Jieli Lu1, Mian Li2, Yu Xu2, Yufang Bi2, Yingfen Qin3, Qiang Li4, Tiange Wang2, Ruying Hu5, Lixin Shi6, Qing Su7, Min Xu2, Zhiyun Zhao2, Yuhong Chen2, Xuefeng Yu8, Li Yan9, Rui Du2, Chunyan Hu2, Guijun Qin10, Qin Wan11, Gang Chen12, Meng Dai2, Di Zhang2, Zhengnan Gao13, Guixia Wang14, Feixia Shen15, Zuojie Luo3, Li Chen16, Yanan Huo17, Zhen Ye5, Xulei Tang18, Yinfei Zhang19, Chao Liu20, Youmin Wang21, Shengli Wu22, Tao Yang23, Huacong Deng24, Donghui Li25, Shenghan Lai26, Zachary T Bloomgarden27, Lulu Chen28, Jiajun Zhao29, Yiming Mu30, Guang Ning2, Weiqing Wang. 1. Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China wqingw61@163.com jielilu@hotmail.com. 2. Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. 3. The First Affiliated Hospital of Guangxi Medical University, Nanning, China. 4. The Second Affiliated Hospital of Harbin Medical University, Harbin, China. 5. Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China. 6. Affiliated Hospital of Guiyang Medical College, Guiyang, China. 7. Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China. 8. Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 9. Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China. 10. The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China. 11. The Affiliated Hospital of Southwest Medical University, Luzhou, China. 12. Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China. 13. Dalian Municipal Central Hospital Affiliated to Dalian Medical University, Dalian, China. 14. The First Hospital of Jilin University, Changchun, China. 15. The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China. 16. Qilu Hospital of Shandong University, Jinan, China. 17. Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China. 18. The First Hospital of Lanzhou University, Lanzhou, China. 19. Central Hospital of Shanghai Jiading District, Shanghai, China. 20. Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China. 21. The First Affiliated Hospital of Anhui Medical University, Hefei, China. 22. Karamay Municipal People's Hospital, Xinjiang, China. 23. The First Affiliated Hospital of Nanjing Medical University, Nanjing, China. 24. The First Affiliated Hospital of Chongqing Medical University, Chongqing, China. 25. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX. 26. Johns Hopkins University School of Medicine, Baltimore, MD. 27. Icahn School of Medicine at Mount Sinai, New York, NY. 28. Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 29. Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China. 30. Chinese People's Liberation Army General Hospital, Beijing, China.
Abstract
OBJECTIVE: We aim to investigate the impact of ideal cardiovascular health metrics (ICVHMs) on the association between famine exposure and adulthood diabetes risk. RESEARCH DESIGN AND METHODS: This study included 77,925 participants from the China Cardiometabolic Disease and Cancer Cohort (4C) Study who were born around the time of the Chinese Great Famine and free of diabetes at baseline. They were divided into three famine exposure groups according to the birth year, including nonexposed (1963-1974), fetal exposed (1959-1962), and childhood exposed (1949-1958). Relative risk regression was used to examine the associations between famine exposure and ICVHMs on diabetes. RESULTS: During a mean follow-up of 3.6 years, the cumulative incidence of diabetes was 4.2%, 6.0%, and 7.5% in nonexposed, fetal-exposed, and childhood-exposed participants, respectively. Compared with nonexposed participants, fetal-exposed but not childhood-exposed participants had increased risks of diabetes, with multivariable-adjusted risk ratios (RRs) (95% CIs) of 1.17 (1.05-1.31) and 1.12 (0.96-1.30), respectively. Increased diabetes risks were observed in fetal-exposed individuals with nonideal dietary habits, nonideal physical activity, BMI ≥24.0 kg/m2, or blood pressure ≥120/80 mmHg, whereas significant interaction was detected only in BMI strata (P for interaction = 0.0018). Significant interactions have been detected between number of ICVHMs and famine exposure on the risk of diabetes (P for interaction = 0.0005). The increased risk was observed in fetal-exposed participants with one or fewer ICVHMs (RR 1.59 [95% CI 1.24-2.04]), but not in those with two or more ICVHMs. CONCLUSIONS: The increased risk of diabetes associated with famine exposure appears to be modified by the presence of ICVHMs.
OBJECTIVE: We aim to investigate the impact of ideal cardiovascular health metrics (ICVHMs) on the association between famine exposure and adulthood diabetes risk. RESEARCH DESIGN AND METHODS: This study included 77,925 participants from the China Cardiometabolic Disease and Cancer Cohort (4C) Study who were born around the time of the Chinese Great Famine and free of diabetes at baseline. They were divided into three famine exposure groups according to the birth year, including nonexposed (1963-1974), fetal exposed (1959-1962), and childhood exposed (1949-1958). Relative risk regression was used to examine the associations between famine exposure and ICVHMs on diabetes. RESULTS: During a mean follow-up of 3.6 years, the cumulative incidence of diabetes was 4.2%, 6.0%, and 7.5% in nonexposed, fetal-exposed, and childhood-exposed participants, respectively. Compared with nonexposed participants, fetal-exposed but not childhood-exposed participants had increased risks of diabetes, with multivariable-adjusted risk ratios (RRs) (95% CIs) of 1.17 (1.05-1.31) and 1.12 (0.96-1.30), respectively. Increased diabetes risks were observed in fetal-exposed individuals with nonideal dietary habits, nonideal physical activity, BMI ≥24.0 kg/m2, or blood pressure ≥120/80 mmHg, whereas significant interaction was detected only in BMI strata (P for interaction = 0.0018). Significant interactions have been detected between number of ICVHMs and famine exposure on the risk of diabetes (P for interaction = 0.0005). The increased risk was observed in fetal-exposed participants with one or fewer ICVHMs (RR 1.59 [95% CI 1.24-2.04]), but not in those with two or more ICVHMs. CONCLUSIONS: The increased risk of diabetes associated with famine exposure appears to be modified by the presence of ICVHMs.