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Is Exposure to Famine in Childhood and Economic Development in Adulthood Associated With Diabetes?
J Clin Endocrinol Metab 2015; 100(12):4514-23JC

Abstract

CONTEXT

The Chinese were afflicted by great famine between 1959 and 1962. These people then experienced rapid economic development during which the gross domestic product per capita increased from $28 in 1978 to $6807 in 2013. We hypothesize that these two events are associated with the booming rate of diabetes in China.

OBJECTIVE

We aimed to explore whether exposure to famine in early life and high economic status in adulthood was associated with diabetes in later life.

DESIGN AND SETTING

Our data of 6897 adults were from a cross-sectional Survey on Prevalence in East China for Metabolic Diseases and Risk Factors study in 2014. Among them, 3844 adults experienced famine during different life stages and then lived in areas with different economic statuses in adulthood.

MAIN OUTCOME MEASURE

Diabetes was considered as fasting plasma glucose of 7.0 mmol/L or greater, hemoglobin A1c of 6.5% or greater, and/or a previous diagnosis by health care professionals.

RESULTS

Compared with nonexposed subjects, famine exposure during the fetal period (odds ratio [OR]1.53, 95% confidence interval [CI]1.09-2.14) and childhood (OR 1.82, 95% CI 1.21-2.73) was associated with diabetes after adjusting for age and gender. Further adjustments for adiposity, height, the lipid profile, and blood pressure did not significantly attenuate this association. Subjects living in areas with high economic status had a greater diabetes risk in adulthood (OR 1.46, 95% CI 1.20-1.78). In gender-specific analyses, fetal-exposed men (OR 1.64, 95% CI, 1.04-2.59) and childhood-exposed women (OR 2.81, 95% CI, 1.59-4.97) had significantly greater risk of diabetes.

CONCLUSIONS

The rapid increase in the prevalence of diabetes in middle-aged and elderly people in China is associated with the combination of exposure to famine during the fetal stage and childhood and high economic status in adulthood. Our findings may partly explain the booming diabetes phenomenon in China.

