In Utero and Early Life Exposure to the Great Chinese Famine and Risk of Rheumatoid Arthritis in Adulthood

Severe maternal undernutrition during pregnancy and its long-term effects on the offspring health, with a focus on kidney health

Maternal undernutrition during pregnancy is associated with adverse effects in the offspring during adulthood and contributes to the risk of developing a number of chronic diseases. Historical events, such as famines, allow us to study the effects that food deprivation in utero has on the offspring's health. In particular, the Dutch Hunger Winter (1944-1945) and the Great Chinese Famine (1959-1961) have been extensively analysed, and it has been shown that prenatal exposure to starvation increases the risk of cardiometabolic, mental and kidney disease in adult life. More importantly, the risk can be transmitted to future generations. However, not all studies agree on the thresholds of risk of exposed subjects or on the timing of starvation during foetal life that could be held responsible for these deleterious lifelong consequences. Gender differences complicate the picture. In this narrative review, we discuss similarities and differences between the two famines and compare the available data, seeking to determine what can be learned from these tragedies.

The burden of rheumatoid arthritis in China from 1990 to 2019 and projections to 2030

OBJECTIVES

This study investigates the independent effects of age, period, and cohort on RA in China from 1990 to 2019, with a comparative analysis by gender, and projects the future burden of RA over the next decade.

STUDY DESIGN

A comprehensive analysis was performed using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019.

METHODS

Data were obtained from the Global Burden of Disease (GBD) study in 2019. The Joinpoint regression model was employed to calculate the annual percentage change in RA, while the Age-Period-Cohort analysis was utilized to estimate the effects of age, period, and cohort. The Bayesian APC model was used to predict the trend of RA incidence in China from 2020 to 2030.

RESULTS

From 1990 to 2019, the incidence, prevalence and DALY associated with RA in China exhibited an upward trend, with varying rates of increase across different periods. The peak incidence occurred between the ages of 60-65 years for men and 55-60 years for women, with DALYs increasing with age in both genders. Incidence was negatively associated with vegetable consumption, while the consumption of other food items and alcohol showed positive associations. The Bayesian APC model predicts a decrease in RA incidence among both genders over the next decade, with women consistently exhibiting higher incidence rates than men.

CONCLUSIONS

The burden of RA remains substantial in China. Therefore, it is crucial to implement targeted health education and screening programs to prevent RA, especially among menopausal women.

Early-life famine exposure and subsequent risk of chronic disease comorbidity in later adulthood: the role of social activities

Background

With the global population aging, the burden of health issues has shifted from infectious diseases to chronic diseases. Research indicates a significant link between exposure to famine in early life and chronic diseases. However, evidence regarding the relationships among early-life famine exposure, social activities, and chronic disease comorbidities is lacking.

Objectives

We aimed to systematically assess how early-life famine exposure influences the risk of chronic disease comorbidities in later adulthood and how social activities modulate this risk.

Methods

In this nationwide study, we utilized data from the fourth wave of the CHARLS conducted in 2018. We included 6,641 participants and categorized them into five groups based on birth dates. We used the LCA model to reclassify the 14 chronic diseases from the CHARLS survey as the main outcome indicators. We employed stepwise logistic regression to examine the link between early-life famine exposure and the subsequent risk of chronic disease comorbidity in adulthood, presenting the findings as ORs and 95% CIs. We conducted subgroup analyses according to baseline characteristics to examine the robustness and potential differences in outcomes for chronic disease comorbidity. We evaluated the interaction between famine exposure and social engagement on both additive and multiplicative scales using generalized linear models (GLM).

Results

The prevalence of chronic disease comorbidity patterns between 1.3% (cancer-related disease) and 19.9% (cardiovascular disease comorbidity). Those who experience famine in early life face a heightened risk of cardiovascular disease comorbidity in late adulthood, with an OR (95% CI) of 1.42 (1.12 to 1.80), urinary system disease with an OR (95% CI) of 1.87 (1.05 to 3.34), and multimorbidity with an OR (95% CI) of 1.39 (1.07 to 1.79) compared to those who did not experience such conditions. Participating in social activities can lower the risk of metabolic disease comorbidities in late adulthood for infants who experienced famine, with an (OR [95% CI] of 0.64 [0.43 to 0.97]). There was an interactive effect on the additive (OR [95% CI] of -0.42 [-2.52 to -0.32], P < 0.01) and multiplicative (P = 0.001) effect between infants with famine exposure and social activity.

