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Li X, Li X, Sun L, Yang L, Wang C, Yuan T, Lei Y, Li J, Liu M, Zhang D, Hua Y, Liu H, Zhang L. Individual and combined effects of famine exposure and obesity parameters on type 2 diabetes in middle-aged and older adults: A population-based cross-sectional study. Medicine (Baltimore) 2024; 103:e39228. [PMID: 39121280 PMCID: PMC11315537 DOI: 10.1097/md.0000000000039228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 07/18/2024] [Indexed: 08/11/2024] Open
Abstract
Malnutrition early in life may have adverse effects on health later in life. The relationship between malnutrition and obesity parameters (body mass index [BMI] and waist circumference [WC]) and type 2 diabetes is inconsistent. This study aimed to identify the effects of famine exposure and obesity parameters on type 2 diabetes individually or in combination among middle-aged and older adults in China. Data were extracted from the China Health and Retirement Longitudinal Study Wave1 in 2011. The sample involved 13,065 adults aged 45 to 90. The t- or F test was employed to compare age among groups. The chi-square test was utilized to compare baseline characteristics according to the categorical WC levels/BMI levels/famine exposure and examine between-group differences in type 2 diabetes (diabetes and non-diabetes). Odds ratio (OR) and 95% confidence interval (CI) were estimated by logistic regression models to estimate the individual and combined associations of BMI/WC levels and famine exposure with the prevalence of type 2 diabetes. In this study, 1559 (11.93%) individuals were exposed to Chinese famine during their fetal stage, 5132 (39.28%) and 4428 (33.89%) in childhood and adolescence/adulthood, respectively. Among BMI measurements, 3780 (28.93%) were overweight, and 1487 (11.38%) were obese, whereas WC measurements showed that 5408 (41.39%) were obesity. In addition, 831 (45.48%) males and 996 (54.52%) females reported type 2 diabetes. In multivariable-adjusted regression models, obesity parameters and famine exposure were independently associated with type 2 diabetes prevalence among all participants (P < .001). In the interaction analysis, there existed a trend of higher odds for prevalence of type 2 diabetes across all groups compared to the combination of no-exposed and normal BMI/WC level group (the most increase in odds, adolescence/adulthood-exposed group with central obesity in WC levels: OR 4.51 (95% CI = 3.42-5.95); adolescence/adulthood-exposed group with obesity in BMI levels: OR 5.84 (95% CI = 4.11-8.30; P for interaction <.001). The findings for females exhibited similar to the overall participants, when by gender stratification. Our results suggest famine exposure and obesity parameters have positive combined effects on type 2 diabetes in middle-aged and older adults in China.
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Affiliation(s)
- Xiaoping Li
- Department of Emergency and Critical Care Nursing, School of Nursing, Wannan Medical College, Wuhu City, An Hui Province, P.R.China
| | - Xiaoguang Li
- National Center for Occupational Safety and Health, National Health Commission of the People’s Republic of China, Beijing, P.R.China
| | - Lu Sun
- Department of Emergency and Critical Care Nursing, School of Nursing, Wannan Medical College, Wuhu City, An Hui Province, P.R.China
| | - Liu Yang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, Wuhu City, An Hui Province, P.R.China
| | - Congzhi Wang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, Wuhu City, An Hui Province, P.R.China
| | - Ting Yuan
- Obstetrics and Gynecology Nursing, School of Nursing, Wannan Medical College, Wuhu City, An Hui Province, P.R.China
| | - Yunxiao Lei
- Obstetrics and Gynecology Nursing, School of Nursing, Wannan Medical College, Wuhu City, An Hui Province, P.R.China
| | - Jing Li
- Department of Surgical Nursing, School of Nursing, Wannan Medical College, Wuhu City, An Hui Province, P.R.China
| | - Mingming Liu
- Department of Surgical Nursing, School of Nursing, Wannan Medical College, Wuhu City, An Hui Province, P.R.China
| | - Dongmei Zhang
- Department of Pediatric Nursing, School of Nursing, Wannan Medical College, Wuhu City, An Hui Province, P.R.China
| | - Ying Hua
- Rehabilitation Nursing, School of Nursing, Wanna Medical College, Wuhu City, An Hui Province, P.R.China
| | - Haiyang Liu
- Student Health Center, Wannan Medical College, Wuhu City, An Hui Province, P.R.China
| | - Lin Zhang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, Wuhu City, An Hui Province, P.R.China
