生命早期饥荒暴露与重庆地区三高症患病风险的关联分析

Association between famine exposure in early life and the risk of diabetes，hypertension and hyperlipidemia in Chongqing

摘要:

目的：探讨重庆地区人群生命早期经历营养不良与成年后三高症（糖尿病、高血压、高脂血症）发生风险之间的关系。方法：运用重庆医科大学附属第二医院健康管理（体检）中心2018年体检人群中1956年10月至1964年9月出生的7 466例成人作为研究对象进行分析。为减少年龄因素对分析结果造成的偏倚，将饥荒年前（1956年10月至1958年9月）出生的1 818人和饥荒年后（1962年10月至1964年9月）出生的4 156人合并为对照组（n=5 974），饥荒年（1959年10月至1961年9月）出生人群定为饥荒暴露组（n=1 492）。采用卡方检验比较2组人群三高症检出情况，并采用logistic回归模型分析生命早期经历营养不良对三高症发生的影响。结果：研究人群总体2型糖尿病患病率为11.3%，对照组、暴露组的糖尿病患病率分别为10.7%和13.6%，差异有统计学意义（P=0.001）。暴露组的空腹血糖平均值较对照组高[（5.89±1.86） mmol/L vs. （5.76±1.65） mmol/L，P=0.005]。高血压和高脂血症总患病率分别为29.7%和35.3%，对照组和暴露组之间差异无统计学意义。logistic回归分析显示生命早期经历饥荒暴露是成年期2型糖尿病的危险因素（OR=1.321，95%CI=1.112~1.569，P=0.001），但不是成年期高血压和高脂血症的危险因素。性别分层分析后发现生命早期饥荒暴露是男性成年期2型糖尿病的危险因素（OR=1.458，95%CI=1.197~1.776，P=0.000），不是女性成年期2型糖尿病的危险因素。结论：重庆地区生命早期经历饥荒暴露的人群，可能会增加成年后患2型糖尿病的风险，主要表现在男性群体中，但对高血压和高脂血症的发生可能无影响。因此，生命早期均衡营养对预防成年后2型糖尿病的发生具有重要意义。

Abstract:

Objective：To explore the association between famine exposure in early life and the risk of diabetes，hypertension and hy－perlipidemia in Chongqing. Methods：The present study was performed on 7 466 participants who were born between October 1956 and September 1964，and who had physical examination in the Health Management（Physical Examination） Center of The Second Affiliated Hospital of Chongqing Medical University in 2018. In order to reduce the bias caused by age factors，1 818 participants born before the famine（from October 1956 to September 1958） and 4 156 participants born after the famine（from October 1962 to September 1964） were combined as the control group（n=5 974），and those who were born during the famine year（from October 1959 to September 1961） were designated as the famine exposure group（n=1 492）. Chi-square test was used to compare the preva－lence of diabetes，hypertension and hyperlipidemia between the famine exposure group and control group，and the effect of famine in early life on diabetes，hypertension and hyperlipidemia in adulthood was examined using a logistic regression model. Results：The total prevalence of type 2 diabetes among partici－pants was 11.3%，and the prevalence of diabetes in control group and famine exposure group was 10.7% and 13.6%，respectively，with statistically significant differences（P=0.001）. The mean fasting glucose of the famine exposure group was higher than that of the control group[（5.89±1.86） mmol/L vs. （5.76±1.65） mmol/L，P=0.005]. The total prevalence of hypertension and hyperlipidemia was 29.7%，and 35.3%，respectively，and there was no statistically significant difference between the control group and the famine exposure group. Logistic regression analysis showed that famine exposure in early life was the risk factor of type 2 diabetes（OR=1.321，95%CI=1.112-1.569，P=0.001），but not of hypertension and hyperlipidemia. The analysis of stratification by gender showed that famine exposure in early life was the risk factor of type 2 diabetes of males in adulthood but not of females（OR=1.458，95%CI=1.197-1.776，P=0.000）. Conclusion：In Chongqing，exposure to famine in early life may increase the risk of type 2 diabetes in adulthood，which is mainly present in males. However，it may have no effect on the occurrence of hypertension or hyperlipidemia. Therefore，balanced nutrition in early life is of great significance to prevent the occurrence of type 2 diabetes in adulthood.