Leon D A, Koupilova I, Lithell H O, Berglund L, Mohsen R, Vagero D, Lithell U B, McKeigue P M
Epidemiology Unit, London School of Hygiene and Tropical Medicine, London, UK.
BMJ. 1996 Feb 17;312(7028):401-6. doi: 10.1136/bmj.312.7028.401.
To clarify the type of fetal growth impairment associated with increased blood pressure in adult life, and to establish whether this association is influenced by obesity and is mediated through impairment of insulin action.
Cross sectional survey with retrospective ascertainment of size at birth from obstetric archives.
1333 men resident in Uppsala, Sweden, who took part in a 1970 study of coronary risk factors at age 50 and for whom birth weight was traced.
Systolic and diastolic blood pressure at age 50.
In the full study population for a 1000g increase in birth weight there was a small change in systolic blood pressure of -2.2mmHg (95% confidence interval -4.2 to - 0.3mmHg) and in diastolic blood pressure of -1.0mmHg (-2.2 to 0.1mmHg). Much stronger effects were observed among men who were born at term and were in the top third of body mass index at age 50, for whom a 1000g increase in birth weight was associated with a change of -9.1mmHg (-16.4 to-1.9mmHg) systolic and -4.2mmHg (-8.3 to -0.1mmHg) diastolic blood pressure. Men who were light at birth (<3250g) but were above median adult height had particularly high blood pressure. Adjustment for insulin concentrations reduced the associations of birth weight with systolic and diastolic blood pressure.
A failure to realise growth potential in utero (as indicated by being light at birth but tall as an adult) is associated with raised adult blood pressure. Impaired fetal growth may lead to substantial increases in adult blood pressure among only those who become obese. Metabolic disturbances, possibly related to insulin resistance, may provide a pathway through which fetal growth affects blood pressure.
明确与成年后血压升高相关的胎儿生长受限类型，并确定这种关联是否受肥胖影响以及是否通过胰岛素作用受损介导。
通过回顾性查阅产科档案确定出生时大小的横断面调查。
瑞典乌普萨拉的1333名男性，他们参与了1970年一项针对50岁时冠心病危险因素的研究，且其出生体重有记录。
50岁时的收缩压和舒张压。
在整个研究人群中，出生体重每增加1000g，收缩压有小幅变化，降低2.2mmHg（95%置信区间为-4.2至-0.3mmHg），舒张压降低1.0mmHg（-2.2至0.1mmHg）。在足月出生且50岁时体重指数处于前三分之一的男性中观察到更强的效应，对于他们，出生体重每增加1000g，收缩压变化为-9.1mmHg（-16.4至-1.9mmHg），舒张压变化为-4.2mmHg（-8.3至-0.1mmHg）。出生时体重较轻（<3250g）但成年身高高于中位数的男性血压特别高。对胰岛素浓度进行校正后，出生体重与收缩压和舒张压之间的关联减弱。
子宫内未能实现生长潜能（如出生时体重轻但成年后身高高所示）与成年后血压升高有关。胎儿生长受限可能仅在那些成年后肥胖的人群中导致成年血压大幅升高。可能与胰岛素抵抗相关的代谢紊乱可能为胎儿生长影响血压提供了一条途径。
