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生命早期经历饥荒与成年后2型糖尿病的相关性研究
齐红焱
杜瑞
胡春艳
张怡
张婕
王霜原
林琳
李勉
徐敏
徐瑜
陈宇红
毕宇芳
王卫庆
陆洁莉
作者及单位信息
·
DOI： 10.3760/cma.j.cn311282-20200403-00242
Relationship between famine exposure in early life and type 2 diabetes mellitus in adulthood
Qi Hongyan
Du Rui
Hu Chunyan
Zhang Yi
Zhang Jie
Wang Shuangyuan
Lin Lin
Li Mian
Xu Min
Xu Yu
Chen Yuhong
Bi Yufang
Wang Weiqing
Lu Jieli
Authors Info & Affiliations
Qi Hongyan
Department of Endocrine and Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
Du Rui
Department of Endocrine and Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
Hu Chunyan
Department of Endocrine and Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
Zhang Yi
Department of Endocrine and Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
Zhang Jie
Department of Endocrine and Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
Wang Shuangyuan
Department of Endocrine and Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
Lin Lin
Department of Endocrine and Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
Li Mian
Department of Endocrine and Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
Xu Min
Department of Endocrine and Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
Xu Yu
Department of Endocrine and Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
Chen Yuhong
Department of Endocrine and Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
Bi Yufang
Department of Endocrine and Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
Wang Weiqing
Department of Endocrine and Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
Lu Jieli
Department of Endocrine and Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
·
DOI： 10.3760/cma.j.cn311282-20200403-00242
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摘要

目的探讨生命早期经历天灾饥荒与成年后2型糖尿病患病风险的相关性。

方法本研究采用整群抽样的方法，纳入8 868名出生于中国天灾饥荒期间(1959至1962)的上海市嘉定社区常住居民。研究对象分为未经历组、胎儿期经历组、儿童期经历组和青少年期经历组。采用 logistic回归模型分析生命早期经历饥荒与成年后2型糖尿病风险的关系。

结果女性在儿童期经历饥荒和青少年期经历饥荒均增加成年后患2型糖尿病的风险。在男性中并未观察到显著的相关性。在较少体育活动、较低文化水平人群中，饥荒经历组成年后罹患2型糖尿病的风险较未经历组显著增加，且具有显著的交互作用。

结论生命早期经历饥荒增加成年后患2型糖尿病风险，尤其是在女性中。

饥荒;营养不良;糖尿病，2型;代谢性疾病
ABSTRACT

ObjectiveTo investigate the correlation between exposure to famine in early life and later risk of type 2 diabetes in adulthood.

MethodsA cluster sampling method was used to include 8 868 residents who were lived in the Jiading community of Shanghai during the Great Famine from 1959 to 1962 in China. Subjects were divided into non-exposed group, fetal exposure group, childhood exposure group, and adolescent exposure group. Logistic regression model was used to analyze the relationship between famine exposure in early life and the risk of type 2 diabetes in adulthood.

ResultsFamine exposure during childhood and adolescent both increased the risk of developing type 2 diabetes in adulthood in women. No significant correlation was observed in men. In subjects with less physical activity and lower education level, the risk of developing type 2 diabetes mellitus in adulthood was significantly higher in the famine-exposed group than that of non-exposed groupand the interactions were statistically significant.

ConclusionEarly life famine exposure increases the risk of developing type 2 diabetes in adults, especially in women.

Famine;Malnutrition;Diabetes mellitus, type 2;Metabolic diseases
Lu Jieli, Email: nc.defmoabc.hjr91311ljl
Project of Shanghai Medical and Health Development Foundation
Copyright by Chinese Medical Association
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引用本文

齐红焱,杜瑞,胡春艳,等. 生命早期经历饥荒与成年后2型糖尿病的相关性研究[J]. 中华内分泌代谢杂志,2020,36(11)：905-911.

DOI:10.3760/cma.j.cn311282-20200403-00242

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在全球，慢性非传染性疾病患病率正在飞速增长，而糖尿病正是其中最常见的疾病之一。截至到2015年，全球约有超过4.5亿人患有糖尿病，预计到2040年，这一数字将增加到6.42亿 [ 1 ]。同时随着社会经济的发展，生活方式和饮食习惯随之改变，超重和肥胖的患病率也显著增加，加之人口老龄化的不断进展，中国糖尿病患病率已经从1980年的0.67%飙升至2013年的10.4% [ 2 ]。此外，与正常糖耐量人群相比，2型糖尿病患者发生心血管疾病的风险将增加2～4倍 [ 3 ]，同时，认知功能障碍、痴呆和神经变性的发生风险也显著增加。因此，糖尿病及其并发症所引发的公共卫生问题将造成巨大的社会经济负担，预计到2030年，每年用于糖尿病及其并发症方面的医疗费用支出将超过450亿美元 [ 4 ]。
随着"健康与疾病的发展起源(Developmental Origins of Health and Disease, DOHaD)"概念的提出，即生命早期营养不良是导致成年后罹患代谢性疾病的重要因素，这是由于胎儿在宫内对营养不良环境所产生的反应，永久性地影响了人体的器官功能和营养代谢。动物实验佐证了这一假说 [ 5 ]，母体营养不良使胎儿在子宫内发生DNA甲基化，最终导致基因表达的改变。人群研究也表明，生命早期营养不良可能会导致一系列代谢性疾病的发生发展，例如肥胖 [ 6 ]、代谢综合征 [ 7 ]、高血压 [ 8 ]、高脂血症 [ 9 ]，甚至引起认知功能障碍风险增加 [ 10 ]。而生命早期营养不良在饥荒发生时最常见。荷兰的一项研究报道，与未接触饥荒的人相比，胎儿期接触饥荒的人成年后更容易发生糖耐量受损 [ 11 ]。据历史报道，中国在1959年至1962年的3年间经历了严重的饥荒，并造成约3 000万人死亡 [ 12 ]。尽管中国大饥荒是非常不幸的，却给了我们机会深入探究生命早期经历饥荒与成年后2型糖尿病患病风险之间的关联性。因此，本研究的目的是探讨生命早期经历饥荒与成年后患2型糖尿病风险的相关性。
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备注信息
A
陆洁莉，Email： nc.defmoabc.hjr91311ljl
B

齐红焱：论文撰写、统计学分析；杜瑞、胡春艳、张怡、张婕、王霜原、林琳：统计学分析和论文修改；李勉、徐敏、徐瑜：数据整理统计和论文完善；陈宇红、毕宇芳、王卫庆、陆洁莉：研究设计和指导

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