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Abstract：
BACKGROUND: Malnutrition during a critical window of development in a fetus or infant can result in abnormal cardiac remodeling and function. It is uncertain whether the contribution of these effects continues to impact the cardiac remodeling and function of adults over the course of several decades of growth. Our study examined the impact of early Chinese famine exposure on cardiac remodeling, left ventricular (LV) diastolic function, and LV systolic function in adults.
METHODS: Participants at high risk of cardiovascular disease from the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project (PEACE MPP) were enrolled. The famine in China lasted from 1959 to 1962. A total of three groups were formed based on the participants\' birth dates: pre-famine group, famine exposure group, and post-famine group. Logistic regression and linear mixed models were used to explore the association between famine exposure and cardiac remodeling, LV diastolic function and LV systolic function in adults.
RESULTS: The study included 2,758 participants, the mean age was 57.05 years, 62.8% were female, 26.4% had LV hypertrophy (LVH), 59.6% had LV diastolic dysfunction (LVDD), and 10.5% had reduced global longitudinal strain (GLS). Compared to post-famine exposure, participants had independently increased risk of LVH in the famine exposure group (OR: 2.02, 95% CI: 1.60-2.56) and pre-famine exposure (OR: 1.36, 95% CI: 1.06-1.76). Compared to post-famine exposure, the risk of LVDD remarkably increased in the famine exposure group (OR: 3.04, 95% CI: 2.49-3.71) and pre-famine exposure group (OR: 1.87, 95% CI: 1.52-2.31). Famine exposure had no significant impact on GLS but was associated with a significant increase in LV ejection fraction (LVEF) and LV end-diastolic diameter (LVEDD). Significant interactions were observed between the effects of famine exposure and other clinical/sociodemographic variables (gender, systolic blood pressure [SBP] ≥140 mm Hg or not, high school or above or not, and annual income <50,000 RMB or not) on these outcomes.
CONCLUSIONS: Exposure to famine, particularly during fetal and infant stages, increases the risk of LVH and LVDD in adults. However, the LV systolic function remains preserved. These impacts are more pronounced in females, individuals with SBP ≥140 mm Hg, those with low income, or those with high educational status.
METHODS: Participants at high risk of cardiovascular disease from the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project (PEACE MPP) were enrolled. The famine in China lasted from 1959 to 1962. A total of three groups were formed based on the participants\' birth dates: pre-famine group, famine exposure group, and post-famine group. Logistic regression and linear mixed models were used to explore the association between famine exposure and cardiac remodeling, LV diastolic function and LV systolic function in adults.
RESULTS: The study included 2,758 participants, the mean age was 57.05 years, 62.8% were female, 26.4% had LV hypertrophy (LVH), 59.6% had LV diastolic dysfunction (LVDD), and 10.5% had reduced global longitudinal strain (GLS). Compared to post-famine exposure, participants had independently increased risk of LVH in the famine exposure group (OR: 2.02, 95% CI: 1.60-2.56) and pre-famine exposure (OR: 1.36, 95% CI: 1.06-1.76). Compared to post-famine exposure, the risk of LVDD remarkably increased in the famine exposure group (OR: 3.04, 95% CI: 2.49-3.71) and pre-famine exposure group (OR: 1.87, 95% CI: 1.52-2.31). Famine exposure had no significant impact on GLS but was associated with a significant increase in LV ejection fraction (LVEF) and LV end-diastolic diameter (LVEDD). Significant interactions were observed between the effects of famine exposure and other clinical/sociodemographic variables (gender, systolic blood pressure [SBP] ≥140 mm Hg or not, high school or above or not, and annual income <50,000 RMB or not) on these outcomes.
CONCLUSIONS: Exposure to famine, particularly during fetal and infant stages, increases the risk of LVH and LVDD in adults. However, the LV systolic function remains preserved. These impacts are more pronounced in females, individuals with SBP ≥140 mm Hg, those with low income, or those with high educational status.
摘要：
引言在胎儿或婴儿的关键发育窗口期间的营养不良可导致异常的心脏重塑和功能。尚不确定这些作用的作用是否在几十年的成长过程中继续影响成年人的心脏重塑和功能。我们的研究检查了中国早期饥荒暴露对心脏重塑的影响，左心室（LV）舒张功能，和成人左心室收缩功能。方法纳入中国以患者为中心的百万人心脏事件评估项目（PEACEMPP）中心血管疾病（CVD）高危人群。中国的饥荒从1959年持续到1962年。根据参与者的出生日期共形成三组：饥荒前期组，饥荒暴露组和后饥荒组。使用Logistic回归和线性混合模型来探讨饥荒暴露与心脏重塑之间的关系。成人左心室舒张功能和左心室收缩功能。结果该研究包括2758名参与者，平均年龄为57.05岁，62.8%为女性，26.4%有左心室肥大(LVH),59.6%有左心室舒张功能不全(LVDD),10.5%的整体纵向应变(GLS)降低。与饥荒后暴露相比，在饥荒暴露组(OR:2.02,95CI:1.60~2.56)和饥荒暴露前(OR:1.36,95CI:1.06~1.76)中,参与者的LVH风险独立增加.与饥荒后暴露相比，饥荒暴露组的LVDD风险显着增加（OR：3.04，95CI：2.49-3.71），和饥荒前暴露组（OR：1.87，95CI：1.52-2.31）。饥荒暴露对GLS没有显著影响，但与左心室射血分数(LVEF)和左心室舒张末期内径(LVEDD)显著增加相关.在饥荒暴露的影响和其他临床/社会人口统计学变量(性别，收缩压（SBP）≥140mmHg，高中或高中以上或年收入<50,000人民币或不）对这些结果。结论暴露于饥荒,特别是在胎儿和婴儿阶段，增加成人LVH和LVDD的风险。然而,左心室收缩功能仍然保留。这些影响在女性中更为明显，SBP≥140mmHg的个体，那些低收入的人，或者那些受过高等教育的人。
