The famine exposure in early life and metabolic syndrome in adulthood

Association of iodized salt intake with the risk of physical frailty in patients with type 2 diabetes

OBJECTIVES

We aimed to investigate the association of the status of iodized salt in terms of consumption of salt type and urinary iodine concentration (UIC) in diabetes, with frailty and examine whether this association could be modified by thyroid function.

DESIGN

A population-based cohort study.

SETTING AND PARTICIPANTS

We included 850 patients with type 2 diabetes from 11 communities in Shanghai, who completed five-year follow-up.

MEASUREMENTS

The type of salt consumed was collected through a standardized questionnaire and UIC was measured by an inductively coupled plasma-mass spectrometer. Frailty was assessed by frailty phenotype. Serum thyroid-stimulating hormone (TSH) and free thyroxine (FT4) were measured by electrochemiluminescence. Modified Poisson regression model with robust variance was used to estimate the relative risks (RRs) with 95% confidence intervals (CIs) for frailty in relation to iodized salt consumption and UIC.

RESULTS

In this five-year follow-up study in patients with diabetes, 111 (12.9%) patients progressed to frailty. Patients who consumed non-iodized salt (RR: 1.09, 95% CI: 1.01-1.18) had an increased risk of frailty, compared to patients who consumed iodized salt. Lower UIC was associated with a higher risk of frailty (1.10, 1.01-1.19). In patients with high TSH and low FT4, the RRs of frailty were 1.20 (1.08-1.34) and 1.15 (1.02-1.29) for non-iodized salt, and 1.14 (1.02-1.28) and 1.12 (0.99-1.27) for low UIC.

CONCLUSIONS

Non-iodized salt consumed and low UIC were associated with an increased risk of frailty in diabetes, particularly in those with high TSH and low FT4. Maintaining adequate iodine intake is critically important for preventing frailty in diabetes, especially for individuals with potential thyroid dysfunction.

Early-life famine exposure, genetic susceptibility and risk of MAFLD in adulthood

OBJECTIVES

Early-famine exposure was reported to be associated with metabolic associated fatty liver disease (MAFLD); however, it has not been fully elucidated whether the gene-famine interaction exist in this association. We aimed to investigate the association between early-life famine exposure in different genetic risk stratifications and the risk of MAFLD in adulthood.

DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS

The study included 8213 participants from the SPECT-China study. Famine exposure subgroups was defined according to the birth year. A genetic risk score (GRS) was constructed with single nucleotide polymorphisms associated with MAFLD in East Asians. Logistic models were used to examine the association of famine exposure and GRS with MAFLD.

RESULTS

Early-life famine exposure was positively associated with MAFLD after adjusting for multiple confounders (OR (95% CI): fetal-exposure 1.3(1.11-1.53), childhood exposure 1.12(1-1.25)). Meanwhile, with per SD increment of GRS (2.49 points), the OR(95%CI) of MAFLD was 1.1(1.04-1.16). In high GRS group, fetal-exposure was positively associated with 45% higher risk of MAFLD (1.45(1.15-1.83)). In men, neither in low or high GRS subgroups observed an association between early-life famine exposure and MAFLD. But in women with high GRS of MAFLD, fetal-exposure was positively associated with even higher risk of MAFLD (1.64(1.22-2.22)).

CONCLUSION

The positive association between early-life famine exposure and MAFLD is intensified by high genetic susceptibility of MAFLD in women and in general population in China; while this association does not exist in men or in those with low genetic risk scores.

Consequences of Exposure to Famine Exposure on the Later Life eGFR Decline Among Survivors of the Great Chinese Famine: A Retrospective Study

OBJECTIVES

Chronic kidney disease (CKD) significantly contributes to the socio-economic burden both in China and worldwide. Previous research has shown that experiencing childhood famine is linked to various chronic conditions like diabetes, hypertension, and proteinuria. However, the long-term effects of early-life famine exposure on adult kidney function remain unclear. This study investigates whether exposure to the Chinese Great Famine (1959-1962) is associated with a decline in glomerular filtration rate (GFR) later in life.

DESIGN AND METHODS

China Health and Retirement Longitudinal Study is a population-based observational study. We analyzed data from 8,828 participants in the 2011-2012 baseline survey, updated in 2014. Participants were categorized based on their birth year into fetal-exposed (1959-1962), childhood-exposed (1949-1958), adolescence/adult-exposed (1912-1948), and nonexposed (1963-1989) groups. The estimated GFR (eGFR) was calculated using the CKD-EPI-Cr-Cys equation (2021), with CKD defined as an eGFR below 60 mL/min/1.73 m2.

RESULTS

Average eGFR values were 103.0, 96.8, 91.2, and 76.3 mL/min/1.73 m2 for the fetal-exposed, childhood-exposed, adolescence/adult-exposed, and nonexposed groups, respectively. The eGFR in the exposed groups was significantly lower compared to the nonexposed group. Specifically, famine exposure correlated with a lower eGFR (coefficient estimates [CE] -9.14, 95% confidence interval [CI] -9.46, -8.82), with the strongest association observed in the adolescence/adult-exposed group (CE -26.74, 95% CI -27.75, -25.74). Adjusting for variables such as demographics, physical and laboratory tests, complications, and personal habits like smoking and drinking did not qualitatively alter this association (CE -1.38, 95% CI -1.72, -1.04). Further stratification by sex, body mass index, alcohol consumption history, hypertension, diabetes, Center for Epidemiologic Studies Depression score, and education level showed that the association remained consistent.

CONCLUSIONS

Exposure to famine during different life stages can have enduring effects on GFR decline in humans.

The effects of vitamin D and gene polymorphisms on susceptibility to thyroid peroxidase antibody positivity

BACKGROUND

The etiology of Hashimoto's thyroiditis (HT) involves genetic and environmental factors. There is a lack of clarity regarding the relationship between Vitamin D and HT. This study aimed to investigate the effect of Vitamin D and gene polymorphisms on thyroid peroxidase antibody (TPOAb) positivity.

METHODS

A total of 9,966 participants were included from a survey conducted in East China from 2014 to 2016. We measured the levels of 25(OH)D, thyroid hormones and autoimmune antibodies. rs11675434, rs9277555, and rs301799 were genotyped. Based on these 3 SNPs, a weighted genetic risk score was calculated for TPOAb.

RESULTS

The proportion of females in the TPOAb-positive group was greater than that in the TPOAb-negative group (74.2% vs. 57.2%, P<0.001). Vitamin D levels were lower in the TPOAb-positive group than in the TPOAb-negative group (40.07±11.87 vs. 40.80±12.84, P=0.01). The GG genotype of rs9277555 and the TT genotype of rs11675434 were correlated with the risk of TPOAb positivity (OR=1.34, 95% CI 1.13-1.59, P=0.001; OR=1.29, 95% CI 1.06-1.58, P=0.01). TPOAb-GRS was associated with TPOAb positivity (OR=3.17, 95% CI 1.72-5.84; P<0.001). When stratified by Vitamin D group, the association between TPOAb-GRS and TPOAb positivity existed only in the Vitamin D deficiency group (OR=3.41, 95% CI 1.73-6.70 P<0.001) but not in the control group (OR=2.45, 95% CI 0.59-10.19, P=0.22).

CONCLUSIONS

This study suggested that TPOAb-GRS was associated with TPOAb positivity in the Han Chinese population, mainly due to rs9277555 and rs11675434. The hereditary effect of TPOAb positivity differed depending on Vitamin D status.

Individual and combined effects of famine exposure and obesity parameters on type 2 diabetes in middle-aged and older adults: A population-based cross-sectional study

Malnutrition early in life may have adverse effects on health later in life. The relationship between malnutrition and obesity parameters (body mass index [BMI] and waist circumference [WC]) and type 2 diabetes is inconsistent. This study aimed to identify the effects of famine exposure and obesity parameters on type 2 diabetes individually or in combination among middle-aged and older adults in China. Data were extracted from the China Health and Retirement Longitudinal Study Wave1 in 2011. The sample involved 13,065 adults aged 45 to 90. The t- or F test was employed to compare age among groups. The chi-square test was utilized to compare baseline characteristics according to the categorical WC levels/BMI levels/famine exposure and examine between-group differences in type 2 diabetes (diabetes and non-diabetes). Odds ratio (OR) and 95% confidence interval (CI) were estimated by logistic regression models to estimate the individual and combined associations of BMI/WC levels and famine exposure with the prevalence of type 2 diabetes. In this study, 1559 (11.93%) individuals were exposed to Chinese famine during their fetal stage, 5132 (39.28%) and 4428 (33.89%) in childhood and adolescence/adulthood, respectively. Among BMI measurements, 3780 (28.93%) were overweight, and 1487 (11.38%) were obese, whereas WC measurements showed that 5408 (41.39%) were obesity. In addition, 831 (45.48%) males and 996 (54.52%) females reported type 2 diabetes. In multivariable-adjusted regression models, obesity parameters and famine exposure were independently associated with type 2 diabetes prevalence among all participants (P < .001). In the interaction analysis, there existed a trend of higher odds for prevalence of type 2 diabetes across all groups compared to the combination of no-exposed and normal BMI/WC level group (the most increase in odds, adolescence/adulthood-exposed group with central obesity in WC levels: OR 4.51 (95% CI = 3.42-5.95); adolescence/adulthood-exposed group with obesity in BMI levels: OR 5.84 (95% CI = 4.11-8.30; P for interaction <.001). The findings for females exhibited similar to the overall participants, when by gender stratification. Our results suggest famine exposure and obesity parameters have positive combined effects on type 2 diabetes in middle-aged and older adults in China.

Nonlinear relationship between body mass index and serum uric acid: An observational and Mendelian randomization study among Chinese adults

BACKGROUND AND AIMS

Conflicting evidence exists on the relationship between body mass index (BMI) and serum uric acid (SUA), and importantly, the causal role of BMI in SUA remains unclear. We aimed to evaluate the BMI-SUA relationship and its causality among Chinese adults using observational and Mendelian randomization (MR) analyses.

METHODS AND RESULTS

Study included 6641 adults from East China. A genetic risk score based on 14 BMI-associated East Asian variants was formulated. One-sample MR and non-linear MR analyses assessed the causal link between BMI_GRS and SUA levels. Mean BMI levels were 24.8 (SD 3.4) and 24.3 (SD 3.6) kg/m2 in men and women, respectively. Spline models revealed gender-specific BMI-SUA associations: a reverse J-shape for men and a J-shape for women (P-values for nonlinearity <0.05). In men, BMI showed a positive correlation with SUA levels when BMI was below 29.6 kg/m2 (beta coefficient 19.1 [95 % CI 15.1, 23.0] μmol/L per 1-SD increase in BMI), while in women, BMI exhibited a negative correlation with SUA levels when the BMI was less than 21.7 kg/m2 (beta coefficient -12.9 [95 % CI -21.6, -4.1] μmol/L) and a positive correlation when BMI exceeded 21.7 kg/m2 (beta coefficient 13.3 [95 % CI 10.9, 15.8] μmol/L). Furthermore, MR analysis suggested non-linear BMI-SUA link in women but not men.

