Frankel S, Elwood P, Sweetnam P, Yarnell J, Smith G D
Department of Social Medicine, University of Bristol, UK.
Lancet. 1996 Nov 30;348(9040):1478-80. doi: 10.1016/S0140-6736(96)03482-4.
Several studies have shown a relation between fetal development, as shown by birthweight, and later coronary heart disease. This study investigated whether this relation is predominantly the consequence of early life exposures, or can best be explained in terms of an interaction between influences in early life and in adulthood.
This prospective study in Caerphilly, South Wales, included 1258 men, aged 45-59 at initial screening, who were able to provide birthweight data. These men are from an initial cohort of 2512 men, from whom information has been obtained in a series of examinations since 1979 on health-related behaviours, incidence of coronary heart disease, and risk factors. The main outcome measure was fatal and non-fatal coronary heart disease during 10 years of follow-up.
Higher birthweight was related to lower risk of coronary heart disease during the follow-up period: coronary heart disease occurred in 46 (11.6%) men in the lowest birthweight tertile, 44 (12.0%) of those in the middle tertile, and 38 (9.1%) of those in the highest tertile (p = 0.03). Stratification of the cohort by body-mass index (BMI) revealed a significant interaction such that the inverse association between birthweight and risk of coronary heart disease was restricted to men in the top tertile of BMI (interaction test p = 0.048 adjusted for age, and p = 0.012 fully adjusted). Within the top BMI tertile, coronary heart disease occurred in 19 (16.4%) of men in the lowest birthweight tertile, 13 (12.6%) of those in the middle tertile, and 13 (7.5%) of those in the highest tertile (p = 0.0005). These associations were not changed substantially by adjustment for age, father's social class, own social class, marital status, fibrinogen and cholesterol concentrations, systolic blood pressure, and smoking history.
The association between birthweight and risk of coronary heart disease cannot be explained by associations with childhood or adulthood socioeconomic status. Nor do conventional risk factors for coronary heart disease in adulthood account for the association. However, there is an important interaction between birthweight and BMI such that the increased risk of coronary heart disease associated with low birthweight is restricted to people who have high BMI in adulthood. Risk of coronary heart disease seems to be defined by the combined effect of early-life and later-life exposures.
多项研究表明，出生体重所反映的胎儿发育情况与日后的冠心病之间存在关联。本研究调查了这种关联主要是早期生活暴露的结果，还是最好用早期生活和成年期影响因素之间的相互作用来解释。
这项在南威尔士卡菲利进行的前瞻性研究纳入了1258名男性，他们在初次筛查时年龄为45 - 59岁，且能够提供出生体重数据。这些男性来自最初的2512名男性队列，自1979年以来，通过一系列检查获取了他们与健康相关行为、冠心病发病率及危险因素的信息。主要结局指标是随访10年间的致命性和非致命性冠心病。
出生体重较高与随访期间较低的冠心病风险相关：出生体重处于最低三分位数的男性中有46人（11.6%）发生冠心病，处于中间三分位数的有44人（12.0%），处于最高三分位数的有38人（9.1%）（p = 0.03）。按体重指数（BMI）对队列进行分层显示存在显著的相互作用，即出生体重与冠心病风险之间的负相关仅限于BMI处于最高三分位数的男性（年龄调整后的相互作用检验p = 0.048，完全调整后p = 0.012）。在BMI最高三分位数组中，出生体重处于最低三分位数的男性中有19人（16.4%）发生冠心病，处于中间三分位数的有13人（12.6%），处于最高三分位数的有13人（7.5%）（p = 0.0005）。对年龄、父亲的社会阶层、自身社会阶层、婚姻状况、纤维蛋白原和胆固醇浓度、收缩压及吸烟史进行调整后，这些关联没有实质性变化。
出生体重与冠心病风险之间的关联无法用与儿童期或成年期社会经济地位的关联来解释。成年期冠心病的传统危险因素也不能解释这种关联。然而，出生体重与BMI之间存在重要的相互作用，即与低出生体重相关的冠心病风险增加仅限于成年期BMI较高的人群。冠心病风险似乎由早期生活和后期生活暴露的综合作用所决定。
