The Interaction Effect Of Famine Exposure During Early Life And Dietary Patterns In Middle-aged And Elderly Population On The Risk Of Hyperuricemia

Objective This study aimed to investigate the characteristics of dietary patterns among middle-aged and elderly Chinese in Hefei,and explore the effect of Chinese famine exposure during early life on dietary patterns in middle-aged and elderly population,which might guide a healthy dietary behavior and provide an important strategy for nutrition intervention and health education for middle-aged and elderly population.Method This cross-sectional study was conducted in a sample of adults who were born between October 1,1952,and September 30,1964,selected from a medical center for physical examination in Hefei.A total of 939 participants were included in the study.The participant was face to face interviewed by the trained interviewer using structured questionnaires,which included the general situation investigation,physical activity survey,dietary survey,physical examination and clinical biochemical indicator measurement.According to the birth date of subject and corresponding exposure period,the participants were categorized into five groups.Since the exact dates of the start and the end of the Chinese famine were not available acquisition and were not the same across regions.To minimize misclassification of the famine exposure periods,subjects who were born between 1 October 1958 and 30 September 1959 or between 1 October 1961 and 30 September 1962 were excluded.The population born between October 1,1962 and September 30,1964 were classified as non-exposed group;the population born between October 1,1959 and September 30,1961 were defined as fetal exposed group whose mother were exposed to famine during the whole gestation period;subjects who were born between October 1,1956 and September 30,1958 were defined as early-childhood exposed group;participants who were born between October 1,1954 and September 30,1956 were defined as mid-childhood exposed group;the population born between October 1,1952 and September 30,1954 were defined as late-childhood exposed group.We used analysis of variance(ANOVA)or non-parametric test to describe mean differences(MD)among continuous variables and the chi-squared or Fisher's exact test to examine the difference between categorical variables.The dietary patterns were derived by factor analysis.Multivariate quantile(5th,10 th,25th,50 th,75th and 90th)regression analysis was used to assess the relationship between famine exposure and dietary pattern.All analysis was performed using STATA 12.0.Result There were 548 male respondents,which accounted for 58.4% of the total number of subject.In our study,the majority of participant consisted of education for being high level(78.4%),or marry status for being married(98.7%),or non-smoking(71.1%)and non-excessive drinking(51.7%),or residence place for being city(63%),or per capita monthly income for being less than 1,000 yuan(55.1%).In addition,the prevalence of obese,hypertension,diabetes,hypercholesterolemia,hypertriglyceridemia,fatty liver and hyperuricemia were 12.5%,33.5%,11.2%,10.8%,16.7%,41.9% and 13.5%,respectively.The four dietary patterns were identified by factor analysis: the “healthy dietary pattern”(high intakes of noodles and their products,coarse grains,fruits,eggs and their products,fish shrimp and seafood,low-fat milk and its products,non-sugar drink);“the high-fat and high-salt dietary pattern”(high intakes of rice and its products,fried food,animal meat,salted products,high-fat snacks,fats and oils);the “western dietary pattern”(high intake of high-fat milk and its products,western fast food,high-fat snacks,non-fat snacks,high sugar drink);the “traditional Chinese dietary pattern”(high intakes of rice and its product,coarse grains,potatoes,vegetables,beans and beans products).After adjusting for gender,education level,activity intensity,smoking status,drinking,per capita monthly income,residence place confounding factors,mid-childhood exposed to famine were positively correlated with the traditional Chinese dietary pattern of 90 th quantile(?=0.825,P<0.05),and early-childhood exposed to famine were positively associated with the traditional Chinese dietary pattern of 10 th quantile(?=0.278,P<0.05),25 th quantile(?=0.260,P<0.05),50 th quantile(?=0.460,P<0.05),75 th quantile(?=0.533,P<0.05),and 90 th quantile(?