CONCLUSION

Our study indicates a non-linear correlation between BMI and SUA in both genders. It is noteworthy that in women, this correlation may have a causal nature. Nevertheless, further longitudinal investigations are required to authenticate our findings.

Exposure to Chinese famine in early life and height across 2 generations: a longitudinal study based on the China Health and Nutrition Survey

BACKGROUND

Poor nutrition early in life is associated with short stature, which is associated with increased risk of cardiovascular disease and mortality in later life. Less evidence is available about the impact of early-life nutrition on height growth in the subsequent generation.

OBJECTIVES

This study investigated the associations of famine exposure in utero and early childhood with height across 2 generations.

METHODS

We used longitudinal data from the China Health and Nutrition Survey. We included 5401 participants (F1) born in 1955-1966 (calendar year around the Chinese famine in 1959-1961) and their 3930 biological offspring (F2). We classified F1 participants into subgroups by famine exposure status (unexposed/exposed) and timing (fetal-/childhood-exposed) according to their birth year and grouped F2 by their parents' exposure. Linear regression models were applied to examine the associations of famine exposure with adult height of F1 and F2. Linear mixed effect models with fractional polynomial functions were performed to estimate the difference in height between exposure groups of F2 during childhood.

RESULTS

Participants (F1) exposed to famine in utero or in childhood were shorter than those unexposed by 0.41 cm (95% CI: 0.03, 0.80) and 1.12 cm (95% CI: 0.75, 1.48), respectively. Offspring (F2) of exposed fathers were also shorter than those of unexposed parents by 1.07 cm (95% CI: 0.28, 1.86) during childhood (<18 y) and by 1.25 cm (95% CI: 0.07, 2.43) in adulthood (≥18 y), and those with exposed parents had a reduced height during childhood by 1.29 cm (95% CI: 0.68, 1.89) (all P values < 0.05). The associations were more pronounced among child offspring of highly-educated F1, particularly for paternal exposure and among female offspring (all P for interaction < 0.05).

CONCLUSIONS

The findings support the intergenerational associations of famine exposure in early life with height in Chinese populations, indicating the public health significance of improving the nutritional status of mothers and children in the long run.

Novel Associations of Dyslipidaemia with Vitamin D and Bone Metabolism in Elderly Patients with Diabetes: A Cross-Sectional Study

Objective

Little is known about whether diabetic dyslipidaemia contributes to increased bone fragility in patients with diabetes. This study aimed to explore the potential effects of dyslipidaemia on vitamin D and bone metabolism in elderly subjects with type 2 diabetes (T2D).

Methods

A total of 1479 male patients and 1356 female patients 50 years or older with T2D were included in Shanghai, China. Lipid profiles, 25-hydroxyvitamin D (25(OH)D), serum procollagen type I N-terminal propeptide (P1NP), β-C-terminal telopeptide (β-CTX) and other parameters were measured. Principal component regression (PCR) and mediation analysis were used to estimate the associations of lipid profile, 25(OH)D and bone turnover levels.

Results

Female patients presented with higher blood lipids, lower 25(OH)D, and higher P1NP and β-CTX levels than male patients with T2D. TC was associated with P1NP in males and females (β=0.056, P<0.05; β=0.095, P<0.01, respectively), and 25(OH)D fully mediated the associations in males and mediated approximately 17.89% of the effects in females. LDL-C was associated with P1NP in males and females (β=0.072 and 0.105 respectively, all P<0.01), and 25(OH)D mediated the relationships approximately 20.83% in males and 14.29% in females. TG was negatively associated with P1NP (in males, β= -0.063, P<0.05; in females, β= -0.100, P<0.01) and β-CTX (in males, β= -0.108; in females, β= -0.128, all P<0.01) independent of 25(OH)D, while HDL-C was not associated with P1NP or β-CTX in diabetic patients.

Conclusion

Hypercholesterolemia and hypertriglyceridaemia might affect bone metabolism by distinguishing pathways in diabetes patients. Ameliorating lipid control in elderly diabetes patients, especially female patients, will benefit both vitamin D and bone metabolism.

Blood Lead Level Is Associated with Visceral Adipose Dysfunction in Patients with Type 2 Diabetes

We aimed to explore whether an elevated blood lead level (BLL) is associated with visceral adipose dysfunction in patients with type 2 diabetes mellitus (T2DM). Four thousand one hundred and fourteen diabetic participants were enrolled from seven communities in Shanghai in 2018 in the cross-sectional METAL study. BLL was measured by graphite furnace atomic absorption spectrometry. Visceral adiposity index (VAI) and lipid accumulation product (LAP)were calculated by simple anthropometric and biochemical parameters. We found that medians (IQR) of BLL were 26.0 μg/L (18.0-37.0) for men and 25.0 μg/L (18.0-35.0) for women, respectively. In men, each doubling of BLL was associated with a 2.0% higher VAI (95% CI, 0.6 to 3.5%) and 1.8% higher LAP (95% CI, 0.2 to 3.3%) after full adjustment. Using the lowest BLL quartile as the referent group, significant positive trends were observed for BLL with VAI and LAP. In women, each doubling of BLL was associated with a 1.9% higher LAP (95% CI, 0.6 to 3.1%). Additionally, there was a marginally significant positive association between BLL and VAI, either using log2-transformed concentrations as continuous variables or categorized in quartiles. In conclusion, lead exposure is associated with visceral adipose dysfunction in patients with T2DM. Further prospective studies are warranted to confirm our findings.

High prevalence of metabolic diseases, liver steatosis and fibrosis among Chinese psychiatric patients

BACKGROUND

We aimed to investigate the differences of metabolic disorders between the general population and psychiatric patients, with an emphasis on the prevalence and influencing factors of liver fibrosis in psychiatric patients.

METHODS

A total of 734 psychiatric patients and 734 general population matched for age, sex, and BMI were enrolled from Shanghai, China. All participants underwent blood pressure, glucose, lipid profile measurements, and anthropometric parameters including body weight, height and waist circumference. FibroScan examinations were also performed on psychiatric patients. Liver steatosis and fibrosis were diagnosed by controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) by professional staff.

RESULTS

Compared with the general population, psychiatric patients revealed significantly higher burden of metabolic disorders. The overall prevalence of liver steatosis (CAP ≥ 233 dB/m) and fibrosis (LSM ≥ 7.0 kPa) was 48.7% and 15.5% in psychiatric patients. Psychiatric patients with liver steatosis or fibrosis showed worse metabolic profile. Meanwhile, the prevalence of liver fibrosis was also significantly higher in patients with overweight, central obesity, diabetes, hypertension, metabolic syndrome, and liver steatosis. In logistic regression analyses, age, BMI and visceral adiposity index were independent risk factors for liver fibrosis in psychiatric patients. Additionally, antipsychotic medication was suggested to be associated with an increased risk of liver fibrosis in psychiatric patients with liver steatosis.

CONCLUSIONS

Prevalence of liver steatosis and fibrosis is high in Chinese psychiatric patients. Those with antipsychotic polypharmacy and obesity are at high risk, and may benefit from early liver assessment in preventing fibrosis progression.

Outcomes in children of women with type 2 diabetes exposed to metformin versus placebo during pregnancy (MiTy Kids): a 24-month follow-up of the MiTy randomised controlled trial

BACKGROUND

Metformin is increasingly being used during pregnancy, with potentially adverse long-term effects on children. We aimed to examine adiposity in children of women with type 2 diabetes from the Metformin in Women with Type 2 Diabetes in Pregnancy (MiTy) trial, with and without in-utero exposure to metformin, up to 24 months of age.

METHODS

MiTy Kids is a follow-up study that included infants of women who participated in the MiTy randomised controlled trial, receiving either oral 1000 mg metformin twice daily or placebo. Caregivers and researchers remained masked to the type of medication (metformin or placebo) mothers received during their pregnancy. Anthropometric measurements, including weight, height, and skinfold thicknesses, were taken at 3, 6, 12, 18, and 24 months. At 24 months, linear regression was used to compare the BMI Z score and sum of skinfolds in the metformin versus placebo groups, adjusted for confounders. Fractional polynomials were used to assess growth trajectories. This study is registered with ClinicalTrials.gov, NCT01832181.

FINDINGS

Of the 465 eligible children, 283 (61%) were included from 19 centres in Canada and Australia. At 24 months, there was no difference between groups in mean BMI Z score (0·84 [SD 1·52] with metformin vs 0·91 [1·38] with placebo; mean difference 0·07 [95% CI -0·31 to 0·45], p=0·72) or mean sum of skinfolds (23·0 mm [5·2] vs 23·8 mm [5·4]; mean difference 0·8 mm [-0·7 to 2·3], p=0·31). Metformin was not a predictor of BMI Z score at 24 months of age (mean difference -0·01 [95% CI -0·42 to 0·37], p=0·92). There was no overall difference in BMI trajectory but, in males, trajectories were significantly different by treatment (p=0·048); BMI in the metformin group was higher between 6 and 24 months. Children of women with type 2 diabetes were approximately 1 SD heavier than the WHO reference population.

INTERPRETATION

Anthropometrics were similar in children exposed and those not exposed to metformin in utero; hence, overall, data are reassuring with regard to the use of metformin during pregnancy in women with type 2 diabetes and the long-term health of their children.

FUNDING

Canadian Institute for Health Research.

Diabetes Mellitus Type 2 Patients with Abdominal Obesity Are Prone to Osteodysfunction: A Cross-Sectional Study

Introduction

The interaction between diabetes, obesity, and bone metabolism was drawing increasing public attention. However, the osteometabolic changes in diabetes mellitus type 2 (T2DM) patients with abdominal obesity have not been fully revealed. This study is aimed at investigating the association between abdominal obesity indices and bone turnover markers among T2DM participants.

Methods

4351 subjects were involved in the METAL study. Abdominal obesity indices included neck, waist, and hip circumference, visceral adiposity index (VAI), lipid accumulation product (LAP), waist-to-hip ratio (WHR), and Chinese visceral adiposity index (CVAI). They were applied to elucidate the nexus between β-C-terminal telopeptide (β-CTX), osteocalcin (OC), and intact N-terminal propeptide of type I collagen (P1NP).

Results

Abdominal obesity indices were strongly negatively associated with β-CTX and OC. Among males, five indices were negatively correlated with β-CTX (BMI, WC, LAP, WHR, and CVAI) and OC (BMI, NC, WC, WHR, and CVAI). There were no significant associations with P1NP. Among females, all eight indices were negatively associated with β-CTX. Seven indices were negatively related to OC (BMI, NC, WC, HC, LAP, WHR, and CVAI). The VAI was negatively correlated with P1NP.