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Yi Q, Wu J, Shen Y, Zhu Y, Zhou Y, Bai H, Hao J, Song P. Associations of concurrent early-life famine exposure and adulthood obesity with type 2 diabetes mellitus in middle-aged Chinese. J Diabetes 2024; 16:e13480. [PMID: 37882478 PMCID: PMC10859315 DOI: 10.1111/1753-0407.13480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Evidence has shown that early-life famine exposure and obesity in adulthood are independently associated with the risk of type 2 diabetes mellitus (T2DM). However, few studies had revealed the combined effect of these risk factors. METHODS Two sets of groups from the China Health and Retirement Longitudinal Study (CHARLS) were selected. The fetal-exposure group born in 1959-1961 from 2011 wave (N = 958) and nonexposure group born in 1963-1965 from 2015 wave (N = 1540) were selected as Comparison 1. The early childhood-exposure group born in 1955-1957 from 2011 wave (N = 1510) and fetal-exposure group born in 1959-1961 from 2015 wave (N = 943) were Comparison 2. Logistic regressions were applied to examine the associations of different famine exposure periods and obesity patterns with T2DM risk. RESULTS Compared with nonexposed participants without central overweight/obesity in adulthood, central overweight/obesity in adulthood together with nonexposure (odds ratio [OR]: 1.89, 95% confidence interval [CI]: 1.19-3.00) or fetal-exposure (OR: 1.99, 95% CI: 1.23-3.23) was associated with higher risks of T2DM. Compared with the early childhood-exposure group, the fetal-exposed participants showed higher risks of T2DM (OR: 1.30, 95% CI: 1.02-1.66). The coexistence of fetal famine exposure and central overweight/obesity in adulthood was associated with higher risks of T2DM (OR: 1.82, 95% CI: 1.19-2.79). Consistent associations were observed among males and participants from less severely affected areas. CONCLUSIONS In conclusion, central overweight/obesity in adulthood is associated with the increased risk of T2DM, but the effect of early-life famine exposure is not very clear.
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Affiliation(s)
- Qian Yi
- School of Public Health and Women's HospitalZhejiang University School of Medicine, Zhejiang UniversityHangzhouChina
| | - Jing Wu
- School of Public Health, Zhejiang University School of MedicineZhejiang UniversityHangzhouChina
| | - Yaojia Shen
- Department of Maternal and Child Health, School of Public HealthPeking UniversityBeijingChina
| | - Yunying Zhu
- School of Public Health, Zhejiang University School of MedicineZhejiang UniversityHangzhouChina
| | - Yiyang Zhou
- School of Public Health, Zhejiang University School of MedicineZhejiang UniversityHangzhouChina
| | - He Bai
- School of Public Health, Zhejiang University School of MedicineZhejiang UniversityHangzhouChina
| | - Jiajun Hao
- School of Public Health, Zhejiang University School of MedicineZhejiang UniversityHangzhouChina
| | - Peige Song
- School of Public Health and Women's HospitalZhejiang University School of Medicine, Zhejiang UniversityHangzhouChina
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He P, Luo Y, Ding R, Zheng X. Is it just a cure? Re-evaluating the effects of prenatal exposure to the Great Chinese Famine on the risk of infectious diseases in adulthood. Soc Sci Med 2022; 314:115487. [PMID: 36335705 DOI: 10.1016/j.socscimed.2022.115487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/03/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Very limited studies focused on the early-life adversities on infectious diseases. Taking the Great Chinese famine as a natural experiment, this study re-evaluated the long-term effect of prenatal famine exposure on infectious diseases by using nationally representative data. METHODS Using difference-in-difference (DID) models, we analyzed 215,216 adults who participated in the Second National Sample Survey on Disability in 2006 across 734 counties of China to detect the effects of prenatal exposure to the Great Chinese Famine on the risk of infectious diseases in adulthood. Infectious diseases were ascertained by using the combination of self-reports or family members' reports and on-site medical diagnosis by experienced specialists, and the severity of famine was measured by the cohort size shrinkage index (CSSI) at the county level. RESULTS All DID estimates of the effects of famine on the probability of infectious diseases were insignificant, with a coefficient of 0.0007 (-0.0024, 0.0026) for all participants and coefficients of 0.0001 (-0.0041, 0.0043) and -0.0002 (-0.0036, 0.0033) for males and females, respectively. That is, the famine cohort dwelling in regions with a greater intensity of famine had similar levels of infectious disease risks than the cohorts with post-famine prenatal exposure experience in less affected famine regions. Furthermore, there were no significant famine and post-famine cohort differences in the DID estimates by examining the variations in subgroups with different types of infectious diseases (trachoma, poliomyelitis, tuberculosis, maternal infections and other infectious diseases). CONCLUSION No significant impact of prenatal exposure to the Chinese famine was observed on the risk of infectious diseases in adulthood. Famine survivors may be "cured" by the famine and were resilient to adverse environments in their life course because selective mortality may weaken the association between adverse prenatal exposure and later health.