Authors+Show Affiliations

Institute and Department of Endocrinology and Metabolism (N.W., B.H., Q.L., Yi.C., C.Z., Yin.C., F.X., M.L., Y.M., C.C., D.L., Y.L.), Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China; Department of Biostatistics (X.W., B.W.), Shanghai JiaoTong University School of Medicine, Shanghai 200025, China; and Endocrine Research Unit (M.D.J.), Mayo Clinic, Rochester, Minnesota 55905.Institute and Department of Endocrinology and Metabolism (N.W., B.H., Q.L., Yi.C., C.Z., Yin.C., F.X., M.L., Y.M., C.C., D.L., Y.L.), Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China; Department of Biostatistics (X.W., B.W.), Shanghai JiaoTong University School of Medicine, Shanghai 200025, China; and Endocrine Research Unit (M.D.J.), Mayo Clinic, Rochester, Minnesota 55905.Institute and Department of Endocrinology and Metabolism (N.W., B.H., Q.L., Yi.C., C.Z., Yin.C., F.X., M.L., Y.M., C.C., D.L., Y.L.), Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China; Department of Biostatistics (X.W., B.W.), Shanghai JiaoTong University School of Medicine, Shanghai 200025, China; and Endocrine Research Unit (M.D.J.), Mayo Clinic, Rochester, Minnesota 55905.Institute and Department of Endocrinology and Metabolism (N.W., B.H., Q.L., Yi.C., C.Z., Yin.C., F.X., M.L., Y.M., C.C., D.L., Y.L.), Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China; Department of Biostatistics (X.W., B.W.), Shanghai JiaoTong University School of Medicine, Shanghai 200025, China; and Endocrine Research Unit (M.D.J.), Mayo Clinic, Rochester, Minnesota 55905.Institute and Department of Endocrinology and Metabolism (N.W., B.H., Q.L., Yi.C., C.Z., Yin.C., F.X., M.L., Y.M., C.C., D.L., Y.L.), Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China; Department of Biostatistics (X.W., B.W.), Shanghai JiaoTong University School of Medicine, Shanghai 200025, China; and Endocrine Research Unit (M.D.J.), Mayo Clinic, Rochester, Minnesota 55905.Institute and Department of Endocrinology and Metabolism (N.W., B.H., Q.L., Yi.C., C.Z., Yin.C., F.X., M.L., Y.M., C.C., D.L., Y.L.), Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China; Department of Biostatistics (X.W., B.W.), Shanghai JiaoTong University School of Medicine, Shanghai 200025, China; and Endocrine Research Unit (M.D.J.), Mayo Clinic, Rochester, Minnesota 55905.Institute and Department of Endocrinology and Metabolism (N.W., B.H., Q.L., Yi.C., C.Z., Yin.C., F.X., M.L., Y.M., C.C., D.L., Y.L.), Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China; Department of Biostatistics (X.W., B.W.), Shanghai JiaoTong University School of Medicine, Shanghai 200025, China; and Endocrine Research Unit (M.D.J.), Mayo Clinic, Rochester, Minnesota 55905.Institute and Department of Endocrinology and Metabolism (N.W., B.H., Q.L., Yi.C., C.Z., Yin.C., F.X., M.L., Y.M., C.C., D.L., Y.L.), Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China; Department of Biostatistics (X.W., B.W.), Shanghai JiaoTong University School of Medicine, Shanghai 200025, China; and Endocrine Research Unit (M.D.J.), Mayo Clinic, Rochester, Minnesota 55905.Institute and Department of Endocrinology and Metabolism (N.W., B.H., Q.L., Yi.C., C.Z., Yin.C., F.X., M.L., Y.M., C.C., D.L., Y.L.), Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China; Department of Biostatistics (X.W., B.W.), Shanghai JiaoTong University School of Medicine, Shanghai 200025, China; and Endocrine Research Unit (M.D.J.), Mayo Clinic, Rochester, Minnesota 55905.Institute and Department of Endocrinology and Metabolism (N.W., B.H., Q.L., Yi.C., C.Z., Yin.C., F.X., M.L., Y.M., C.C., D.L., Y.L.), Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China; Department of Biostatistics (X.W., B.W.), Shanghai JiaoTong University School of Medicine, Shanghai 200025, China; and Endocrine Research Unit (M.D.J.), Mayo Clinic, Rochester, Minnesota 55905.Institute and Department of Endocrinology and Metabolism (N.W., B.H., Q.L., Yi.C., C.Z., Yin.C., F.X., M.L., Y.M., C.C., D.L., Y.L.), Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China; Department of Biostatistics (X.W., B.W.), Shanghai JiaoTong University School of Medicine, Shanghai 200025, China; and Endocrine Research Unit (M.D.J.), Mayo Clinic, Rochester, Minnesota 55905.Institute and Department of Endocrinology and Metabolism (N.W., B.H., Q.L., Yi.C., C.Z., Yin.C., F.X., M.L., Y.M., C.C., D.L., Y.L.), Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China; Department of Biostatistics (X.W., B.W.), Shanghai JiaoTong University School of Medicine, Shanghai 200025, China; and Endocrine Research Unit (M.D.J.), Mayo Clinic, Rochester, Minnesota 55905.Institute and Department of Endocrinology and Metabolism (N.W., B.H., Q.L., Yi.C., C.Z., Yin.C., F.X., M.L., Y.M., C.C., D.L., Y.L.), Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China; Department of Biostatistics (X.W., B.W.), Shanghai JiaoTong University School of Medicine, Shanghai 200025, China; and Endocrine Research Unit (M.D.J.), Mayo Clinic, Rochester, Minnesota 55905.Institute and Department of Endocrinology and Metabolism (N.W., B.H., Q.L., Yi.C., C.Z., Yin.C., F.X., M.L., Y.M., C.C., D.L., Y.L.), Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China; Department of Biostatistics (X.W., B.W.), Shanghai JiaoTong University School of Medicine, Shanghai 200025, China; and Endocrine Research Unit (M.D.J.), Mayo Clinic, Rochester, Minnesota 55905.Institute and Department of Endocrinology and Metabolism (N.W., B.H., Q.L., Yi.C., C.Z., Yin.C., F.X., M.L., Y.M., C.C., D.L., Y.L.), Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China; Department of Biostatistics (X.W., B.W.), Shanghai JiaoTong University School of Medicine, Shanghai 200025, China; and Endocrine Research Unit (M.D.J.), Mayo Clinic, Rochester, Minnesota 55905.Institute and Department of Endocrinology and Metabolism (N.W., B.H., Q.L., Yi.C., C.Z., Yin.C., F.X., M.L., Y.M., C.C., D.L., Y.L.), Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China; Department of Biostatistics (X.W., B.W.), Shanghai JiaoTong University School of Medicine, Shanghai 200025, China; and Endocrine Research Unit (M.D.J.), Mayo Clinic, Rochester, Minnesota 55905.Institute and Department of Endocrinology and Metabolism (N.W., B.H., Q.L., Yi.C., C.Z., Yin.C., F.X., M.L., Y.M., C.C., D.L., Y.L.), Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China; Department of Biostatistics (X.W., B.W.), Shanghai JiaoTong University School of Medicine, Shanghai 200025, China; and Endocrine Research Unit (M.D.J.), Mayo Clinic, Rochester, Minnesota 55905.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26509871

