背景:尽管来自出生队列分析的证据表明,在中国,生命早期暴露于大跃进饥荒(GLFF)的代谢风险,三种混杂效应,包括曝光窗口,老化,以及饥荒严重程度的地理差异,已经被带到辩论十年了。这项研究旨在解决这些混杂效应,并广泛研究GLFF暴露如何与中晚期糖尿病风险及其与城乡移民的相互作用相关。
方法:采用年龄分层和阶梯式楔形方法分析了中国健康与退休纵向研究(CHARLS)的数据。使用加权患病率和多变量logistic回归研究GLFF暴露和城乡迁移对中晚期糖尿病风险的影响以及GLFF暴露与城乡迁移之间的相互作用。出生省份被控制为固定效应,以解释各省饥荒严重程度的变化。
结果:与从未接触过GLFF的人相比,在控制省份后,胎儿GLFF暴露与成人发病糖尿病的风险较高相关,人口统计,和健康状况。然而,在将儿童成长环境的代理添加到模型中之后,胎儿暴露于GLFF与成年糖尿病发病风险无显著相关(OR=1.22,p=0.10),与从未接触过GLFF的人相比。在三个年龄分层组中,静态城市居民,总的来说,与静态农村居民相比,患糖尿病的风险更高。在所有三个年龄分层组中,GLFF暴露与城乡移民之间的交互作用均不重要。
结论:胎儿暴露于GLFF可能对成人发病的糖尿病风险有可追溯的影响。然而,生长环境和城市生活方式超过并进一步混淆了GLFF暴露对成年糖尿病发病风险的影响.
BACKGROUND: Although evidence from birth cohort analysis has indicated the metabolic risk of early-life exposure to the Great Leap Forward
Famine (GLFF) in China, three confounding effects, including the exposure windows, aging, and geographical variations in
famine severity, have been brought to debates for a decade. This study aimed to address these confounding effects and extensively examine how GLFF exposure is associated with diabetes risk in mid-to-late life and its interaction with urban-rural migration.
METHODS: Data from the China Health and Retirement Longitudinal Study (CHARLS) were analyzed with age-stratification and stepped wedge approaches. Weighted prevalence and multivariable logistic regression were used to investigate the effects of GLFF exposure and urban-rural migration on mid-to-late life diabetes risk and the interaction between GLFF exposure and urban-rural migration. Birth provinces were controlled as a fixed effect to account for variations in
famine severity across provinces.
RESULTS: Compared to those who were never exposed to GLFF, fetal GLFF exposure was associated with a higher risk of adult-onset diabetes after controlling for provinces, demographics, and health statuses. Yet, after adding the proxy of childhood growth environments into the model, fetal exposure to GLFF was not significantly associated with adult-onset diabetes risk (OR = 1.22, p = 0.10), compared to those who were never exposed to GLFF. Across the three age-stratification groups, static urban residents, in general, had a higher risk of diabetes compared to static rural residents. Interaction effects between GLFF exposure and urban-rural migration were insignificant across all three age-stratification groups.
CONCLUSIONS: Fetal exposure to GLFF might have a traceable effect on adult-onset diabetes risk. Yet, the growth environment and urban lifestyle outweigh and further confound the impact of GLFF exposure on adult-onset diabetes risk.