Conclusion

Experiencing famine in early life is associated with a heightened risk of chronic disease comorbidities in later adulthood, a relationship modulated by participation in social activities. Social activities and early life exposure to famine have an interactive effect on chronic disease comorbidities in later adulthood.

Early-life famine exposure and subsequent risk of chronic diseases in later adulthood: a population-based retrospective cohort study

Background

Over the past few decades, China has experienced significant demographic and epidemiological changes. The sharp decline in fertility and mortality rates has accelerated population aging, contributing to an increase in the prevalence of chronic diseases. The nutritional condition during early life is associated with the onset of chronic illnesses later in adulthood. However, it remains unclear whether this association also increases the risk of multimorbidity in later adulthood.

Objectives

This study aimed to systematically evaluate the association between early-life famine exposure and the subsequent development of 14 chronic diseases, as well as multimorbidity, and whether there exists a discrepancy in gender, residence, and famine severity.

Methods

Data are from the 2018 Wave 4 CHARLS database, a national survey covering 19,816 participants aged 45 years or older. Drawing from our past research on famine in China, we incorporated 3,867 participants, categorizing them into three groups based on their birth years. Considering that climate conditions and population density can influence the intensity of famine, we characterize its severity by establishing a threshold of 50% excess death rate. The 14 chronic diseases assessed by CHARLS were used as the main outcome indicator, with multimorbidity as a secondary outcome indicator. We conducted a stepwise logistic regression analysis to investigate the impact of exposure to famine in early life affects the development of chronic diseases in adulthood, presenting the findings as ORs and 95% CIs. Additionally, we assess multiple moderating factors such as gender, residence, and famine severity to evaluate the outcomes.

Results

Of the 3,867 participants included, the prevalence of each chronic disease ranged from 1.1% (Psychiatric disease) to 10.7% (Hypertension). Overall, 27.0% of participants reported being affected by at least one chronic disease, while 9.6% indicated they had suffered from two or more chronic conditions. Early-life exposure to famine makes it more likely to develop diabetes in later adulthood OR (95% CI) of 1.85 (1.26 to2.72), stroke OR (95% CI) of 1.96 (1.17 to 3.29), kidney disease OR (95% CI) of 1.91 (1.07 to 3.40), and multimorbidity OR (95% CI) of 1.39 (1.08 to 1.80), compared to those who did not face such conditions. The moderating effects analysis revealed that less severe famine exposure during toddlerhood was associated with an increased risk of multimorbidity in adulthood OR (95% CI) of 1.43 (1.01 to 2.03). Males exposed to famine during toddlerhood had a higher risk of multimorbidity in adulthood OR (95% CI) of 2.26 (1.29 to 3.98). Compared to the unexposed group, rural residents who experienced famine exposure in their early life are at a higher risk of developing multimorbidity by about 1.5 times in adulthood.

Conclusion

Experiencing famine in early childhood increases susceptibility to developing chronic diseases in later adulthood, with the risk of diabetes, stroke, and kidney disease nearly doubling. The association of multimorbidity in later adulthood varies according to the severity of the famine, gender, and residential area.

Famine exposure in early life increases risk of cataracts in elderly stage

BACKGROUND

Epidemiological studies have shown that early-life nutritional deficiencies are associated with an increased risk of diseases later in life. This study aimed to explore the correlation between famine exposure during the early stages of life and cataracts.

METHODS

We included 5,931 participants from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) 2018 cross-sectional data in our study. Subjects were categorized into three groups by their age during the famine: adulthood group, school age famine exposure group, and teenage famine exposure group. Utilizing binary logistic regression models, we investigated the relationship between early-life famine exposure and cataracts.

RESULTS

Compared to the adulthood group, both the school age exposure group (OR = 2.49, 95%CI = 1.89-3.27) and teenage exposure group (OR = 1.45, 95%CI = 1.20-1.76) had a heightened risk of developing cataracts in elderly stage. And the sex differences in the impact of famine during early years on elderly cataract risk were observed, particularly indicating a higher risk among women who experienced childhood famine compared to men with similar exposure.

CONCLUSION

Famine exposure during the early stages of life is associated with a heightened risk of developing cataracts in old age. To prevent cataracts in elderly individuals, particularly in females, measures should be taken to address nutritional deficiencies in these specific periods.

Early-Life Exposure to Malnutrition From the Chinese Famine on Risk of Asthma and Chronic Obstructive Pulmonary Disease in Adulthood

Objectives

Intrauterine malnutrition has a long-term effect on respiratory and lung function. However, few studies have explored the association between early-life exposure to famine with asthma and chronic obstructive pulmonary disease (COPD) in adulthood. Therefore, we aimed to investigate the association of early-life exposure to the Chinese famine of 1959–1962 with asthma and COPD later in life.

