良/饥荒，对非传染性疾病具有显著的长期影响。然而，这个窗口期一直持续到青年期。这凸显了需要在预防和治疗儿童/青少年营养不良方面投入更多，以应对成年后的非传染性疾病。