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Affiliation(s)
- Ping He
- China Center for Health Development Studies, Peking University, Beijing, China.
| | - Yanan Luo
- Department of Global Health, School of Public Health, Peking University, Beijing, China; Institute for Global Health and Development, Peking University, Beijing, China.
| | - Ruoxi Ding
- China Center for Health Development Studies, Peking University, Beijing, China.
| | - Xiaoying Zheng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China.
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Xiao X, Su L. Editorial: Intrauterine nutrition and adult metabolism. Front Nutr 2022; 9:1085083. [DOI: 10.3389/fnut.2022.1085083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/08/2022] [Indexed: 11/18/2022] Open
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Li C, Lumey LH. Early-Life Exposure to the Chinese Famine of 1959-1961 and Type 2 Diabetes in Adulthood: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:nu14142855. [PMID: 35889812 PMCID: PMC9317968 DOI: 10.3390/nu14142855] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The fast-growing literature suggests that the Chinese famine of 1959-1961 drives current and future type 2 diabetes (T2D) epidemics in China. This conclusion may be premature, as many Chinese famine studies have major methodological problems. We examine these problems, demonstrate how they bias the study results, and formulate recommendations to improve the quality of future studies. METHODS We searched English and Chinese databases for studies that examined the relationship between prenatal exposure to the Chinese famine and adult T2D from inception to 8 February 2022. We extracted information on T2D cases and study populations of individuals born during the famine (famine births), before the famine (prefamine births), and after the famine (postfamine births). We used random-effects models to compare the odds of T2D in famine births to several control groups, including postfamine births, combined pre- and postfamine births, and prefamine births. We used meta-regressions to examine the impacts of age differences between comparison groups on famine effect estimates and the role of other characteristics, including participant sex, age, and T2D assessments; famine intensity; residence; and publication language. Potential sources of heterogeneity and study quality were also evaluated. RESULTS Twenty-three studies met our inclusion criteria. The sample sizes ranged from less than 300 to more than 360,000 participants. All studies defined the famine exposure based on the participants' dates of birth, and 18 studies compared famine births and postfamine births to estimate famine effects on T2D. The famine and postfamine births had an age difference of three years or more in all studies. The estimates of the famine effect varied by the selection of controls. Using postfamine births as controls, the OR for T2D among famine births was 1.50 (95% CI 1.34-1.68); using combined pre- and postfamine births as controls, the OR was 1.12 (95% CI 1.02-1.24); using prefamine births as controls, the OR was 0.89 (95% CI 0.79-1.00). The meta-regressions further showed that the famine effect estimates increased by over 1.05 times with each one-year increase in ignored age differences between famine births and controls. Other newly identified methodological problems included the poorly assessed famine intensity, unsuitable study settings for famine research, and poor confounding adjustment. INTERPRETATION The current estimates of a positive relationship between prenatal exposure to the Chinese famine and adult T2D are mainly driven by uncontrolled age differences between famine births and postfamine births. Studies with more rigorous methods, including age-balanced controls and robust famine intensity measures, are needed to quantify to what extent the famine exposure is related to current T2D patterns in China.
