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Early Life Famine Exposure, Ideal Cardiovascular

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Early Life Famine Exposure, Ideal Cardiovascular Diabetes Care 1 Jieli Lu,1 Mian Li,1 Yu Xu,1 Yufang Bi,1 Early Life Famine Exposure, Ideal Yingfen Qin,2 Qiang Li,3 Tiange Wang,1 Ruying Hu,4 Lixin Shi,5 Qing Su,6 Min Xu,1 Cardiovascular Health Metrics, Zhiyun Zhao,1 Yuhong Chen,1 Xuefeng Yu,7 Li Yan,8 Rui Du,1 Chunyan Hu,1 Guijun Qin,9 and Risk of Incident Diabetes: Qin Wan,10 Gang Chen,11 Meng Dai,1 Di Zhang,1 Zhengnan Gao,12 Findings From the 4C Study Guixia Wang,13 Feixia Shen,14 Zuojie Luo,2 15 16 4 https://doi.org/10.2337/dc19-2325 Li Chen, Yanan Huo, Zhen Ye, Xulei Tang,17 Yinfei Zhang,18 Chao Liu,19 Youmin Wang,20 Shengli Wu,21 Tao Yang,22 Huacong Deng,23 Donghui Li,24 Shenghan Lai,25 Zachary T. Bloomgarden,26 Lulu Chen,27 Jiajun Zhao,28 Yiming Mu,29 Guang Ning,1 and Weiqing Wang,1 for the 4C Study Group OBJECTIVE We aim to investigate the impact of ideal cardiovascular health metrics (ICVHMs) on the association between famine exposure and adulthood diabetes risk. RESEARCH DESIGN AND METHODS This study included 77,925 participants from the China Cardiometabolic Disease and Cancer Cohort (4C) Study who were born around the time of the Chinese Great Famine and free of diabetes at baseline. They were divided into three famine exposure groups according to the birth year, including nonexposed (1963–1974), fetal exposed (1959–1962), and childhood exposed (1949–1958). Relative risk regression was used to examine the associations between famine exposure and 1Shanghai National Clinical Research Center for ICVHMs on diabetes. MetabolicDiseases,KeyLaboratoryforEndocrine and Metabolic Diseases of the National Health RESULTS Commission of the PR China, Shanghai National During a mean follow-up of 3.6 years, the cumulative incidence of diabetes was Center for Translational Medicine, Shanghai In- stitute of Endocrine and Metabolic Diseases, 4.2%, 6.0%, and 7.5% in nonexposed, fetal-exposed, and childhood-exposed CARDIOVASCULAR AND METABOLIC RISK Department of Endocrine and Metabolic Dis- participants, respectively. Compared with nonexposed participants, fetal-exposed eases, Ruijin Hospital, Shanghai Jiao Tong Uni- but not childhood-exposed participants had increased risks of diabetes, with versity School of Medicine, Shanghai, China 2 multivariable-adjusted risk ratios (RRs) (95% CIs) of 1.17 (1.05–1.31) and 1.12 (0.96– The First Affiliated Hospital of Guangxi Medical University, Nanning, China 1.30), respectively. Increased diabetes risks were observed in fetal-exposed individuals 3The Second Affiliated Hospital of Harbin Medical 2 with nonideal dietary habits, nonideal physical activity, BMI ‡24.0 kg/m , or blood University, Harbin, China pressure ‡120/80 mmHg, whereas significant interaction was detected only in BMI 4Zhejiang Provincial Center for Disease Control strata (P for interaction 5 0.0018). Significant interactions have been detected and Prevention, Hangzhou, China 5 fi P Af liated Hospital of Guiyang Medical College, between number of ICVHMs and famine exposure on the risk of diabetes ( for Guiyang, China interaction 5 0.0005). The increased risk was observed in fetal-exposed participants 6Xinhua Hospital Affiliated to Shanghai Jiao Tong with one or fewer ICVHMs (RR 1.59 [95% CI 1.24–2.04]), but not in those with two or University School of Medicine, Shanghai, China 7 more ICVHMs. Tongji Hospital, Tongji Medical College, Huaz- hong University of Science and Technology, Wu- CONCLUSIONS han, China 8Sun Yat-sen Memorial Hospital, Sun Yat-sen The increased risk of diabetes associated with famine exposure appears to be University, Guangzhou, China modified by the presence of ICVHMs. 9The First Affiliated Hospital of Zhengzhou Uni- versity, Zhengzhou, China 10The Affiliated Hospital of Southwest Medical Emerging evidence indicated that early life development was associated with the risk University, Luzhou, China 11Fujian Provincial Hospital, Fujian Medical Uni- of type 2 diabetes mellitus (T2DM) in adulthood (1,2). Low birth weight was associated versity, Fuzhou, China with a higher risk of diabetes in later life (3–5). In addition, studies of the Ukraine 12Dalian Municipal Central Hospital Affiliated famine and the Dutch “Hunger Winter” famine suggested that exposure to starvation to Dalian Medical University, Dalian, China Diabetes Care Publish Ahead of Print, published online June 4, 2020 2 Famine Exposure, ICVHMs, and Risk of Diabetes Diabetes Care in utero was associated with an elevated association between famine exposure The study was approved by the Med- risk of T2DM in later life (6,7). As one of and adulthood diabetes risk. Therefore, ical Ethics Committee of Ruijin Hospital, the largest catastrophes in human his- we conducted this prospective study in a Shanghai Jiao Tong University (Shanghai, tory, the Chinese Great Famine has nationwide large cohort of the China China). Written informed consent was aroused much attention from scholars Cardiometabolic Disease and Cancer Co- obtained from all participants. (8). The Chinese Great Famine had over- hort (4C) Study, with two aims: 1)to whelmingly cardiometabolic