Stein C E, Fall C H, Kumaran K, Osmond C, Cox V, Barker D J
Medical Research Council Environmental Epidemlology Unit, Southampton General Hospital.
Lancet. 1996 Nov 9;348(9037):1269-73. doi: 10.1016/s0140-6736(96)04547-3.
Coronary heart disease is predicted to become the commonest cause of death in india within 15 years People from India living overseas already have high rates of the disease that are not explained by known coronary risk factors. Small size at birth is a newly described risk factor for coronary heart disease, but associations between size at birth and the disease have not been examined in India.
We studied 517 men and women who were born between 1934 and 1954 in a mission hospital in Mysore, South India, and who still lived near to the hospital. We related the prevalence of coronary heart disease, defined by standard criteria, to their birth size.
25 (9%) men and 27 (11%) women had coronary heart disease. Low birthweight, short birth length, and small head circumference at birth were associated with a raised prevalence of the disease. Prevalence fell from 11% in people whose birthweights were 5.5 lb (2.5 kg) or less to 3% in those whose birthweights were more than 7 lb (3.1 kg), p for trend = 0.09. The trends were stronger and statistically significant among people aged 45 years and over (p = 0.03 for birthweight, 0.04 for length, and 0.02 for head circumference). High rates of disease were also found in those whose mothers had a low body weight during pregnancy. The highest prevalence of the disease (20%) was in people who weighted 5.5 lb (2.5 kg) or less at birth and whose mothers weighted less than 100 lb (45 kg) in pregnancy. These associations were largely independent of known coronary risk factors.
In India, as in the UK, coronary heart disease is associated with small size at birth, suggesting that its pathogenesis is influenced by events in utero. The association with low maternal bodyweight is further evidence that the disease originates through fetal undernutrition. Prevention of the rising epidemic of the disease in India may require improvements in the nutrition and health of young women.
预计冠心病将在15年内成为印度最常见的死因。生活在海外的印度人患这种疾病的比例已经很高，而已知的冠心病危险因素并不能解释这一现象。出生时体型小是一种新发现的冠心病危险因素，但在印度，出生时的体型与该疾病之间的关联尚未得到研究。
我们研究了1934年至1954年间在印度南部迈索尔的一家教会医院出生、仍居住在医院附近的517名男性和女性。我们将根据标准标准定义的冠心病患病率与其出生时的体型相关联。
25名（9%）男性和27名（11%）女性患有冠心病。低出生体重、出生时身长较短和头围较小与该疾病患病率升高有关。患病率从出生体重5.5磅（2.5千克）或更低的人群中的11%降至出生体重超过7磅（3.1千克）的人群中的3%，趋势p值 = 0.09。在45岁及以上的人群中，这些趋势更强且具有统计学意义（出生体重p值 = 0.03，身长p值 = 0.04，头围p值 = 0.02）。在母亲孕期体重低的人群中也发现了高患病率。该疾病患病率最高（20%）的是出生体重5.5磅（2.5千克）或更低且母亲孕期体重低于100磅（45千克）的人群。这些关联在很大程度上独立于已知的冠心病危险因素。
在印度，与英国一样，冠心病与出生时体型小有关，这表明其发病机制受子宫内事件的影响。与母亲低体重的关联进一步证明该疾病起源于胎儿营养不良。预防印度该疾病不断上升的流行趋势可能需要改善年轻女性的营养和健康状况。
