Prenatal famine exposure, adulthood obesity patterns and risk of type 2 diabetes

Abstract

BackgroundPrenatal exposure to famine and adulthood obesity have been independently related to the risk of type 2 diabetes; however, little is known about the joint effects of these risk factors at different stages of life on adulthood diabetes risk.MethodsThe analysis included 88 830 participants of the China Kadoorie Biobank, who were born around the time of the Chinese Great Famine and without diabetes, cardiovascular diseases, or cancer at baseline. We defined famine exposure subgroups as nonexposed (born between 1 October 1962 and 30 September 964), fetal-exposed (born between 1 October 1959 and 30 September 1961) and early-childhood exposed (born between 1 October 1956 and 30 September 1958). General obesity was assessed by body mass index (BMI: overweight ≥ 24.0, obesity ≥ 28.0) and abdominal obesity assessed by waist-to-hip ratio (WHR, men/women: moderate ≥ 0.90/0.85, high ≥ 0.95/0.90).ResultsDuring a median 7.3 years (642 552 person-years) of follow-up, we identified 1372 incident cases of type 2 diabetes. Compared with nonexposed and early-childhood exposed participants combined as a single comparison group, fetal-exposed participants showed an increased risk of diabetes in adulthood [hazard ratio (HR) = 1.25; 95% confidence interval (CI): 1.07–1.45]. The association between general obesity and diabetes was consistent across subgroups according to famine exposure (P for interaction > 0.05). A stronger association between abdominal obesity and diabetes was observed in the fetal-exposed subgroup than in other subgroups (P for interaction = 0.025 in the whole population). This interaction was more obvious in women (P = 0.013) but not in men (P = 0.699). Compared with normal-BMI and -WHR participants, those with both general (BMI ≥ 24.0) and abdominal (WHR ≥ 0.90/0.85) obesity in adulthood had 5.32 (95% CI: 3.81–7.43)-, 3.13 (2.48–3.94)- and 4.43 (3.45–5.68)-fold higher risks if these were carried during, before and after times of famine, respectively.ConclusionsCoexistence of prenatal experience of undernutrition and abdominal obesity in adulthood was associated with a higher risk of type 2 diabetes.

Foetal and childhood exposure to famine and the risks of cardiometabolic conditions in adulthood: A systematic review and meta‐analysis of observational studies

“…Of these 71 articles, 24 were further excluded for various reasons (Appendix S1). Finally, 47 articles were included in the present meta‐analysis. The articles were published between 2006 and 2019, mostly published from 2014 onwards.…”

“…Birthdates were used as a proxy for famine exposure in nearly all studies. The vast majority of the studies investigated the prevalence of the outcomes of interest, with only a few studies estimating the incidence of the outcomes of interest. The definition used to identify the cases was considerably different across the studies.…”

“…Foetal exposure to famine was associated with higher risks of T2DM (RR 1.37, 95% CI, 1.23‐1.52; Figure ), metabolic syndrome (RR 1.26, 95% CI, 1.07‐1.50; Figure ), hypertension (RR 1.30, 95% CI, 1.07‐1.57; Figure ), hyperglycaemia (RR 1.27, 95% CI, 1.11‐1.45; Figure ), dyslipidaemia (RR 1.48, 95% CI, 1.33‐1.66; Figure 2), obesity (RR 1.19, 95% CI, 1.02‐1.39; Figure ), overweight (RR 1.17, 95% CI, 1.07‐1.29; Figure ), coronary heart disease (RR 1.22, 95% CI, 1.00‐1.51; Figure ), and moderate‐to‐severe NAFLD (RR 1.66, 95% CI, 1.07‐2.57; Figure 3) . No association was observed for the risks of stroke (RR 1.21, 95% CI, 0.96‐1.52; Figure ) or mild NAFLD (RR 1.04, 95% CI, 0.64‐1.70; Figure 3) .…”

Epidemiological evidence for the developmental origins of health and disease: effects of prenatal undernutrition in humans

“…People who had been exposed prenatally to the Biafran famine during the Nigerian civil war (1967)(1968)(1969)(1970) were found that have increased rates of hypertension and type 2 diabetes at the age of 40 years compared to those who had not been exposed to the Biafran famine in utero. Similarly, studies of people exposed to the Great Leap Forward famine in China have shown similar effects of prenatal famine exposure in later life risk of diabetes, hypertension and schizophrenia (Chen et al 2007, Li et al 2017, Meng et al 2018. A unique Austrian study among showed excess risk of diabetes among people born around the time of the three periods of famine that struck the country in 1918-1919, 1938and 1946-1947(Thurner et al 2013.…”

Early weaning induces short‐ and long‐term effects on pancreatic islets in Wistar rats of both sexes

“…Recently, it has been observed that pandemic obesity and T2DM are related not only to changes in lifestyle but also to nutritional patterns in early life (Meng et al 2018). According to the World Health Organization (2018), malnutrition is one of the most common causes of child morbidity and mortality in all countries; high rates of malnutrition may be due to the interruption of breastfeeding, which deprives the child of nutritional and hormonal components essential for development (Victora et al 2016;World Health Organization, 2018).…”