Yun Li1, Yanping Li1, M Edip Gurol1, Yesong Liu1, Peng Yang1, Jihong Shi1, Sheng Zhuang1, Michele R Forman1, Shouling Wu2, Xiang Gao2. 1. From the Department of Preventive Medicine (Yun Li), School of Public Health, North China University of Science and Technology, Tangshan; Department of Nutritional Sciences (Yun Li, X.G.), Pennsylvania State University, State College; Department of Nutrition (Yanping Li), Harvard T.H. Chan School of Public Health; Department of Neurology (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Neurology (Y. Liu) and Cardiology (J.S., S.W.), Kailuan General Hospital, North China University of Science and Technology; Department of Neurosurgery (P.Y.), Affiliated Hospital of North China University of Science and Technology, Tangshan; Department of Neurology (S.Z.), The Second Affiliated Hospital of Soochow University, Suzhou, China; and Department of Nutrition Science (M.R.F.), Purdue University, West Lafayette, IN. 2. From the Department of Preventive Medicine (Yun Li), School of Public Health, North China University of Science and Technology, Tangshan; Department of Nutritional Sciences (Yun Li, X.G.), Pennsylvania State University, State College; Department of Nutrition (Yanping Li), Harvard T.H. Chan School of Public Health; Department of Neurology (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Neurology (Y. Liu) and Cardiology (J.S., S.W.), Kailuan General Hospital, North China University of Science and Technology; Department of Neurosurgery (P.Y.), Affiliated Hospital of North China University of Science and Technology, Tangshan; Department of Neurology (S.Z.), The Second Affiliated Hospital of Soochow University, Suzhou, China; and Department of Nutrition Science (M.R.F.), Purdue University, West Lafayette, IN. xxg14@psu.edu drwusl@163.com.
Abstract
OBJECTIVE: To investigate whether in utero exposure to the Great Chinese Famine in 1959 to 1961 was associated with risk of intracerebral hemorrhage (ICH) in adulthood. METHODS: In this cohort analysis, we included 97,399 participants of the Kailuan Study who were free of cardiovascular disease and cancer at baseline (2006). Cases of incident ICH were confirmed by medical record review. We used the Cox proportional hazards model to calculate the hazard ratio (HR) and 95% confidence interval (CI) for ICH according to in utero famine exposure status. RESULTS: Among 97,399 participants in the current analyses, 6.3% (n = 6,160) had been prenatally exposed to the Great Chinese Famine. During a median 9.0 years of follow-up (2006-2015), we identified 724 cases of incident ICH. After adjustment for potential confounders, the HR of ICH was 1.99 (95% CI 1.39-2.85) for in utero famine-exposed individuals vs individuals who were not exposed to the famine. When exposure to famine and severity of famine were examined jointly, the adjusted HR was 2.99 (95% CI 1.21-7.39) for in utero exposure to severe famine and 1.94 (95% CI 1.32-2.84) for in utero exposure to less severe famine relative to those without exposure to famine. CONCLUSIONS: Individuals with in utero exposure to famine, especially those exposed to severe famine, were more likely to have ICH in midlife, highlighting the role of nutritional factors in susceptibility to this severe cerebral condition.
OBJECTIVE: To investigate whether in utero exposure to the Great Chinese Famine in 1959 to 1961 was associated with risk of intracerebral hemorrhage (ICH) in adulthood. METHODS: In this cohort analysis, we included 97,399 participants of the Kailuan Study who were free of cardiovascular disease and cancer at baseline (2006). Cases of incident ICH were confirmed by medical record review. We used the Cox proportional hazards model to calculate the hazard ratio (HR) and 95% confidence interval (CI) for ICH according to in utero famine exposure status. RESULTS: Among 97,399 participants in the current analyses, 6.3% (n = 6,160) had been prenatally exposed to the Great Chinese Famine. During a median 9.0 years of follow-up (2006-2015), we identified 724 cases of incident ICH. After adjustment for potential confounders, the HR of ICH was 1.99 (95% CI 1.39-2.85) for in utero famine-exposed individuals vs individuals who were not exposed to the famine. When exposure to famine and severity of famine were examined jointly, the adjusted HR was 2.99 (95% CI 1.21-7.39) for in utero exposure to severe famine and 1.94 (95% CI 1.32-2.84) for in utero exposure to less severe famine relative to those without exposure to famine. CONCLUSIONS: Individuals with in utero exposure to famine, especially those exposed to severe famine, were more likely to have ICH in midlife, highlighting the role of nutritional factors in susceptibility to this severe cerebral condition.
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