Conclusions

The present study demonstrated that in T2DM, abdominal obesity had an obviously negative correlation with bone metabolism. Abdominal obesity indices were significantly negatively associated with skeletal destruction (β-CTX) and formation (OC). In routine clinical practice, these easily obtained indices could be used as a preliminary screening method and relevant factors for osteodysfunction incidence risk at no additional cost and may be of particular value for postmenopausal women in T2DM populations.

The associations of total testosterone with probable nonalcoholic steatohepatitis and nonalcoholic fatty liver disease fibrotic progression in men with type 2 diabetes: a cross-sectional study

BACKGROUND

Testosterone has an impact on metabolic disorders and men with type 2 diabetes mellitus (T2DM) are predisposed to hypogonadism; meanwhile, patients with T2DM have higher risk of NAFLD. Therefore, we speculate that testosterone may affect the progression of NAFLD in T2DM patients and we aim to investigate whether total testosterone is associated with NAFLD progression in men with T2DM.

METHODS

A cross-sectional study. A total of 1782 male participants with T2DM were enrolled from seven communities in Shanghai. Probable nonalcoholic steatohepatitis (NASH) was defined by the concurrence of NAFLD and metabolic syndrome (MetS). NAFLD fibrosis score was used to identify patients with probable advanced fibrosis. Multinomial logistic regression and ordinal logistic regression was used to measure the association of total testosterone (independent variable) and the progression category of NAFLD (dependent variable).

RESULTS

In male, TT quartiles were negatively associated with probable NASH (Q1 vs. Q4 OR 2.07 95% CI 1.31-3.28, P for trend = 0.001) and inflammatory progression of NAFLD with OR of 1 SD increment of ln (TT) 0.81 (95% CI 0.72-0.92, P for trend < 0.001), but positively with fibrotic progression (Q1 vs. Q4 OR 0.45, 95% CI 0.29-0.72, P for trend = 0.001) with OR of 1 SD increment of ln (TT) 1.24 (95% CI 1.07-1.45). According to stratified analyses, for inflammatory progression, the interactions of age strata, duration of diabetes strata, and dyslipidemia status with 1 SD increment of ln (TT) were significant (P for interaction 0.007, 0.003, and 0.012, respectively); as for fibrotic progression, we found no interactions (all P for interaction ≥ 0.05).

CONCLUSIONS

Different associations between TT and inflammatory and fibrotic progression of NAFLD in male were observed, suggesting different roles of TT in inflammatory and fibrotic stages of NAFLD.

Exposure to lead and cadmium is associated with fasting plasma glucose and type 2 diabetes in Chinese adults

AIMS

Exposure to lead and cadmium has been associated with type 2 diabetes, but the results are largely inconsistent, and little is known about their joint effect. We aimed to investigate the associations of lead and cadmium co-exposure with fasting plasma glucose (FPG) and type 2 diabetes.

MATERIALS AND METHODS

The study included 5732 participants aged ≥18 years from 16 communities in East China. Blood levels of lead and cadmium were determined using graphite furnace atomic absorption spectrometry. Multivariable linear and logistic regression models were performed to evaluate the associations of lead and cadmium alone or in combination with FPG and diabetes.

RESULTS

The median (interquartile range) values of blood lead and cadmium were 40.0 (26.8-57.9) and 1.70 (0.56-3.60) μg/L, respectively. After adjustment for potential confounders, blood lead levels were positively associated with FPG (difference comparing extreme lead quartiles = 0.11 [95% CI: 0.03, 0.20] mmol/L) and prevalent diabetes (odds ratio [OR] = 1.35 [95% CI: 1.03, 1.78]). The association between lead and diabetes was observed among participants with high cadmium, but not among those with low cadmium (P for interaction = 0.03). In the joint analysis, compared with participants with low levels of blood lead and cadmium, participants with high levels of two metals had a 0.16 (95% CI: 0.07, 0.25) mmol/L increase in FPG and a 51% (OR = 1.51, 95% CI: 1.15, 1.99) increase in odds of diabetes.

CONCLUSIONS

Our findings suggest that lead and cadmium co-exposure is significantly associated with elevated FPG and type 2 diabetes in the general population.

Famine exposure in adolescence is associated with a higher risk of overweight/obesity and abdominal obesity in adulthood: A meta-analysis

Some studies have shown that famine exposure during adolescence can increase cardiovascular disease and diabetes susceptibility in later life. The association between famine exposure in adolescence and overweight/obesity and abdominal obesity in adulthood has been inconsistent. Based on previous studies, we hypothesized that famine exposure in adolescence increases the risk of overweight/obesity and abdominal obesity in adulthood. Eight databases, including PubMed, Embase, Cochrane Library, and Web of Science, were searched from their inception until November 2021. We initially identified 3982 records and finally included 7 articles after screening. The included articles were of moderate to high quality, containing 16 estimates of overweight/obesity and 3 estimates of abdominal obesity. Pooled odds ratios (ORs) with 95% CIs were used to estimate the association between them. The random effects model was adopted as the pooling method. There was a significant association between famine exposure in adolescence and overweight/obesity in adulthood (OR, 1.17; 95% CI, 1.02-1.33). Adolescents exposed to famine had a greater risk of abdominal obesity in adulthood than their unexposed counterparts (OR, 1.35; 95% CI, 1.03-1.76). These results were more pronounced in females than in males. In summary, our meta-analysis indicates that famine exposure during adolescence increases the risk of overweight/obesity and abdominal obesity in adulthood. This suggests that we need to pay timely attention to the nutritional status of adolescents to prevent adverse health consequences of malnutrition. More high-quality studies are needed to confirm these conclusions, given the limitations of this study.

Effect of foetal exposure to famine on the risk of nonalcoholic fatty liver disease in adulthood: A systematic review and meta-analysis

OBJECTIVE

The risk of metabolic disease in adulthood is not only attributed to an unhealthy lifestyle after birth but also to famine exposure during the foetal period. This systematic review and meta-analysis aimed to evaluate the effects of foetal exposure to famine as a risk factor for developing nonalcoholic fatty liver disease (NAFLD) in adulthood.

METHODS

Studies were retrieved from PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang databases to evaluate the effect of foetal exposure to famine on the risk of nonalcoholic fatty liver disease in adulthood.

RESULTS

Six studies involving 90,582 subjects were included in this meta-analysis. Foetal exposure to famine was associated with an increased risk of NAFLD(RR = 1.17, 95% CI: 1.08-1.27, P < 0.0001). Exposure to famine during the foetal period significantly increased the incidence of NAFLD in women (RR = 1.27, 95% CI: 1.16-1.40, P <0.00001), while similar results were not observed in the male subgroup (RR =0.99, 95% CI: 0.89-1.11, P = 0.88). Foetal exposure to famine was associated with the risk of mild NAFLD (RR = 1.17, 95% CI: 1.02-1.33, P = 0.02) and moderate to severe NAFLD (RR = 1.51, 95% CI: 1.16-1.98, P = 0.002).

CONCLUSIONS

Foetal exposure to famine is associated with an increased risk of NAFLD in adulthood. Women with NAFLD and moderate to severe NAFLD have a more robust association with foetal exposure to famine.

Association between early life famine exposure and risk of metabolic syndrome in later life

BACKGROUND

Previous studies reported that famine exposure had an effect on metabolic syndrome (MetS). However, there is an inadequacy of study regarding the association between famine exposure, adulthood general obesity, and the risk of MetS.

METHODS

A total of 8883 subjects aged ≥40 years from Jiading community in Shanghai were included. We defined famine exposure subgroups as nonexposed (1963-1974), fetal exposed (1959-1962), childhood exposed (1949-1958), and adolescence exposed (1941-1948). MetS was defined based on the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria.

RESULTS

Compared with the nonexposed group, the risks of MetS were increased in the fetal-, childhood-, and adolescence-exposed groups with odds ratios (OR) and 95% confidence intervals (CI) of 1.48 (1.23-1.78), 1.89 (1.63-2.20), and 2.34 (1.99-2.74), respectively. After adjusting for sex, age, smoking status, drinking status, education, body mass index (BMI), and physical activity, the increased risk of MetS related to the fetal-exposed and childhood-exposed groups with OR and 95% CI of 1.42 (1.04-1.94) and 1.50 (1.02-2.21), respectively, were observed only in women. Famine exposure was significantly associated with MetS among individuals with a BMI < 23 kg/m² (p for interaction between BMI categories and famine exposure = 0.0002 in the whole cohort), while there existed a gender difference (p = 0.0023 in females, p = 0.4484 in males). When evaluating the joint effects of the combination of famine exposure in early life and general obesity in adulthood on MetS, we observed the highest estimate in participants with both adulthood general obesity and fetal famine exposure (OR 17.52; 95% CI, 10.07-30.48) compared with those without famine exposure nor adulthood obesity.

CONCLUSIONS

Obesity in adulthood significantly further aggravated the risk of MetS in individuals who experienced early life undernutrition, especially in females.

Lead exposure and impaired glucose homeostasis in Chinese adults: A repeated measures study with 5 years of follow-up

Experimental studies suggest the diabetogenic effects of lead, but relevant data in humans are limited and have been primarily based on cross-sectional study design. We aimed to prospectively examine the association between lead exposure and glucose homeostasis in general population using repeated measurements. This cohort study included 5505 Chinese adults free of glucose-lowering medication use at baseline in 2014 and followed up 5 years later. Blood lead and glucose metabolic traits including fasting plasma glucose (FPG), fasting serum insulin, the homeostasis model assessment of insulin resistance (HOMA-IR), and HOMA of beta-cell function (HOMA-B) were measured at baseline and follow-up. Linear mixed models and linear regression models were performed to evaluate the associations between blood lead and markers of glucose homeostasis. After full adjustment for confounders including BMI, an interquartile range (IQR) increase in blood lead levels was associated with a 2.26 % increase in FPG (95 % CI: 0.16 %, 4.39 %) and an 11.3 % decrease in HOMA-B (95 % CI: - 19.1 %, - 2.71 %) in women. The odds ratios of hyperglycemia and beta-cell dysfunction corresponding to an IQR increase in blood lead levels were 1.39 (95 % CI: 0.99, 1.95) and 1.74 (95 % CI: 1.00, 3.03), respectively. Similar results were found for 5-year changes of glucose metabolic markers. Compared with the first quartile of baseline lead levels, the highest lead quartile was associated with an additional 3.03 % increase in FPG (95 % CI: 0.84 %, 5.26 %) and an additional 13.3 % decrease in HOMA-B (95 % CI: - 20.4 %, - 5.53 %) in women during follow-up. We observed no overall associations between blood lead levels and glucose metabolic markers in men. Our findings provide suggestive evidence that environmental exposure to lead might contribute to sex-dependent disruption of glucose homeostasis in general adult population.

Association between sex hormone-binding globulin and kidney function in men: results from the SPECT-China study

BACKGROUND

The association between sex hormone-binding globulin (SHBG) and renal function has rarely been reported in men. We aimed to investigate the above association in a community-based Chinese population.

