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.
Highlights
Since 1980, the diabetes burden has shown a faster increase in low- and middle-income countries than in high-income countries.[1]
We prospectively examined whether early exposure to the Chinese Great Famine interacted with general and abdominal obesity in adulthood to increase the risk of incident type 2 diabetes in the China Kadoorie Biobank (CKB) cohort
The interaction between the joint categories of obesity and famine exposure was clearly observed in women (P for interaction 1⁄4 0.036), but not in men (P for interaction 1⁄4 0.923). In this large prospective cohort of over 88 000 adults born around the time of the Chinese Great Famine, famine exposure in the fetal stage was associated with an increased risk of type 2 diabetes in adulthood
Summary
Since 1980, the diabetes burden has shown a faster increase in low- and middle-income countries than in high-income countries.[1]. Low birthweight has been consistently related to later risk of type 2 diabetes.[7] Analyses of populations with prenatal exposure to famine provide more a direct link between intrauterine malnutrition and adulthood risk of type 2 diabetes.[8,9,10] A recent study found that the prevalence of hyperglycaemia associated with fetal exposure to famine was higher among individuals with higher adulthood body mass index (BMI), suggesting that prenatal exposure to famine may interact with obesity in later life to increase the risk of type 2 diabetes.[11] In addition, recent studies suggest that distinct obesity patterns, such as combinations of general and abdominal obesity, may differently affect diabetes risk.[12] no prospective study has assessed the joint associations of these factors with risk of type 2 diabetes. A stronger association between abdominal obesity and diabetes was observed in the fetal-exposed subgroup than in other subgroups
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