Association Between Fetal Famine Exposure And Risk Of Diabetes In Midlife

Objectives To explore the effect of fetal famine on the onset of diabetes in adults,so as to provide scientific basis for further prevention of diabetes mellitus(DM)and the formulation of sign-based health care plan and health education plan.Methods Among the 101510 participants who took part in the physical examination of Kailuan Group in 2006～2007,18035 met the inclusion criteria of birth date,excluding those with a previous history of diabetes patients(1440)and missing research data(1),and finally 16594 participants were included in the statistical analysis.According to the date of birth,the individuals born on 1 October 1962～30 September 1964 were divided into the non-exposed group(used as the reference group),the individuals born on 1 October1959～30 September 1961 were divided into the fetal exposure group,and the early childhood exposure group included those born on 1 October 1956～30 September 1958.Statistical analysis was carried out with SAS 9.4 and SPSS 22.0 software.The cumulative incidence curve was drawn by multiplicative active limit method.The non-exposed group was taken as the control group.The cumulative incidence of diabetes in each group was compared with log-rank test.Taking the occurrence of diabetes as the dependent variable,adjusted for sex,body mass index,systolic blood pressure,diastolic blood pressure,highdensity lipoprotein cholesterol,low-density lipoprotein cholesterol,family history of diabetes,smoking,drinking,physical exercise,education level,income level,taking antihypertensive drugs and lipid lowering drugs were substituted into the Cox proportional hazard regression analysis model.and the cox regression model was used to analyze the effects of fetal experience of famine on risk of diabetes.Results 1 In this study,16594 participants were included in the statistical analysis,including 12244 males(73.79%)and 4350 females(26.21%).During a median 10.27 years(170358 person years)of follow-up(2006～2017),2069 incident DM cases were identified,and the cumulative incidence rate was 12.47%.The cumulative incidences of DM in nonexposed group,fetal exposure group and early childchood exposure group were 11.42%,13.43% and 12.95%.and the cumulative incidence of DM in the fetal exposure group was the highest(P<0.05).2 After adjusting for a variety of confounding factors,the hazard ratio(HR)value of DM in fetal exposure group was 1.222(95%CI: 1.087～1.374,P<0.05),which was slightly higher than that in the early childhood exposure group(95%CI:1.011～1.240,P<0.05),compared with the reference gourp.3 Statistical analysis shows that this association is altered by the interaction of gender,hypertension,and famine exposure(both P interaction less than 0.05).After gender stratification,the HR values of men and women who experienced fetal famine in adulthood were 1.173(95%CI:1.027～1.339,P<0.05)and 1.429(95%CI: 1.105～1.849,P<0.05),respectively.The risk of onset in the early childhood exposure group was higher than that in the early childhood exposure group 1.057(95%CI: 0.944～1.183,P>0.05),1.418(95%CI: 1.113～1.805,P<0.05).After blood pressure stratification,the HR values of DM in hypertensive and nonhypertensive people who experienced famine during fetal period were 1.211(95%CI:1.023～1.433,P<0.05)and 1.231(95%CI: 1.04～1.451,P<0.05),respectively.The risk of onset in the early childhood exposure group was higher than that in the early childhood exposure group 1.156(95%CI: 1.003～1.332,P<0.05)and 1.070(95%CI: 0.924～1.240,P>0.05).4 On the basis of the total population,those who took antihypertensive drugs,lipid-lowering drugs,blood pressure-lowering drugs and lipid-lowering drugs were excluded respectively.Cox regression analysis showed that the risk of DM in the participants exposed to famine during the fetal period was basically the same as the previous statistical results,and the risk of DM in the fetal exposure group was still the highest.Conclusions Fetal famine experience increases the risk of DM in adults.This association was more pronounced among female and hypertensives.Figure 3;Table 8;Reference 115...