Methods

This national population-based study included 6,771 participants from the baseline survey of the China Health and Retirement Longitudinal Study (CHARLS) who were born around the time of the Chinese famine. The famine exposure groups were determined according to the participants' birth year as non-exposed (1964–1967), fetal-exposed (1959–1962), preschool-exposed (1954–1957), and school-age exposed (1950–1953). Information about the demographic characteristics, self-reported doctor-diagnosed asthma and COPD, behavior and lifestyles, and indoor pollution were collected using validated questionnaires. In addition, peak expiratory flow (PEF) was measured to assess pulmonary function. Multivariable logistic regression and generalized linear mixed models were performed to explore the risk of adult asthma and COPD, PEF changes during various famine exposure periods compared with the non-exposed group. Stratified and sensitivity analyses were conducted to examine the modification and robustness of the association.

Results

The prevalence of doctor-diagnosed asthma and COPD was 2.8 and 8.1%, respectively. Compared with the non-exposed group, the risk was significantly higher in the fetal-exposed group for asthma [adjusted odds ratio, (aOR) = 1.87, 95% confidence interval (CI):1.14–3.07] and the school-age exposed group [1.30 (1.00–1.69)] for COPD after controlling for confounders. Furthermore, we observed that fetal exposure to famine was significantly associated with a decrement of PEF in adulthood [β = −11.38 (−22.75 to −0.02)] compared with the non-exposed group. Stratified analyses showed that the association of asthma was stronger in men, who resided in severely famine-affected areas, smoked, and used solid fuels for cooking. No clearly consistent association was observed for subsequent COPD.

Conclusions

Our results suggest that fetal exposure to the Chinese famine is significantly associated with the increased risk of asthma in adulthood. Future prospective studies are warranted to examine the association and mechanisms.

Low-Density Lipoprotein Cholesterol and the Risk of Rheumatoid Arthritis: A Prospective Study in a Chinese Cohort

Objective: This study aimed to investigate whether low-density lipoprotein cholesterol (LDL-C) concentration was associated with the risk of rheumatoid arthritis (RA) in Chinese adults. Methods: The study included the 97,411 participants in the Kailuan Study without RA, with complete baseline LDL-C data, and who did not use lipid-lowering medications at baseline or during follow-up. We used Cox proportional hazards modeling to calculate the hazard ratio (HR) and 95% confidence interval (95% CI) of RA according to baseline LDL-C tertiles, adjusting for age, sex, body mass index, HDL-C, triglycerides, diabetes, hypertension, alcohol consumption, and smoking. We also calculated the HR and 95% CI of RA using updated LDL-C measurements prior to the end of follow-up, adjusting for covariates. Results: We identified 97 incident RA cases between 2006 and 2018. After adjusting for potential confounders, updated LDL-C concentration—rather than baseline LDL-C—was inversely associated with RA risk. The adjusted HR of RA was 0.64 (95% CI: 0.38, 1.09; p-trend = 0.10) comparing the two extreme baseline LDL-C tertiles, and 0.38 (95% CI: 0.22, 0.64; p-trend < 0.01) comparing the two extreme tertiles of the updated LDL-C concentrations. Conclusions: In this prospective study, high LDL-C concentrations, when measured closest to RA diagnosis or the end of follow-up, were associated with a low risk of RA. These findings highlight the changes in LDL-C prior to RA diagnosis, and the importance of including lipid analyses into studies of the pathogenesis of RA.

Exposure to Chinese Famine during Early Life Increases the Risk of Fracture during Adulthood

This study focused on identifying whether exposure to the Chinese Great Famine (1959–1961) in early life amplified the potential for fractures in adulthood. The survey was conducted using data from the 1997–2015 China Health and Nutrition Survey (CHNS)—5235 adults born between 1954 and 1964 were selected as the sample size. Fracture was defined based on self-report. Those born from 1962–1964 were treated as non-exposure group. Those with exposure to famine were divided into four subgroups: Fetal, early childhood, mid-childhood, and late childhood cohorts. The association between the groups and fracture was determined using Cox regression. In follow-up data (mean of 11 years), fractures were identified in 418 of the participants. The incidence of fracture was 8.7 in late childhood, 8.1 in mid-childhood, 8.3 in early childhood, 7.0 in fetal, and 5.4 in non-exposed cohorts per 1000 person-year. Compared with the non-exposed group, the famine-exposed groups had an increased risk of developing fracture in adulthood with hazard ratio (HR) and 95% CI of 1.29 (0.90–1.85), 1.48 (1.08–2.03), 1.45 (1.02–2.06), and 1.54 (1.08–2.20), respectively. The positive link of famine exposure to risk of fracture occurred primarily in those participants with a modern diet who lived in urban areas. In conclusion, the risk of fracture in Chinese adults is associated with famine exposure.

