Exposure to the Chinese Famine in Early Life and the Risk of Hyperglycemia and Type 2 Diabetes in Adulthood
- Yanping Li1,2,
- Yuna He1,3,
- Lu Qi2,4,
- Vincent W. Jaddoe2,5,
- Edith J.M. Feskens3,
- Xiaoguang Yang1,
- Guansheng Ma1 and
- Frank B. Hu2,4
- 1National Institute for Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing, China;
- 2Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts;
- 3Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands;
- 4Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts;
- 5Departments of Epidemiology and Pediatrics, Erasmus MC, Rotterdam, the Netherlands.
- Corresponding authors: Yanping Li, ; or Guansheng Ma, ; or Frank B. Hu, .
Y.L. and Y.H. contributed equally to this study.
OBJECTIVE Early developmental adaptations in response to undernutrition may play an essential role in susceptibility to type 2 diabetes, particularly for those experiencing a “mismatched rich nutritional environment” in later life. We examined the associations of exposure to the Chinese famine (1959–1961) during fetal life and childhood with the risk of hyperglycemia and type 2 diabetes in adulthood.
RESEARCH DESIGN AND METHODS We used the data for 7,874 rural adults born between 1954 and 1964 in selected communities from the cross-sectional 2002 China National Nutrition and Health Survey. Hyperglycemia was defined as fasting plasma glucose ≥6.1 mmol/l and/or 2-h plasma glucose ≥7.8 mmol/l and/or a previous clinical diagnosis of type 2 diabetes.
RESULTS Prevalences of hyperglycemia among adults in nonexposed, fetal exposed, early-childhood, mid-childhood, and late-childhood exposed cohorts were 2.4%, 5.7%, 3.9%, 3.4%, and 5.9%, respectively. In severely affected famine areas, fetal-exposed subjects had an increased risk of hyperglycemia compared with nonexposed subjects (odds ratio = 3.92; 95% CI: 1.64–9.39; P = 0.002); this difference was not observed in less severely affected famine areas (odds ratio = 0.57; 95% CI: 0.25–1.31; P = 0.185). The odds ratios were significantly different between groups from the severe and less severe famine areas (P for interaction = 0.001). In severely affected famine areas, fetal-exposed subjects who followed an affluent/Western dietary pattern (odds ratios = 7.63; 95% CI: 2.41–24.1; P = 0.0005) or who had a higher economic status in later life experienced a substantially elevated risk of hyperglycemia (odds ratios = 6.20; 95% CI: 2.08–18.5; P = 0.001).
CONCLUSIONS Fetal exposure to the severe Chinese famine increases the risk of hyperglycemia in adulthood. This association appears to be exacerbated by a nutritionally rich environment in later life.
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See accompanying commentary, p. 2349.
- Received March 19, 2010.
- Accepted June 24, 2010.
- © 2010 by the American Diabetes Association.
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