consequen- examine the association between early Data Collection ces, including increasing the risk of life famine exposure and risk of T2DM All questionnaire data collection and obesity (9,10) and metabolic syndrome later in life, and 2) to explore whether the anthropometric measurements were (11). Several previous epidemiological ICVHMs might modify the association performed by trained staff according to a studies have shown an association be- between famine exposure and risk of standard protocol at local health stations tween Chinese famine exposure and the diabetes. or community clinics at each study center. risk of T2DM (12–14). However, whether Using a detailed questionnaire, we col- andwhatfactorsinlater lifemight modify RESEARCH DESIGN AND METHODS lected information on sociodemographic this association have not been exten- Study Population characteristics, lifestyle factors, as well as sively investigated. The China Cardiometabolic Disease and medical history through personal inter- Rapid economic development and as- Cancer Cohort (4C) Study was a multi- views. Education levels were divided into sociated dramatic lifestyle changes have center, prospective, population-based highschool educationoraboveversusless led to a substantial increase in the prev- cohort study investigating the associa- than high school. The type and frequency alence of T2DM in China (15–17). The tions of glucose homeostasis with clinical of alcohol consumptions and smoking association between early life develop- outcomes, including diabetes, cardiovas- habits were recorded. Participants were ment and risk of T2DM may be modified cular disease, cancer, and all-cause mor- classified as never, former, or current by lifestyle in adulthood (5,14,18,19). In tality. A total of 20 communities from drinkers according to alcohol drinking 2010, the American Heart Association various geographic regions in China were habits. The information on intensity, du- proposed seven components critical to selected to represent the general pop- ration, and frequency of physical activity ideal cardiovascular health (CVH), includ- ulation in China. Eligible men and women was gathered using the short form of the ing four ideal health behaviors (nonsmok- aged $40 years were identified from International Physical Activity Question- ing within the last year, idealBMI,physical local resident registration systems. Trained naire, and the metabolic equivalent mi- activityatgoallevels,andadietarypattern community health workers visited eligible nutes per week were used to estimate recommended) and three biological fac- individuals’ homes and invited them to physical activities (one metabolic equiva- tors (ideal total cholesterol [TC], blood participate in the study. A total of 193,846 lent represents the energy expenditure for pressure (BP), and fasting plasma glucose) individuals were recruited for the study at an individual at rest) (27). A previously (20). There has been accumulating evi- baselinefrom2011to2012(24–26).During evaluated and validated dietary question- dence suggesting that ideal CVH might 2014–2016, all participants were invited to naire (25) was used to collect information be a marker of insulin sensitivity and participate in an in-person follow-up visit. on dietary intake over the past 12 months. related to lower risk of T2DM (21–23). Lifestyle risk factors and medical history The questionnaire was designed to cap- However, previous studies only exam- were queried by trained staff using the ture information on frequency and quan- ined the effect of diet and adult obesity same standard questionnaire as at base- tity of major food items such as red meat, on the association between famine ex- line. Anthropometric and BP measure- fruits and vegetables, dairy, and Chinese posure and the risk of T2DM (14,19). To ments, oral glucose tolerance tests, traditional food like pickles and salty the best of our knowledge, there have and blood samples were obtained using vegetables. been no studies to explore the impact of the same protocol that was used in the Height and weight were measured to these ideal CVH metrics (ICVHMs) on the baseline examination. the nearest 0.1 kg and 0.1 cm separately 13The First Hospital of Jilin University, Chang- 22The First Affiliated Hospital of Nanjing Medical Corresponding author: Weiqing Wang, wqingw61@ chun, China University, Nanjing, China 163.com, or Jieli Lu, [email protected] 14 fi 23 fi The First Af liated Hospital of Wenzhou Med- The First Af liated Hospital of Chongqing Med- Received 20 November 2019 and accepted 23 ical University, Wenzhou, China ical University, Chongqing, China April 2020 15Qilu Hospital of Shandong University, Jinan, 24Department of Gastrointestinal Medical On- China cology, The University of Texas MD Anderson This article contains supplementary material online fi 16Jiangxi Provincial People’s Hospital Affiliated to Cancer Center, Houston, TX at https://doi.org/10.2337/ gshare.12185469. Nanchang University, Nanchang, China 25Johns Hopkins University School of Medicine, J.L., M.L., Y.X., Y.B., Y.Q., Q.L., and T.W. contrib- 17The First Hospital of Lanzhou University, Lanz- Baltimore, MD uted equally to this work.
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