=1.072,P<0.05).No significant association were observed between famine exposure and healthy dietary pattern,high-fat and high-salt dietary pattern,and western dietary pattern.Conclusion The four dietary patterns,including healthy dietary pattern,high-fat and high-salt dietary pattern,western dietary pattern and traditional Chinese dietary pattern,are identified in our study.After adjustment for potential confounders,our study find that the experience of early-childhood and mid-childhood famine exposure are remarkably associated with the high intake of traditional Chinese dietary pattern,while no significant association were observed between famine exposure and healthy dietary pattern,high-fat and high-salt dietary pattern,western dietary pattern.Objective The aim of this study was to investigate the effects of early life exposure to famine and dietary patterns in middle-aged and elderly population on the risk of hyperuricemia,and analysis their interaction effect on the risk of hyperuricemia.It might provide scientific basis for the prevention and control of diseases.Method The 939 middle-aged and elderly people with health examination were based on Part one.The 88 participants were excluded due to data missing,and a total of 851 participants were included in this study.Dietary pattern score were divided into binary quantile,and low-dichotomous dietary patterns were taken as the reference group.Analysis of variance and t-test were used to compare the differences of blood uric acid values in different exposure groups and in different dietary pattern scores,respectively.The chi-square test was used to evaluate the distribution of hyperuricemia in general demographic characteristics.Log-binomial regression was used to assess the impact of famine exposure and dietary patterns on the prevalence ratio of hyperuricemia.The multiplication interactions effect of famine exposure and dietary pattern on hyperuricemia prevalence ratio was performed using SPSS 22.0.The additive interaction effect between famine exposure and dietary patterns on the prevalence ratio of hyperuricemia was estimated using relative excess risk due to interaction(RERI),attributable proportion due to interaction(AP),and synergy index(S).Significant RERI> 0,AP> 0,and S> 1 indicated additive interaction.Result After adjusting for Model 1(gender,education level,place of residence,marital status,level of physical activity,per capita monthly income),Model 2(Model 1 + smoking and drinking status),Model 3(Mode 2 + chronic disease status),compared with non-exposed group,fetal exposed(PR=2.43,95% CI: 1.01,5.86),(PR=2.42,95% CI: 1.00,5.86),(PR=2.30,95% CI: 1.01,5.61)and early-childhood exposed(PR=2.81,95% CI: 1.09,6.80),(PR=2.81,95% CI: 1.09,6.81),(PR=2.80,95% CI: 1.08,6.80)to famine had a higher prevalence ratio for hyperuricemia,respectively.After adjusting for Model 1(gender,education level,place of residence,marital status,level of physical activity,per capita monthly income),Model 2(Model 1 + smoking and drinking status),Model 3(Mode 2 + chronic disease status),compared with low-dichotomous high-fat and high-salt dietary pattern,those who experienced to high-dichotomous high-fat and high-salt dietary pattern had a higher prevalence ratio for hyperuricemia(PR=1.37,95% CI: 1.01,2.00),(PR=1.38,95% CI: 1.01,2.01),(PR=1.44,95% CI: 1.02,2.13),respectively.However,it was not found in other dietary pattern.After adjustment for potential factors,there were no multiplicative interaction effect between different famine exposure and different dietary pattern on the prevalence ratio of hyperuricemia.The PR values were based on the effect of different famine exposure conditions and different dietary patterns on prevalence ratio of hyperuricemia.According to the PR values,we calculated the respective regression coefficients and the respective covariance among the factors.The RERI,AP and S of different famine exposure and different dietary pattern were performed using the EXCEL additive interaction formula.The result suggested that there were additive interaction between early-childhood famine exposures and dietary patterns on the prevalence ratio of hyperuricemia(RERI=0.40,95% CI: 0.05,0.76),(AP=0.12,95% CI: 0.03,0.21),(S=1.19,95% CI: 1.04,1.38).Conclusion Fetal exposed to famine,early-childhood exposed to famine and high-fat and high-salt dietary pattern are significantly correlated with increased risk of hyperuricemia in adulthood.The additive interaction effect between early-childhood famine exposure and high-fat and high-salt dietary pattern on the risk of hyperuricemia is observed.And the combination of early-childhood exposure group and high-dichotomous high-fat and high-salt dietary pattern are associated with incremental risk of hyperuricemia.