Early Life Famine Exposure, Ideal Cardiovascular Health Metrics and Risk of Incident Diabetes: Findings from the 4C Study

Zhengnan Gao,Guijun Qin,Yu Xu,Xulei Tang,Rui Du,Yinfei Zhang,Li Chen,Shengli Wu,Guang Ning,Meng Dai,Zuojie Luo,Qing Su,Di Zhang,Lulu Chen,Qiang Li,Tao Yang,Ruying Hu,Jieli Lu,Yiming Mu,Guixia Wang,Zhen Ye,Yufang Bi,Shenghan Lai,Donghui Li,Chao Liu,Min Xu,Mian Li,Youmin Wang,Weiqing Wang,Zachary T Bloomgarden,Tiange Wang,Yanan Huo,Chunyan Hu,Feixia Shen,Yingfen Qin,Gang Chen,Li Yan,Zhongwei Zhao ,Jing Zhao ,Lijun Shi ,Qing Wan ,Yuhong Chen ,Hongkui Deng ,Xue‐Feng Yu

doi:10.2337/figshare.12185469.v1

Abstract

OBJECTIVE We aim to investigate the impact of ideal cardiovascular heath 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 3 famine exposure groups according to the birth year, including non-exposed (1963-1974), fetal-exposed (1959-1962) and childhood exposed (1949-1958). Relative risk regression was used to examine the associations between famine exposure and ICVHMs on diabetes. RESULTS During a mean follow-up of 3.6 years, the cumulative incidence of diabetes was 4.2%, 6.0% and 7.5% in non-exposed, fetal-exposed and childhood-exposed participants, respectively. Compared with non-exposed participants, fetal-exposed but not childhood-exposed participants had increased risks of diabetes with multivariable-adjusted risk ratios (RRs) (95% confidence intervals) (CIs) of 1.17 (1.05-1.31) and 1.12 (0.96-1.30), respectively. Increased diabetes risks were observed in fetal-exposed individuals with non-ideal dietary habits, non-ideal physical activity, BMI ≥24.0 kg/m2, or blood pressure ≥120/80 mmHg, whereas significant interaction was detected only in BMI strata (P for interaction=0.0018). Significant interactions have been detected between number of ICVHMs and famine exposure on the risk of diabetes (P for interaction=0.0005). The increased risk was observed in fetal-exposed participants with 1 or less ICVHMs (RR, 1.59; 95% CI, 1.24-2.04), but not in those with 2 or more ICVHMs. CONCLUSIONS The increased risk of diabetes associated with famine exposure appears to be modified by the presence of ICVHMs.

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