METHODS

A total of 5027 men were included from the survey on prevalence for metabolic diseases and risk factors, which is a population-based study conducted from 2014 to 2016 in Eastern China. The estimated glomerular filtration rate (eGFR) was calculated according to the chronic kidney disease Epidemiology Collaboration equation. Low eGFR was defined as eGFR <60 mL·min -1 ·1.73 m -2 .

RESULTS

After adjusting for age, smoking, metabolic factors, and testosterone, through increasing quartiles of SHBG, a significantly positive association between SHBG quartiles and eGFR was detected in men (Q1 vs. Q4, β -2.53, 95% confidence interval -3.89, -1.17, Ptrend < 0.001). Compared with the highest quartile of SHBG, SHBG in the lowest quartile was associated with 96% higher odds of low eGFR (odds ratio 1.96, 95% confidence interval 1.10, 3.48) in the model after full adjustment. According to the stratified analyses, the associations between a 1-standard deviation increase in serum SHBG and the prevalence of low eGFR were significant in men aged ≥60 years old, waist circumference <90 cm, diabetes (no), hypertension (yes), dyslipidemia (no), and nonalcoholic fatty liver disease (no).

CONCLUSIONS

Lower serum SHBG levels were significantly associated with lower eGFR and a higher prevalence of low eGFR in Chinese men independent of demographics, lifestyle, metabolic-related risk factors, and testosterone. Large prospective cohort and basic mechanistic studies are warranted in the future.

The association between early-life famine exposure and adulthood obesity on the risk of dyslipidemia

BACKGROUND AND AIMS

The joint effect of famine exposure and adulthood obesity on risk of dyslipidemia remains unclear. Thus, we aim to explore the joint effect of famine exposure and adulthood obesity on the risk of dyslipidemia, and the potential effect of adult general or abdominal obesity on the association between famine exposure and dyslipidemia.

METHODS AND RESULTS

We conducted a community-based cohort study in 8880 subjects aged 40 years or older. Participants were divided into nonexposed, fetal-exposed, childhood-exposed, adolescent-exposed according to birth date. General obesity and abdominal obesity were defined according to body mass index (BMI: overweight≥24.0 kg/m², obesity≥28.0 kg/m²) and waist-to-hip ratio (WHR, men/women: moderate≥0.90/0.85, high≥0.95/0.90). Dyslipidemia was defined using the National Cholesterol Education Program Adult Treatment Panel III criteria. Compared with nonexposed participants, fetal-exposed individuals had significantly increased risk of dyslipidemia (OR:1.24, 95%CI: 1.03-1.50) in the whole study. Significant increased risk of dyslipidemia related to famine exposure was observed in women [ORs (95%CIs) were 1.36 (1.05-1.76) and 1.70 (1.22-2.37) for the fetal and childhood-exposed group, respectively] but not in men. Moreover, both general and central obesity had significant multiplicative interactions with famine exposure for the risk of dyslipidemia (P for interaction = 0.0001 and < 0.0001, respectively). Significant additive interaction was found between famine exposure and WHR on risk of dyslipidemia in women, with the relative excess risk due to interaction (RERI) and 95% CI of 0.43 (0.10-0.76).

CONCLUSION

Coexistence of early-life undernutrition and adulthood obesity was associated with a higher risk of dyslipidemia in later life.

Cardiometabolic traits mediated the relationship from early life famine exposure to adulthood nonalcoholic fatty liver disease risk

Early life exposure to famine was associated with adulthood metabolic syndrome and nonalcoholic fatty liver disease (NAFLD), and NAFLD was also affected by cardiometabolic traits. However, the role of cardiometabolic traits in the associations from famine exposure to NAFLD was largely unknown. This study aimed to investigate whether the relationship between early life famine exposure and adulthood NAFLD risk was mediated by cardiometabolic traits. Overall, 7578 subjects aged 56·0 (sd 3·7) years in the Dongfeng-Tongji cohort were included and classified into late-exposed (1952-1954), middle-exposed (1954-1956), early-childhood-exposed (1956-1958), fetal-exposed (1959-1961) and non-exposed (1962-1966, reference) group according to the birth year. NAFLD was diagnosed by experienced physicians via abdominal B-type ultrasound inspection. Mediation analysis was used to evaluate the mediating effects of cardiometabolic traits. Compared with those non-exposed, after multivariable adjustment, participants in fetal-exposed group (OR: 1·37; 95 % CI 1·08, 1·73) had 37 % higher risk to develop NAFLD, and the overall childhood-exposed group had marginally significant association with NAFLD (OR: 1·39; 95 % CI 0·99, 1·94). Stratification analysis found the famine-NAFLD associations more evident in women and those born in areas severely affected by famine. Mediation analysis showed that cardiometabolic traits such as total cholesterol, TAG glucose index, γ-glutamyl transpeptidase, alkaline phosphatase and alanine aminotransferase mediated 6·7-22·2 % of the relation from famine exposure to higher NAFLD risk. Early life exposure to famine was related to increased adulthood NAFLD risk, and this relationship was partly mediated by cardiometabolic traits.

Association between Early Life Famine Exposure and Metabolic Syndrome in Adulthood

To analyze the relationship between famine exposure at different stages of early life and the risk of developing metabolic syndrome (MetS) in adulthood, 11,865 study participants from the 2015 Chinese Adult Chronic Disease and Nutrition Surveillance Program were enrolled and then divided into a non-exposed group, fetal exposure group, early childhood exposure group, middle childhood exposure group and late childhood exposure group according to their birth time and famine exposure. MetS was defined by the NCEP ATP III criteria. Using logistic regression to explore the association between famine exposure at different stages of early life and the increased risk of developing MetS in adulthood. After adjusting other factors, compared with the non-exposure group, famine exposure during the fetal period (OR = 1.23, 95% CI = 1.00–1.51), early childhood (OR = 1.44, 95% CI = 1.11–1.87), middle childhood (OR = 1.50, 95% CI = 1.13–1.99) and late childhood (OR = 1.67, 95% CI = 1.21–2.30) had a higher risk of developing MetS in adulthood. Stratified analysis found an association between early life famine exposure and the increased risk of MetS in adulthood in females, overweight or obese participants and those who lived in areas of severe famine, in city areas and in southern China. Compared with the non-exposed group, the fetal, early childhood, middle childhood and late childhood famine-exposed groups are more likely to suffer from MetS in adulthood, especially the subjects who are females, overweight or obese and had lived in severe famine areas, city areas and southern China.

Maternal Adipocyte Connexin43 Gap Junctions Affect Breastmilk Lactose Levels and Neonate Growth in Mice

Simple Summary

Breastfeeding offers many health benefits for both mothers and infants. However, overnutrition and a steady increase in obesity in the U.S. has made it harder for many mothers to produce and express breastmilk. Moreover, the quality of breastmilk from obese mothers is frequently compromised in that it contains fewer nutrients and more inflammatory components. In this study, we used mice to model this phenomenon. We found that short-term high-fat feeding at the start of breeding reduces litter size and pups’ body weight. It also impairs adipocyte remodeling during lactation. Connexin43 is the primary building block for gap junctions in the adipose tissue. It is postulated to play an essential role in adipose tissue remodeling to accommodate mammary gland development and breastmilk production. Using genetically engineered mice without Connexin43 in their adipocytes, we demonstrated that the deletion of adipocyte Connexin43 affects the disappearance of adipocytes during lactation and affects milk composition, which is postulated to impair the pups’ growth. Altogether, this study suggests that increasing or enhancing adipocyte Connexin43 gap junctions may help obese mothers produce better breastmilk to support their neonates.

Abstract

Breastfeeding offers a broad spectrum of health benefits for infants. However, overnutrition and a steady increase in maternal obesity in the U.S. have made it harder for many mothers to produce and express breastmilk, and the quality of milk from obese mothers is also frequently compromised. Adipocytes, the primary cell type in the non-lactating breast, display a drastic morphological and functional change during lactation in mice. Lipid-filled adipocytes undergo lipolysis, and lipid droplets disappear to provide fatty acids and energy for breastmilk production. Once the animal stops lactation, these lipid-depleted adipocytes return as lipid-laden cells. This dynamic remodeling of the tissue is likely the result of active intercellular communications. Connexin43 (Cx43) is the most abundant connexin in the mammary adipose tissue that makes up the gap junctions for direct intercellular communications. Its expression is increased during lactation and reduced in obese mammary adipose tissue, which is resistant to lactation-induced remodeling. However, whether Cx43 is required for adipocyte remodeling and breastmilk production to support neonates’ growth has not been established. In this study, we used doxycycline-inducible adipocyte-specific Cx43-deleted mice and demonstrated that adipocyte Cx43 played a vital role in determining the carbohydrate levels in breastmilk, which may subsequently affect neonates’ growth.

Early life famine exposure and anthropometric profile in adulthood: a systematic review and Meta-analysis

Background

Previous famine studies reported the association between early life famine exposure and adulthood anthropometric profile. However, the findings were variable. Thus, a systematic review and meta-analysis was conducted to clarify the association of famine exposure in early life with the anthropometric profiles in adults.

Methods

Potentially relevant studies were searched through Scopus, Medline, Google Scholar and Google for gray literature and reference lists of previous studies. The random effects model (REM) and I² test was used to adapt the pooling method and assess heterogeneity, respectively.

Results

Prenatal famine exposure was associated with increased risk of body mass index [SMD = 0.10 (95% CI: 0.02, 0.18)], waist circumference [SMD = 0.21 (95% CI: 0.11, 0.31)] in adults. Likewise, famine exposure during prenatal life was associated with decreased adult height [SMD) = − 0.26 (95% CI: − 0.44, − 0.09)]. Moreover, famine exposure during early childhood was associated with increased risk of waist circumference [SMD = 0.09 (95% CI: 0.01, 0.16)] and decreased adult height [SMD = − 0.16 (95% CI: − 0.27, − 0.04)].

Conclusion

Our finding indicates that exposure to famine during early life was associated with the anthropometric profile of adults. In terms of public health significance, the results of the study further underscore the importance of improving the nutritional status of mothers and children to prevent adulthood diseases in the long run.

Systematic review registration number

PROSPERO CRD42020168424

Supplementary Information

The online version contains supplementary material available at 10.1186/s40795-022-00523-w.

Adolescence exposure to China's great famine period and the association of metabolic syndrome in adulthood: a retrospective study

BACKGROUND

Exposure to famine during early life is related to several adverse health outcomes in adulthood, but the effect of famine exposure during adolescence is unclear. This study aims to examine whether exposure to famine in adolescence is associated with metabolic syndrome (MetS) in adulthood.

METHODS

This study included 4130 Chinese adults (2059 males and 2071 females) aged 59-71 from the 2011 China Health and Retirement Longitudinal Study (CHARLS). All the selected participants were exposed to the three-year time period (1959-1961) of China's Great Famine. Participants were categorized into an adolescent-exposed group (born 01/01/1944-12/31/1948) and a non-adolescent-exposed group (born 01/01/1940-12/31/1941 and 01/01/1951-12/31/1952). Sex-stratified multiple logistic regression models were used to estimate the association between exposure to famine in adolescence and MetS.