Citation

Wang, Ningjian, et al. "Is Exposure to Famine in Childhood and Economic Development in Adulthood Associated With Diabetes?" The Journal of Clinical Endocrinology and Metabolism, vol. 100, no. 12, 2015, pp. 4514-23.
Wang N, Wang X, Han B, et al. Is Exposure to Famine in Childhood and Economic Development in Adulthood Associated With Diabetes? J Clin Endocrinol Metab. 2015;100(12):4514-23.
Wang, N., Wang, X., Han, B., Li, Q., Chen, Y., Zhu, C., ... Lu, Y. (2015). Is Exposure to Famine in Childhood and Economic Development in Adulthood Associated With Diabetes? The Journal of Clinical Endocrinology and Metabolism, 100(12), pp. 4514-23. doi:10.1210/jc.2015-2750.
Wang N, et al. Is Exposure to Famine in Childhood and Economic Development in Adulthood Associated With Diabetes. J Clin Endocrinol Metab. 2015;100(12):4514-23. PubMed PMID: 26509871.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is Exposure to Famine in Childhood and Economic Development in Adulthood Associated With Diabetes? AU - Wang,Ningjian, AU - Wang,Xiaojin, AU - Han,Bing, AU - Li,Qin, AU - Chen,Yi, AU - Zhu,Chunfang, AU - Chen,Yingchao, AU - Xia,Fangzhen, AU - Cang,Zhen, AU - Zhu,Chaoxia, AU - Lu,Meng, AU - Meng,Ying, AU - Chen,Chi, AU - Lin,Dongping, AU - Wang,Bingshun, AU - Jensen,Michael D, AU - Lu,Yingli, Y1 - 2015/10/28/ PY - 2015/10/29/entrez PY - 2015/10/29/pubmed PY - 2016/4/19/medline SP - 4514 EP - 23 JF - The Journal of clinical endocrinology and metabolism JO - J. Clin. Endocrinol. Metab. VL - 100 IS - 12 N2 - CONTEXT: The Chinese were afflicted by great famine between 1959 and 1962. These people then experienced rapid economic development during which the gross domestic product per capita increased from $28 in 1978 to $6807 in 2013. We hypothesize that these two events are associated with the booming rate of diabetes in China. OBJECTIVE: We aimed to explore whether exposure to famine in early life and high economic status in adulthood was associated with diabetes in later life. DESIGN AND SETTING: Our data of 6897 adults were from a cross-sectional Survey on Prevalence in East China for Metabolic Diseases and Risk Factors study in 2014. Among them, 3844 adults experienced famine during different life stages and then lived in areas with different economic statuses in adulthood. MAIN OUTCOME MEASURE: Diabetes was considered as fasting plasma glucose of 7.0 mmol/L or greater, hemoglobin A1c of 6.5% or greater, and/or a previous diagnosis by health care professionals. RESULTS: Compared with nonexposed subjects, famine exposure during the fetal period (odds ratio [OR]1.53, 95% confidence interval [CI]1.09-2.14) and childhood (OR 1.82, 95% CI 1.21-2.73) was associated with diabetes after adjusting for age and gender. Further adjustments for adiposity, height, the lipid profile, and blood pressure did not significantly attenuate this association. Subjects living in areas with high economic status had a greater diabetes risk in adulthood (OR 1.46, 95% CI 1.20-1.78). In gender-specific analyses, fetal-exposed men (OR 1.64, 95% CI, 1.04-2.59) and childhood-exposed women (OR 2.81, 95% CI, 1.59-4.97) had significantly greater risk of diabetes. CONCLUSIONS: The rapid increase in the prevalence of diabetes in middle-aged and elderly people in China is associated with the combination of exposure to famine during the fetal stage and childhood and high economic status in adulthood. Our findings may partly explain the booming diabetes phenomenon in China. SN - 1945-7197 UR - https://www.unboundmedicine.com/medline/citation/26509871/Is_Exposure_to_Famine_in_Childhood_and_Economic_Development_in_Adulthood_Associated_With_Diabetes L2 - https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2015-2750 DB - PRIME DP - Unbound Medicine ER -