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Affiliation(s)
- Chihua Li
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA;
- Department of Endocrinology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou 450007, China
| | - L. H. Lumey
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA;
- Correspondence: ; Tel.: +1-212-305-9222
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Zhang Y, Pu J, Ding Y, Wu L, Yin Y, Sun M, Gu Y, Zhang D, Zhang Z, Zheng Q, He Q, Xu T, He Y, Su H, Zhou X, Li L, Ye Y, Li J, Xu Z. Sex Differences at Early Old Stage in Glycolipid Metabolism and Fatty Liver in Offspring Prenatally Exposed to Chinese Great Famine. Front Nutr 2022; 9:913966. [PMID: 35811949 PMCID: PMC9257182 DOI: 10.3389/fnut.2022.913966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAbout 50 years ago, Chinese Great Famine (CGF) affected the entire population in China, and its long-term influence on the offspring has attracted significant attention for research. However, information on possible metabolic differences between sexes is limited. This study explored whether there might be sex differences in the risks of development of glucolipid metabolic dysfunction and fatty liver following prenatal exposure to CGF.Materials and MethodsThere were 11,417 subjects around 55 years of age (6,661 women and 4,756 men). They were divided as the exposed group in which the fetal stage was in CGF, and the unexposed group included those born after CGF. Analysis focused on comparisons between sexes.ResultsCompared to the unexposed group, the BMI and triglyceride (P < 0.05) in men were higher in exposed group, while waist circumference and blood sugar (P < 0.05) in the exposed women were significantly higher. With the ages being properly balanced, the risks of glycolipid metabolic dysfunction were significantly higher in both men and women in the exposed than in the unexposed group (P < 0.001). Prenatal exposure to CGF significantly increased risks of abnormal BMI (P < 0.001, 95% CI: 2.305–2.93), blood sugar (P < 0.05, 95% CI: 1.050–1.401), triglycerides (P < 0.05, 95% CI: 1.006–1.245), and fatty liver (P < 0.001, 95% CI: 1.121–1.390) in men, and increased risks of abnormal blood sugar (P < 0.05, 95% CI: 1.024–1.689) and positive urine sugar (P < 0.05, 95% CI: 1.062–6.211) in women. Height and body weight were either the same or higher in the exposed subjects compared with the unexposed ones, regardless of sexes.ConclusionThis study is the first to identify sex differences in the long-term effects of CGF on metabolism and fatty liver. Importance of the findings include the benefits of prescribing medicine for the early prevention of certain diseases for each sex before aging based on the differences revealed. This study also shows “catch-up growth” in the offspring prenatally exposed to CGF as possible mechanisms underlying the long-term effects.
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Affiliation(s)
- Yumeng Zhang
- Institute for Fetology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jianhong Pu
- The Center of Management, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yi Ding
- Department of Preventive Medicine, College of Clinical Medicine, Suzhou Vocational Health College, Suzhou, China
| | - Lei Wu
- Suzhou Industrial Park Centers for Disease Control and Prevention, Suzhou, China
| | - Yongxiang Yin
- Wuxi Maternity and Child Health Care Hospital, Wuxi, China
| | - Mingya Sun
- Wuxi Maternity and Child Health Care Hospital, Wuxi, China
| | - Ying Gu
- Wuxi Maternity and Child Health Care Hospital, Wuxi, China
| | - Daiyi Zhang
- The Center of Management, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ze Zhang
- Institute for Fetology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qiutong Zheng
- Institute for Fetology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qinyuan He
- Institute for Fetology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ting Xu
- Institute for Fetology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yun He
- Institute for Fetology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hongyu Su
- Institute for Fetology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiuwen Zhou
- Institute for Fetology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Lingjun Li
- Institute for Fetology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yang Ye
- Wuxi Maternity and Child Health Care Hospital, Wuxi, China
| | - Jingyang Li
- Wuxi Maternity and Child Health Care Hospital, Wuxi, China
| | - Zhice Xu
- Institute for Fetology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Wuxi Maternity and Child Health Care Hospital, Wuxi, China
- *Correspondence: Zhice Xu,
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David Bell SH. DEATH FROM DIABETES IN IRELAND/HISTORY. THE ULSTER MEDICAL JOURNAL 2020; 89:130-131. [PMID: 33093707 PMCID: PMC7576398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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