RESULTS

Participants exposed to famine during adolescence were more likely to report MetS (aOR = 1.35; 95%CI 1.01-1.78) compared to the non-adolescent-exposed group. Further, males were 45% less likely to report MetS than females (aOR = 0.55; 95%CI 0.36-0.83). After stratification by sex, the effects of famine exposure during adolescence on MetS were detected among males only (aOR = 1.97; 95%CI 1.20-3.24). Additionally, males with a history of drinking were more likely to report MetS compared to those with no history of drinking (aOR = 2.63; 95%CI 1.41-4.90).

CONCLUSIONS

Our findings reveal that exposure to famine during adolescence is associated with higher odds of MetS in adulthood overall, and this association is only pronounced among males. This study emphasizes that undernutrition in early life, including adolescence, may have a long-term effect and be associated with adverse health events in middle-to-late life. Targeting those elderly people who suffered famine during adolescence may help prevent the development of MetS in later life.

Early-life exposure to Chinese famine and stroke risk in mid- to late life: the mediating roles of cognitive function and depression

BACKGROUND

Limited research has examined the role that famine exposure plays in adulthood stroke risk. We aim to explore the causal implications of early exposure to the Great Chinese Famine on stroke risk and determine whether these associations were mediated by cognitive function, and depression.

METHODS

We sampled 12,681 individuals aged 45 years and older from the China Health and Retirement Longitudinal Study (CHARLS) and divided them into fetally exposed, childhood-exposed, adolescence/adulthood-exposed and unexposed groups. Stroke was defined by self- or proxy-reported physician diagnosis. Based on a counterfactual framework, marginal structural models were used to estimate the natural direct effect and the natural indirect effects through cognitive function and depression for causal inference.

RESULTS

We found that early-life exposure to Chinese famine was directly related to increased stroke risk in mid- to late life. Cognitive function and depression accounted for a greater part of the effect for childhood famine exposure, mediating 36.35% (95%CI: 14.19, 96.19%) of the overall association between famine exposure and incident stroke, than for the fetal, adolescence/adulthood famine exposure groups. However, the natural indirect effect through depression was not significant in the fetally exposed group. The results were robust in the sensitivity analysis of model specification and unobserved confounding.

CONCLUSIONS

Our findings are consistent with the latency, pathway, and accumulation models, supporting the life-course theory. Early stages of life exposed to the Chinese Famine were associated with higher risk of stroke in mid- to late life. Enhanced cognitive and depression interventions may reduce stroke risk in middle-aged and older Chinese adults who exposure to famine in early life.

Association between fetal famine exposure and risk of type 2 diabetes: a prospective cohort study

The objective of this study was to explore the effects of fetal experience of famine on the onset of type 2 diabetes mellitus (T2DM) in adults. The analysis included 16 594 participants from the Kailuan Study who were free of diabetes at baseline (2006). According to the date of birth, the individuals born on October 1, 1962 - September 30, 1964, were divided into the non-exposed group (used as the reference group), individuals born on October 1, 1959 - September 30, 1961, were divided into the fetal exposure group, and the early childhood exposure group included those born on October 1, 1956 - September 30, 1958. The cumulative incidence of T2DM for each group was calculated and compared among the 3 groups, and the Cox regression model was used to analyze the effects of fetal famine experience on the risk of diabetes. During a median 10.27 years (170 358 person-years) (2006-2017), 3509 incident T2DM cases were identified, with a cumulative incidence rate of 19.46%. The cumulative incidences of T2DM in the non-exposed, fetal exposure, and early childhood exposure groups were 17.38%, 20.85%, and 20.65%, respectively (P < 0.01). After adjusting for confounding factors, the hazard ratio (HR) of T2DM in the fetal exposure group was 1.222 (95% confidence interval: 1.087-1.374, P < 0.01), compared with the reference group. The association was modified by sex and hypertension (both P interaction less than 0.05). Fetal famine exposure may increase the risk of developing T2DM in adults. This association was more pronounced among women and those with hypertension. Novelty: The association was modified by sex and hypertension. Long follow-up time.

Moderation effect of economic status in the association between early life famine exposure and MAFLD in adulthood

BACKGROUND & AIMS

The double burden of malnutrition (DBM) in China resulted in high prevalence of diet-related non-communicable diseases. The aim of this study was to analyse the moderation of economic status in the association between early famine exposure and metabolic dysfunction associated with fatty liver disease (MAFLD) in adulthood.

METHODS

10 190 participants in the SPECT-China study enrolled from 2014 to 2016 were included in this study. Participants with fetal famine exposure (birth year 1959-1962) or early-childhood famine exposure (birth year 1955-1958) formed the exposure group. The associations with MAFLD were assessed via regression analyses.

RESULTS

In men, economic status could not moderate the association between early life famine and MAFLD after adjusting for age, excess alcohol drinking, current smokers, famine severity, waist circumference, diabetes, hypertension, and dyslipidemia (P for interaction = .52). However, in women and in the total population, economic status could moderate the association between early life famine and MAFLD after adjusting for the above confounders (P for interaction = .01). In the total population and in women, early life famine exposure was associated with MAFLD in both low economic status and high economic status. However, in men, early life famine exposure was not associated with MAFLD in low economic status, while in high economic status, early-childhood famine exposure was associated with MAFLD.

CONCLUSIONS

Economic status could moderate the association between early life famine exposure and MAFLD in total population and in women.

Catch-up growth in juvenile rats, fat expansion, and dysregulation of visceral adipose tissue

BACKGROUND

Accelerated catch-up growth following intrauterine restriction increases the risk of developing visceral adiposity and metabolic abnormalities. However, the underlying molecular mechanisms of such metabolic programming are still poorly understood.

METHODS

A Wistar rat model of catch-up growth following intrauterine restriction was used. A gene expression array was performed in the retroperitoneal adipose tissue sampled at postnatal day (PD) 42.

RESULTS

Five hundred and forty-six differentially expressed genes (DEGs) were identified (adjusted p value < 0.05). Gene ontology enrichment analysis identified pathways related to immune and lipid metabolic processes, brown fat cell differentiation, and regulation of PI3K. Ccl21, Npr3, Serpina3n, Pnpla3, Slc2a4, and Serpina12 were validated to be upregulated in catch-up pups (all p < 0.01) and related to several fat expansion and metabolic parameters, including body weight at PD42, postnatal body weight gain, white and brown adipose tissue mass, plasma triglycerides, and insulin resistance index (all p < 0.05).

CONCLUSIONS

Genes related to immune and metabolic processes were upregulated in retroperitoneal adipose tissue following catch-up growth in juvenile rats and were found to be associated with fat expansion and metabolic parameters. Our results provide evidence for several dysregulated genes in white adipose tissue that could help develop novel strategies to prevent the metabolic abnormalities associated with catch-up growth.

IMPACT

Catch-up growth presents several dysregulated genes in white adipose tissue related to metabolic abnormalities. Ccl21, Npr3, Serpina3n, Pnpla3, Slc2a4, and Serpina12 were validated to be upregulated in catch-up pups and related to visceral fat expansion and metabolic parameters. Profiling and validation of these dysregulated genes in visceral adipose tissue could help develop novel strategies to prevent the metabolic abnormalities associated with catch-up growth.

Chinese famine exposure in early life and metabolic obesity phenotype in middle age: Results from the China health and retirement longitudinal study

OBJECTIVE

To assess the association between early life exposure to famine and the risk of metabolic obesity phenotypes among adults in middle age.

METHODS

The study selected two comparison groups. Comparison A consisted of a non-exposed group born between 1963-1965 from the China Health and Retirement Longitudinal Study (CHARLS) 2015 wave (N=862) and a fetal-exposed group born between 1959-1961 from the 2011 wave (N=507). Comparison B consisted of an early childhood-exposed group born between 1955-1957 from the 2011 wave (N=830) and a fetal-exposed group born between 1959-1961 from the 2015 wave (N=552). Multivariable logistic regressions were conducted to explore the associations between different periods of famine exposure and obesity, metabolic health status, and metabolic obesity phenotypes, with stratification by sex.

RESULTS

Compared with the non-exposed group, participants exposed to famine in the fetal period had a significantly lower risk of overweight/obesity (OR: 0.78, 95%CI: 0.63-0.97) and a higher risk of metabolically unhealthy status (OR: 1.73, 95%CI: 1.34-2.23) and metabolically unhealthy non-obesity (MUNO) (OR: 2.12, 95%CI: 1.46-3.08) at the age of 50-52 years. In the sex-stratified analysis, males exposed to famine in the fetal period had a significantly lower risk of overweight/obesity (OR: 0.59, 95%CI: 0.43-0.80) and metabolically healthy obesity (MHO) (OR: 0.56, 95%CI: 0.37-0.85), while such associations were not found in females. Compared with the early childhood exposure group, participants in the fetal exposure group had a significantly lower risk of metabolic unhealthy status (OR: 0.65, 95%CI: 0.51-0.85) and MUNO (OR: 0.50, 95%CI: 0.35-0.72). Those associations were observed in both males and females.

CONCLUSION

Exposure to famine in early life increased the risk of metabolically unhealthy status in adulthood. Different metabolic subtypes should be identified at an early stage and followed by classification, intervention, and treatment.

Glucagon is associated with NAFLD inflammatory progression in type 2 diabetes, not with NAFLD fibrotic progression

OBJECTIVES

Higher prevalence of progressive stages of nonalcoholic fatty liver disease (NAFLD) and hyperglucagonemia were observed in type 2 diabetes. We aim to investigate whether islet alpha cell dysfunction (evaluated by glucagon) associates with NAFLD progression in type 2 diabetic adults.

METHODS

A total of 4937 diabetic participants were enrolled from seven communities in Shanghai, China. Probable nonalcoholic steatohepatitis (NASH) was defined by the presence of NAFLD and metabolic syndrome. Probable NAFLD fibrosis score was used to identify patients with different risk stratification of bridging fibrosis (stage 3) or cirrhosis (stage 4).

RESULTS

After adjustment for age, sex, duration of diabetes, current smoking, waist circumference, C-peptide, HbA1c, dyslipidemia, hypertension and use of incretins and SGLT2 inhibitor, glucagon quartiles were negatively associated with probable NASH (Q4 vs. Q1 OR 0.71, 95% confidence interval, 0.53-0.96, P for trend=0.010), though they were not associated with simple NAFLD (P for trend=0.176). Furthermore, glucagon was not significantly associated with fibrotic progression of liver steatosis in diabetic patients with NAFLD (P for trend=0.889).

CONCLUSIONS

Significant associations were observed among glucagon and inflammatory progression of NAFLD, but not with fibrotic progression. Further understanding the association between islet alpha cell and liver may lead to development of treatment strategies for NAFLD patients with type 2 diabetes.