In utero and childhood exposure to the Great Chinese Famine and risk of cancer in adulthood: the Kailuan Study

BACKGROUND

The risk of cancer in adulthood can be influenced by exposure to environmental factors (e.g., food shortage and stress) in early life.

OBJECTIVES

This study compared the risk of cancer morbidity and mortality between Chinese adults who were or were not exposed to the Great Chinese Famine (1959-1961) in utero or during early childhood.

METHODS

The Kailuan Study participants (n = 101,095) were classified into 5 famine exposure groups by birth year collected at study baseline (2006-2007): after 1961 (unexposed), 1959-1961 (in utero exposed), 1956-1958 (infancy and early childhood exposed, aged 0.1-2.9 y), 1953-1955 (childhood exposed, aged 3.0-5.9 y), and before 1953 (exposed, aged 6+ y). They were further classified by the severity of famine exposure. Cancer and cancer mortality cases from 2006 to 2016 were confirmed by reviewing medical records. Cox proportional hazard models were computed, adjusting for sex, socioeconomic status, and other time-varying cancer-related covariates.

RESULTS

During a median follow-up of 10.0 y, we identified 3560 incident cancer cases and 1749 cancer deaths. Famine exposure at all ages was positively associated with the risk of cancer morbidity and mortality (P < 0.001 for all, compared with unexposed). Severe exposure to famine in early childhood, but not other ages, had a higher risk of composite cancer events [adjusted HR = 2.04 (95% CI: 1.47, 2.84) for 0.1-2.9 y; and 1.61 (95% CI: 1.15, 2.25) for 3.0-5.9 y], relative to the less severely exposed groups of the same age range. When cancer morbidity and mortality were studied separately, similar patterns were observed.

CONCLUSIONS

In utero and early childhood exposures to famine, especially severe famine, were associated with a higher risk of cancer morbidity and mortality in adulthood. Awareness should be raised regarding the long-term effect of early life nutritional status.Trial registration number: ChiCTR-TNRC-11001489 (http://www.chictr.org.cn/showprojen.aspx?proj=8050).

Alcohol Consumption and Risk of Rheumatoid Arthritis among Chinese Adults: A Prospective Study

Alcohol consumption may be associated with the risk of rheumatoid arthritis (RA), but potential sex-related differences in this association have not been explored. Thus, we utilized 87,118 participants in the Kailuan Study, a prospective cohort initiated in 2006 to study the risk factors of cardiovascular disease in a Chinese population. We included those that did not have RA at baseline (2006), and performed cox proportional hazard modeling to calculate the hazard ratio (HR) and 95% confidence interval (95% CI) of RA according to the levels of alcohol consumption (never or past, light or moderate (<1 serving/day for women, <2 servings/day for men), and heavy (>1 serving/day for women, >2 servings/day for men), adjusting for age, sex, body mass index, and smoking. Diagnoses of RA were confirmed via medical record review by rheumatologists. From 2006 to 2018, we identified 87 incident RA cases. After adjusting for potential confounders, the HR of RA was 1.26 (95% CI: 0.62, 2.56) for participants with light or moderate alcohol consumption and 1.98 (95% CI: 0.93, 4.22) for participants with heavy alcohol consumption) versus non-drinkers. The HR of each 10 g increase in alcohol consumption was 1.11 (95% CI: 0.98, 1.26) (p-trend = 0.09). A significant association between alcohol consumption and RA risk was observed in women, but not in men (p for interaction = 0.06). Among women, each 10 g increase in alcohol consumption was significantly associated with a high risk of RA (HR: 1.56; 95% CI: 1.06, 2.29). In contrast, each 10 g increase in alcohol consumption was not significantly associated with the risk of RA in men (HR: 1.10; 95% CI: 0.97, 1.25). Excluding past drinkers generated similar results. In this prospective Chinese cohort, increasing alcohol consumption was associated with an elevated risk of RA among women, but not in men. These findings highlight the importance of incorporating analysis of sex differences into future studies of alcohol consumption and RA risk.