Ideal Cardiovascular Health Metrics Modify the Association Between Exposure to Chinese Famine in Fetal and Cardiovascular Disease: A Prospective Cohort Study

Background: No study has explored the modification effect of ideal cardiovascular health metrics (ICVHMs) on the association between famine exposure and risk of cardiovascular disease (CVD) so far. We aim to examine the effect of ICVHMs on the association between exposure to famine early in life and the risk of CVD in adulthood.

Methods: A total of 61,527 participants free of CVD were included in this study from the Kailuan Study. All participants were divided into three groups, included nonexposed, fetal-exposed, and childhood-exposed groups. Cox regression was used to estimate the effect of famine exposure and ICVHMs on CVD risk.

Results: After a median of 13.0 (12.7–13.2) years follow-up, 4,814 incident CVD cases were identified. Compared with nonexposed participants, the CVD risk increased in participants with fetal famine exposure (hazard ratio [HR]: 1.21; 95% CI: 1.07–1.37), but not in childhood famine-exposed participants. After stratifying by the number of ICVHMs, the increased CVD risk associated with fetal famine exposure was only observed in participants with less ICVHMs ( ≤ 2) (HR: 1.30; 95% CI: 1.11–1.52, P for interaction=0.008), but disappeared in those with three or more ICVHMs. The modified effect of ICVHMs was sex specific (P for sex interaction = 0.031).

Conclusions: Exposing to famine in the fetal period could increase the risk of CVD in late life; however, ICVHMs might modify the effect of famine exposure on CVD risk, especially in men.

Association of early-life undernutrition and risk of dyslipidemia in adulthood: a population-based cohort study

BACKGROUND

The association of early-life undernutrition and dyslipidemia found in previous studies may be confounded by the uncontrolled age difference between exposed and unexposed participants. The study aimed to investigate the association of early-life undernutrition and the risk of dyslipidemia in adulthood with good control of the age variable.

METHODS

We took the Great Chinese Famine (1959-1961) as a natural experiment of severe undernutrition. This study was based on the baseline investigation of a population-based cohort in rural China. Undernutrition in early life was defined as being exposed to famine at younger than 3 years of age. Three approaches including Adjustment, Restriction, and Matching were applied to control the confounding effect of age. Logistic regression models were applied to evaluate the association between early-life famine and the presence of dyslipidemia. Stratified analysis by gender was also performed, and potential effect modification was tested by adding the interaction term of the famine exposure variable and gender into the model.

RESULTS

Undernutrition in early life was associated with increased risk of borderline high and above (BHA) levels of total cholesterol (TC, OR_Adjustment = 1.61; OR_Restriction = 1.56; OR_Matching = 1.87), triglycerides (TG, OR_Adjustment = 1.33; OR_Restriction = 1.30; OR_Matching = 1.34), low-density lipoprotein cholesterol (LDL-C, OR_Adjustment = 1.75; OR_Restriction = 1.53; OR_Matching = 1.77) and dyslipidemia (OR_Adjustment = 1.52; OR_Restriction = 1.45; OR_Matching = 1.60), as well as high levels of TC, TG, LDL-C and dyslipidemia. An inverse association of undernutrition and risk of low high-density lipoprotein cholesterol (HDL-C) was found. Female participants with undernutrition experience had an increased risk of BHA TG and LDL-C (TG: OR_{Adjustment, female} = 1.45; OR_{Restriction, female} = 1.39; OR_{Matching, female} = 1.51; LDL-C: OR_{Adjustment, female} = 2.11; OR_{Restriction, female} = 1.80; OR_{Matching, female} = 2.15), but this association was not found in males.

CONCLUSION

Early-life undernutrition increased the risk of TC, TG, LDL-C, and dyslipidemia. Gender would significantly modify this effect for TG and LDL-C. These results emphasize the importance of nutritional conditions in the early stages of life to long-term health consequences.

Early-Life Exposure to Famine and Risk of Metabolic Associated Fatty Liver Disease in Chinese Adults

Background: Early-life exposure to the Chinese famine has been related to the risk of obesity, type 2 diabetes, and nonalcoholic fatty liver disease later in life. Nevertheless, the long-term impact of famine exposure on metabolic associated fatty liver disease (MAFLD), a recently proposed term to describe liver disease associated with known metabolic dysfunction, remains unknown. The aim of our study was to explore the relationship between early famine exposure and MAFLD in adulthood. Methods: A total of 26,821 participants (10,994 men, 15,827 women) were recruited from a cohort study of Chinese adults in Shanghai. We categorized participants into four famine exposure subgroups based on the birth year as nonexposed (1963–1967), fetal-exposed (1959–1962), childhood-exposed (1949–1958), and adolescence-exposed (1941–1948). MAFLD was defined as liver steatosis detected by ultrasound plus one of the following three criteria: overweight/obesity, type 2 diabetes, or evidence of metabolic dysregulation. Multivariable logistic regression models were performed to examine the association between famine exposure and MAFLD. Results: The mean ± standard deviation age of the participants was 60.8 ± 6.8 years. The age-adjusted prevalence of MAFLD was 38.3, 40.8, 40.1, and 36.5% for the nonexposed, fetal-exposed, childhood-exposed, and adolescence-exposed subgroups, respectively. Compared with nonexposed participants, fetal-exposed participants showed an increased risk of adulthood MAFLD (OR = 1.10, 95% CI 1.00–1.21). The significant association between fetal famine exposure and MAFLD was observed in women (OR = 1.22, 95% CI 1.08–1.37), but not in men (OR = 0.88, 95% CI 0.75–1.03). In age-balanced analyses combining pre-famine and post-famine births as the reference, women exposed to famine in the fetal stage still had an increased risk of MAFLD (OR = 1.15, 95% CI 1.05–1.26). Conclusions: Prenatal exposure to famine showed a sex-specific association with the risk of MAFLD in adulthood.

Exposure to phthalates and cardiovascular diseases in Chinese with type 2 diabetes

Cardiovascular disease (CVD) results in more than half of the mortality and the majority of morbidity in patients with type 2 diabetes. We aim to evaluate the associations of urinary concentrations of phthalate metabolites with CVD in diabetic patients and explore whether CVD risk factors mediate or interact with these associations. A total of 675 type 2 diabetic participants were enrolled from Shanghai, China, in 2018. CVD was defined as a self-reported diagnosis by a physician including coronary heart disease, myocardial infarction, or stroke; it was further reconfirmed in the records from the registration platform. Ten phthalate metabolites were measured in urine. We found positive associations were found among the level of monoethyl phthalate and monoisobutyl phthalate and CVD (OR 1.138, 95% CI 1.032, 1.254; OR 1.369, 95% CI 1.049, 1.786, respectively). Monoisobutyl phthalate and monobenzyl phthalate were marginally and positively associated with carotid intima-media thickness and common carotid artery diameter, respectively. None of the CVD risk factors, including HOMA-IR, body mass index, lipid profile, or blood pressure, significantly mediated the association between the metabolites and CVD. The conditional indirect effect on CVD was significantly stronger for current smoking and dyslipidemia for monoethyl phthalate and for no statin usage and men for monoisobutyl phthalate. In conclusion, phthalate exposure was positively associated with CVD in Chinese with type 2 diabetes. Type 2 diabetic men who are currently smoking, have an uncontrolled lipid profile, and are not using statins might be more susceptible to CVD when exposed to phthalates.

Epigenetic regulation of energy metabolism in obesity

Obesity has reached epidemic proportions globally. Although modern adoption of a sedentary lifestyle coupled with energy-dense nutrition is considered to be the main cause of obesity epidemic, genetic preposition contributes significantly to the imbalanced energy metabolism in obesity. However, the variants of genetic loci identified from large-scale genetic studies do not appear to fully explain the rapid increase in obesity epidemic in the last four to five decades. Recent advancements of next-generation sequencing technologies and studies of tissue-specific effects of epigenetic factors in metabolic organs have significantly advanced our understanding of epigenetic regulation of energy metabolism in obesity. The epigenome, including DNA methylation, histone modifications, and RNA-mediated processes, is characterized as mitotically or meiotically heritable changes in gene function without alteration of DNA sequence. Importantly, epigenetic modifications are reversible. Therefore, comprehensively understanding the landscape of epigenetic regulation of energy metabolism could unravel novel molecular targets for obesity treatment. In this review, we summarize the current knowledge on the roles of DNA methylation, histone modifications such as methylation and acetylation, and RNA-mediated processes in regulating energy metabolism. We also discuss the effects of lifestyle modifications and therapeutic agents on epigenetic regulation of energy metabolism in obesity.

Liver disease in obesity and underweight: the two sides of the coin. A narrative review

PURPOSE

Malnutrition, whether characterized by not enough or too much nutrient intake, is detrimental to the liver. We herein provide a narrative literature revision relative to hepatic disease occurrence in over or undernourished subjects, to shed light on the paradox where both sides of malnutrition lead to similar liver dysfunction and fat accumulation.

METHODS

Medline, EMBASE, and Cochrane Library were searched for publications up to July 2020. Articles discussing the association between both chronic and acute liver pathology and malnutrition were evaluated together with studies reporting the dietary intake in subjects affected by malnutrition.

RESULTS

The association between overnutrition and non-alcoholic fatty liver disease (NAFLD) is well recognized, as the beneficial effects of calorie restriction and very low carbohydrate diets. Conversely, the link between undernutrition and liver injury is more complex and less understood. In developing countries, early exposure to nutrient deficiency leads to marasmus and kwashiorkor, accompanied by fatty liver, whereas in developed countries anorexia nervosa is a more common form of undernutrition, associated with liver injury. Weight gain in undernutrition is associated with liver function improvement, whereas no study on the impact of macronutrient distribution is available. We hypothesized a role for very low carbohydrate diets in the management of undernutrition derived liver pathology, in addition to the established one in overnutrition-related NAFLD.

CONCLUSIONS

Further studies are warranted to update the knowledge regarding undernutrition-related liver disease, and a specific interest should be paid to macronutrient distribution both in the context of refeeding and relative to its role in the development of hepatic complications of anorexia nervosa.

LEVEL OF EVIDENCE

Narrative review, Level V.

Combined Effect of Famine Exposure and Obesity Parameters on Hypertension in the Midaged and Older Adult: A Population-Based Cross-Sectional Study

OBJECTIVES

Undernutrition early in life may increase the incidence of adverse effects on adult health. The relations between undernutrition and obesity parameters (body mass index (BMI) and WC (waist circle)) and hypertension were often contradictory. Our study is aimed at identifying the combined effects of famine exposure and obesity parameters on hypertension in middle-aged and older Chinese.

DESIGN

A population-based cross-sectional study. Setting. Data were selected from the China Health and Retirement Longitudinal Study Wave2011 (CHARLS Wave2011). Participants. The sample included 12945 individuals aged 45 to 96. Main Outcome Measurements. The study analyzed data from 12945 middle-aged and older Chinese selected from CHARLS Wave2011. Differences between baseline characteristics and famine exposure/BMI levels/WC levels were evaluated using the t-, Chi-square- (χ 2-), and F-test. Then, the difference in the prevalence of hypertension between baseline characteristics was estimated by the t- and χ 2-test. Finally, multivariable-adjusted logistic regression models were used to explore the associations of famine exposure and obesity parameters with odds of prevalence of hypertension.

RESULTS

Among the 12945 participants, 1548 (11.96%) participants had been exposed to the Chinese famine during the fetal group, whereas 5101 (39.41%) participants and 4362 (33.70%) participants had been exposed to the famine during childhood and adolescence/adult group, respectively. Regarding the participants with BMI levels, 3746 (28.94%) were overweight, and 1465 (11.32%) were obese, whereas 5345 (41.29%) of the participants with WC levels were obese, respectively. Furthermore, 1920 (31.17%) had hypertension in males and 2233 (32.91%) in females. In multivariable-adjusted models, famine exposure and obesity parameters were related with prevalence of hypertension independently in total populations ((1) model threec, famine exposure with prevalence of hypertension: the fatal-exposed vs. no-exposed group (OR1.27; 95% CI 1.08, 1.49); childhood-exposed vs. no-exposed group (OR1.64; 95% CI 1.44, 1.87); the adolescence/adult-exposed vs. no-exposed group (OR3.06; 95% CI 2.68, 3.50); P for trend < 0.001; (2) model threee, famine exposure with prevalence of hypertension: the fatal-exposed vs. no-exposed group (OR1.25; 95% CI 1.06, 1.47); childhood-exposed vs. no-exposed group (OR1.52; 95% CI 1.34, 1.73); the adolescence/adult-exposed vs. no-exposed group (OR2.66; 95% CI 2.33, 3.03); P for trend < 0.001; (3) model threeg, BMI levels with prevalence of hypertension: overweight vs. normal (OR1.75; 95% CI 1.60, 1.91); obesity vs. normal (OR2.79; 95% CI 2.48, 3.15); P for trend < 0.001; (4) WC levels with prevalence of hypertension: overweight vs. normal (OR1.42; 95% CI 1.36, 1.48)). When stratified by sex, results in both males and females were mostly similar to those in the total population. In general, interaction analysis in the multivariable-adjusted model, compared with the combination of normal BMI/WC levels and no-exposed famine group, all groups trended towards higher odds of prevalence of hypertension (the greatest increase in odds, adolescence/adult-exposed group with obesity in BMI levels: (OR8.13; 95% CI 6.18, 10.71); adolescence/adult-exposed group with obesity in WC levels: (OR6.36; 95% CI 5.22, 7.75); P for interaction < 0.001). When stratified by sex, the results in both males and females were also similar to those in the total population.

CONCLUSION

Our data support a strongly positive combined effect of famine exposure and obesity parameters on hypertension in middle-aged and elderly Chinese.

Individual and combined association analysis of famine exposure and serum uric acid with hypertension in the mid-aged and older adult: a population-based cross-sectional study

Background

Malnutrition in early life may affect health in later life. The associations between malnutrition and serum uric acid (SUA) and hypertension were inconsistent. The present study aimed to investigate the individual and combined association between famine exposure and serum uric acid and hypertension in middle-aged and older Chinese.

Methods

Data were selected from the China Health and Retirement Longitudinal Study (CHARLS) Wave2011. The analytic sample included 9368 individuals aged 45 to 90. Differences between baseline characteristics and famine exposure/SUA level were evaluated using the Chi-square test, t-test, and F-test. Then, the differences in the prevalence of hypertension between characteristic groups was also estimated by the Chi-square and t-test. Finally, multivariable-adjusted logistic regression models examined association of famine exposure and serum uric acid with odds of prevalence of hypertension.

Results

A total of 9368 individuals were enrolled in the study, 4366 (46.61%) and 5002 (53.39%) were male and female, respectively. Among males, 459 (10.51%) had been exposed to the Chinese famine during the fetal stage, whereas 1760 (40.31%) and 1645 (37.68%) had been exposed to the famine during childhood and adolescence/adult stage, respectively. Among females, 635 (12.69%) had been exposed to the Chinese famine during the fetal stage, whereas 1988 (39.74%) and 1569 (31.37%) had been exposed to the famine during childhood and adolescence/adult stage, respectively. Regarding the participants with SUA level measurements, 290 (6.64%) reported having Hyperuricemia (HUA) in males and 234 (4.68%) in the females. Furthermore, 1357 (31.08%) reported having hypertension in male and 1619 (32.37%) in the female. In multivariable-adjusted model, famine exposure and serum uric acid were associated with prevalence of hypertension independently in total populations [(1) Model four^d, fatal exposed group vs non-exposed group: 1.25 (95% CI 1.03, 1.52); childhood-exposed group vs non-exposed group:1.60 (95% CI 1.37, 1.87); adolescence/adult exposed group vs non-exposed group: 2.87 (95% CI 2.44, 3.37), P for trend < 0.001; (2) Model four ^e, high vs normal:1.73 (95% CI 1.44, 2.08)]. When stratified by sex, the results in both males and females were similar to those in the total population. In general, interaction analysis in the multivariable-adjusted model, compared with the combination of normal SUA level and no-exposed famine stage, all groups trended towards higher odds of prevalence of hypertension [the greatest increase in odds, adolescence/adult exposed stage and high SUA level in total participants: OR4.34; 95%CI 3.24, 5.81; P for interaction < 0.001]. When stratified by sex, the results in both males and females were also similar to those in the total population.

Conclusion

Our data support a strongly positive individual and combined association of famine exposure and serum uric acid with hypertension in middle-aged and elderly Chinese.

Early-life exposure to the Chinese famine, genetic susceptibility and the risk of type 2 diabetes in adulthood

AIMS/HYPOTHESIS

Early famine exposure has been related to the development of type 2 diabetes; however, little is known about whether the genetic background modifies this association. We aimed to investigate the joint effects of famine exposure at different stages of early life and genetic susceptibility on diabetes risk in adulthood.

METHODS

The study included 8350 participants from the Survey on Prevalence in East China for Metabolic Diseases and Risk Factors (SPECT-China) who were born around the time of the Chinese Great Famine. We determined famine exposure subgroups according to the birth year as nonexposed (1963-1974), fetal-exposed (1959-1962), childhood-exposed (1949-1958), and adolescence-exposed (1941-1948). We developed a genetic risk score of 21 variants previously associated with type 2 diabetes in East Asians. Hierarchical logistic models were used to examine the association of famine exposure and genetic risk with diabetes.

RESULTS

The age-standardised prevalence of diabetes in nonexposed, fetal-exposed, childhood-exposed and adolescence-exposed subgroups was 13.0%, 18.2%, 15.1% and 13.2%, respectively. Compared with nonexposed participants, fetal-exposed participants showed an increased risk of diabetes in adulthood (OR 1.47; 95% CI 1.13, 1.93). A higher genetic risk score was associated with an increased risk of diabetes (OR 1.23; 95% CI 1.15, 1.31 per SD increment). The association between famine exposure and diabetes was consistent across genetic risk strata (all p for interaction >0.05). When considered jointly, fetal- or childhood-exposed participants at high genetic risk (highest tertile of genetic risk score) had 2.60-fold (95% CI 1.71, 3.93) and 1.95-fold (95% CI 1.24, 3.05) higher risks of diabetes, respectively, compared with nonexposed participants at low genetic risk (lowest tertile).

CONCLUSIONS/INTERPRETATIONS

Prenatal exposure to famine was associated with an increased risk of type 2 diabetes in Chinese adults independent of genetic risk score using 21 variants common in the East Asian population. Famine exposure and genetic susceptibility may exhibit an additive effect on diabetes development.

Low-level lead exposure promotes hepatic gluconeogenesis and contributes to the elevation of fasting glucose level

BACKGROUND

Lead (Pb) is considered an endocrine-disrupting chemical. However, few studies have investigated the effects of low-level Pb exposure on plasma glucose levels. Herein, we aimed to investigate whether low-level Pb exposure causes elevated plasma glucose levels and the possible mechanisms involved.

METHODS

We conducted a cross-sectional study of 5747 participants from 16 sites in China. The participants underwent measurements of anthropometric factors, blood lead level (BLL) and fasting plasma glucose (FPG). Wistar rats were exposed to 0.05% Pb through drinking water or fed with a high-fat diet (HFD) for 28 weeks. The relevant parameters of glucose homeostasis, hepatic glucose production (HGP) and gene expression levels of hepatic gluconeogenesis enzymes, including phosphoenolpyruvate carboxy kinase (PEPCK), glucose-6-phosphatase (G6PC) and fructose-1,6-bisphosphatase (FBP1), were measured. In addition, gene expression levels of gluconeogenesis enzymes were also measured in HepG2 cells administered with different concentrations of lead acetate for 24 h.

RESULTS

In humans, after adjusting for confounders, the odds of having High_FPG (≥5.6 mmol/L) were significantly increased by 25% in the participants in the fourth BLL quartile (OR 1.25, 95% CI 1.05, 1.49). In the animals exposed to 0.05% Pb, FPG, HGP and hepatic gene expression levels of PEPCK, G6PC and FBP1 were increased. In addition, the mRNA expression levels of PEPCK, G6PC and FBP1 in HepG2 cells were also increased in response to Pb exposure.

CONCLUSIONS

These findings support the possibility that low-level Pb exposure may increase HGP by affecting key enzymes of hepatic gluconeogenesis, eventually resulting in impaired FPG and hyperglycemia.

Early-life famine exposure and rheumatoid arthritis in Chinese adult populations: a retrospective cohort study

OBJECTIVE

This study aimed to explore the association between famine exposure in early life and the odds of rheumatoid arthritis (RA) in adulthood.

DESIGN

A population-based retrospective cohort study.

SETTING

China.

PARTICIPANTS

A total of 111 706 participants (1775 with RA) born from 1956 to 1964 were selected from the baseline survey of a large cohort in China.

PRIMARY AND SECONDARY OUTCOME MEASURES

Four famine exposure groups were generated based on dates of birth, namely prenatal-exposed, infant-exposed, preschool-exposed and non-exposed groups. Logistic regressions were used to explore the association between famine exposure and self-reported RA in adulthood, adjusting for sex, region, monthly income, highest education, alcohol consumption, tobacco use, body mass index (BMI) and metabolic equivalent tasks. Analyses were also performed with stratification for sex (female or male), residing region (urban or rural), famine severity (severe or non-severe) and BMI (≥24 or <24).

RESULTS

The study included 1775 (1.59%) RA cases and 109 931 (98.41%) non-RA controls. Among them, 22 413 (20.06%) were prenatal-exposed, 14 899 (13.34%) were infant-exposed and 34 356 (30.76%) were preschool-exposed. Prenatal exposure to famine was not associated with onset of RA in adulthood. Infant-exposed group and preschool-exposed group had significantly elevated odds of getting RA compared with non-exposed group (infant-exposed: OR=1.44, 95% CI 1.24 to 1.67; preschool-exposed: OR=1.38, 95% CI 1.22 to 1.57, p<0.001), and the relationship was stronger among women, urban residents and participants with BMI ≥24. Similar results were additionally observed when an age-balanced control group was used.

CONCLUSIONS

Exposure to the Great Chinese Famine in early life after birth especially in infancy may be associated with a higher risk of RA in adulthood. Strengthening early-life nutrition could be an implication to prevent future RA.

Severe acute malnutrition in childhood, chronic diseases, and human capital in adulthood in the Democratic Republic of Congo: the Lwiro Cohort Study

BACKGROUND

Little is known about the long-term outcome of children treated for severe acute malnutrition (SAM) after nutritional rehabilitation.

OBJECTIVES

To explore the association between SAM in childhood, noncommunicable diseases (NCDs), and low human capital in adulthood.

METHODS

We identified 524 adults (median age: 22 y) who were treated for SAM during childhood in Eastern Democratic Republic of Congo between 1988 and 2007. They were compared with 407 community unexposed age- and sex-matched subjects with no history of SAM. The variables of interest were cardiometabolic risk markers for NCDs and human capital. For the comparison, we used linear and logistic regressions to estimate the association between SAM in childhood and the risk of NCDs and ordinal logistic regression for the human capital.

RESULTS

Compared with unexposed subjects, the exposed participants had a higher waist circumference [1.2 (0.02, 2.3) cm; P = 0.015], and a larger waist-to-height ratio [0.01 (0.01, 0.02) cm; P < 0.001]. On the other hand, they had a smaller hip circumference [-1.5 (-2.6, -0.5) cm; P = 0.021]. Regarding cardiometabolic markers for NCDs, apart from a higher glycated hemoglobin (HbA1c) [0.4 (0.2, 0.6); P < 0.001], no difference was observed in other cardiometabolic markers for NCD between the 2 groups. Compared with unexposed participants, exposed participants had a higher risk of metabolic syndrome (crude OR: 2.35; 95% CI: 1.22, 4.54; P = 0.010) and visceral obesity [adjusted OR: 1.44 (1.09, 1.89); P = 0.001]. The prevalence of hypertension, diabetes, overweight, and dyslipidaemia was similar in both groups. Last, the proportion of malnutrition survivors with higher socioeconomic status level was lower.

CONCLUSION

SAM during childhood was associated with a high risk of NCDs and lower human capital in adulthood. Thus, policymakers and funders seeking to fight the global spread of NCDs in adults in low-resource settings should consider the long-term benefit of reducing childhood SAM as a preventive measure to reduce the socioeconomic burden attributable to NCDs.

Early-life nutrition and metabolic disorders in later life: a new perspective on energy metabolism

Type 2 diabetes mellitus and metabolic disorders have become an epidemic globally. However, the pathogenesis remains largely unclear and the prevention and treatment are still limited. In addition to environmental factors during adulthood, early life is the critical developmental window with high tissue plasticity, which might be modified by external environmental cues. Substantial evidence has demonstrated the vital role of early-life nutrition in programming the metabolic disorders in later life. In this review, we aim to overview the concepts of fetal programming and investigate the effects of early-life nutrition on energy metabolism in later life and the potential epigenetic mechanism. The related studies published on PubMed database up to March 2020 were included. The results showed that both maternal overnutrition and undernutrition increased the riskes of metabolic disorders in offspring and epigenetic modifications, including DNA methylation, miRNAs, and histone modification, might be the vital mediators. The beneficial effects of early-life lifestyle modifications as well as dietary and nutritional interventions on these deleterious metabolic remolding were initially observed. Overall, characterizing the early-life malnutrition that reshapes metabolic disease trajectories may yield novel targets for early prevention and intervention and provide a new point of view to the energy metabolism.

Effects of Maternal Resveratrol Intake on the Metabolic Health of the Offspring

Maternal nutritional imbalances, in addition to maternal overweight and obesity, can result in long-term effects on the metabolic health of the offspring, increasing the risk of common non-communicable disorders such as obesity, diabetes and cardiovascular disease. This increased disease risk may also be transmitted across generations. Unfortunately, lifestyle interventions have shown reduced compliancy and limited efficacy. Resveratrol is a natural polyphenolic compound reported to have pleiotropic beneficial actions including a possible protective effect against the metabolic programming induced by poor dietary habits during development. However, studies to date are inconclusive regarding the potential metabolic benefits of maternal resveratrol supplementation during pregnancy and lactation on the offspring. Moreover, the responses to metabolic challenges are suggested to be different in males and females, suggesting that the effectiveness of treatment strategies may also differ, but many studies have been performed only in males. Here we review the current evidence, both in humans and animal models, regarding the possible beneficial effects of maternal resveratrol intake on the metabolic health of the offspring and highlight the different effects of resveratrol depending on the maternal diet, as well as the differential responses of males and females.

Maternal nutrition and its intergenerational links to non-communicable disease metabolic risk factors: a systematic review and narrative synthesis

BACKGROUND

Non-communicable diseases (NCDs) are the leading cause of death and disability globally, while malnutrition presents a major global burden. An increasing body of evidence suggests that poor maternal nutrition is related to the development of NCDs and their risk factors in adult offspring. However, there has been no systematic evaluation of this evidence.

METHODS

We searched eight electronic databases and reference lists for primary research published between 1 January 1996 and 31 May 2016 for studies presenting data on various dimensions of maternal nutritional status (including maternal exposure to famine, maternal gestational weight gain (GWG), maternal weight and/or body mass index (BMI), and maternal dietary intake) during pregnancy or lactation, and measures of at least one of three NCD metabolic risk factors (blood pressure, blood lipids and blood glucose) in the study population of offspring aged 18 years or over. Owing to high heterogeneity across exposures and outcomes, we employed a narrative approach for data synthesis (PROSPERO= CRD42016039244, CRD42016039247).

RESULTS

Twenty-seven studies from 10 countries with 62,607 participants in total met our inclusion criteria. The review revealed considerable heterogeneity in findings across studies. There was evidence of a link between maternal exposure to famine during pregnancy with adverse blood pressure, blood lipid, and glucose metabolism outcomes in adult offspring in some contexts, with some tentative support for an influence of adult offspring adiposity in this relationship. However, the evidence base for maternal BMI, GWG, and dietary intake of specific nutrients during pregnancy was more limited and revealed no consistent support for a link between these exposures and adult offspring NCD metabolic risk factors.

CONCLUSION

The links identified between maternal exposure to famine and offspring NCD risk factors in some contexts, and the tentative support for the role of adult offspring adiposity in influencing this relationship, suggest the need for increased collaboration between maternal nutrition and NCD sectors. However, in view of the current scant evidence base for other aspects of maternal nutrition, and the overall heterogeneity of findings, ongoing monitoring and evaluation using large prospective studies and linked data sets is a major priority.

Vitamin D is associated with blood lead exposure through bone turnover in type 2 diabetes patients

BACKGROUND

Bone is thought to be the reservoir of the human lead burden, and vitamin D is associated with bone turnover. We aimed to explore whether exposure to lower 25-hydroxy vitamin D (25(OH)D) levels was associated with higher blood lead levels (BLLs) by increasing the bone turnover rate in individuals with type 2 diabetes.

METHODS

A total of 4103 type 2 diabetic men and postmenopausal women in Shanghai, China, were enrolled in 2018. Their 25(OH)D, β-C-terminal telopeptide (β-CTX), N-MID osteocalcin and procollagen type 1 N-peptide (P1NP) levels were detected. Their BLLs were determined by atomic absorption spectrometry. Mediation analyses were performed to identify the possible role that bone turnover played in the underlying mechanisms.

RESULTS

In both the men and postmenopausal women, all three bone turnover markers were inversely associated with 25(OH)D and positively associated with the BLL (all P < 0.01) after adjusting for age, current smoking habits, metabolic parameters, duration of diabetes, vitamin D intake, and use of anti-osteoporosis medication. In the mediation analyses, none of the direct associations between 25(OH)D and BLL was significant for the three bone turnover markers, but all three bone turnover markers were found to be significant mediators of the indirect associations between 25(OH)D and BLL.

CONCLUSION

The association between vitamin D and BLL was fully mediated by bone turnover markers in type 2 diabetic patients (mediation effect). This finding suggested that vitamin D may protect against blood lead exposure from the bone reservoir by decreasing bone turnover in individuals with type 2 diabetes.

Metabolites in the association between early-life famine exposure and type 2 diabetes in adulthood over a 5-year follow-up period

INTRODUCTION

Exposure to malnutrition in early life has been found to significantly elevate type 2 diabetes risk in adulthood. However, the changes in metabolites resulting from malnutrition in early life have not been studied. The aim of this study was to identify metabolites with levels associated with type 2 diabetes resulting from exposure to China's Great Famine (1959-1962).

RESEARCH DESIGN AND METHODS

Participants were from SPECT-China 2014 and SPECT-China2 2019, two cross-sectional studies performed at the same site. In total, 2171 subjects participated in SPECT-China and SPECT-China2 simultaneously. The sample size of fetal-exposed (1959-1962) versus non-exposed (1963-1974) individuals was 82 vs 79 in 2014 and 97 vs 94 in 2019. Metabolomic profiling was performed between famine-exposed and non-exposed groups.

RESULTS

Among the different famine exposure groups, the fetal-exposed group (1959-1962) had the greatest incidence rate (12.5%), with an OR of 2.11 (95% CI 1.01 to 4.44), compared with the non-exposed group (1963-1974). Moreover, compared with those in the non-exposed group (1963-1974), four metabolites (indole-3-carbinol (I3C), phosphatidylcholine (PC) (22:6(4Z,7Z,10Z,13Z,16Z,19Z)/16:1(9Z)), pyrimidine, and PC(16:1(9Z)/22:5(4Z,7Z,10Z,13Z,16Z))) showed significantly lower relative intensities in the famine and diabetes groups both in 2014 and 2019. Pyrimidine significantly mediated the association of famine exposure with diabetes, and I3C marginally mediated this association.

CONCLUSIONS

Famine exposure in the fetal period could increase type 2 diabetes risk in adults, even those in their 60s. I3C and pyrimidine are potential mediators of the effects of famine exposure on diabetes development.

Understanding Health and Social Challenges for Aging and Long-Term Care in China

The second King's College London Symposium on Ageing and Long-term Care in China was convened from 4 to 5th July 2019 at King's College London in London. The aim of the Symposium was to have a better understanding of health and social challenges for aging and long-term care in China. This symposium draws research insights from a wide range of disciplines, including economics, public policy, demography, gerontology, public health and sociology. A total of 20 participants from eight countries, seek to identify the key issues and research priorities in the area of aging and long-term care in China. The results published here are a synthesis of the top four research areas that represent the perspectives from some of the leading researchers in the field.