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Early Life Famine Exposure, Ideal Cardiovascular Health Metrics and Risk of Incident Diabetes: Findings from the 4C Study

posted on 04.06.2020 by Jieli Lu, Mian Li, Yu Xu, Yufang Bi, Yingfen Qin, Qiang Li, Tiange Wang, Ruying Hu, Lixin Shi, Qing Su, Min Xu, Zhiyun Zhao, Yuhong Chen, Xuefeng Yu, Li Yan, Rui Du, Chunyan Hu, Guijun Qin, Qin Wan, Gang Chen, Meng Dai, Di Zhang, Zhengnan Gao, Guixia Wang, Feixia Shen, Zuojie Luo, Li Chen, Yanan Huo, Zhen Ye, Xulei Tang, Yinfei Zhang, Youmin Wang, Shengli Wu, Chao Liu, Tao Yang, Huacong Deng, Donghui Li, Shenghan Lai, Zachary T. Bloomgarden, Lulu Chen, Jiajun Zhao, Yiming Mu, Guang Ning, Weiqing Wang

We aim to investigate the impact of ideal cardiovascular heath metrics (ICVHMs) on the association between famine exposure and adulthood diabetes risk.


This study included 77 925 participants from the China Cardiometabolic Disease and Cancer Cohort (4C) Study, who were born around the time of the Chinese Great Famine and free of diabetes at baseline. They were divided into 3 famine exposure groups according to the birth year, including non-exposed (1963-1974), fetal-exposed (1959-1962) and childhood exposed (1949-1958). Relative risk regression was used to examine the associations between famine exposure and ICVHMs on diabetes.


During a mean follow-up of 3.6 years, the cumulative incidence of diabetes was 4.2%, 6.0% and 7.5% in non-exposed, fetal-exposed and childhood-exposed participants, respectively. Compared with non-exposed participants, fetal-exposed but not childhood-exposed participants had increased risks of diabetes with multivariable-adjusted risk ratios (RRs) (95% confidence intervals) (CIs) of 1.17 (1.05-1.31) and 1.12 (0.96-1.30), respectively. Increased diabetes risks were observed in fetal-exposed individuals with non-ideal dietary habits, non-ideal physical activity, BMI ≥24.0 kg/m2, or blood pressure ≥120/80 mmHg, whereas significant interaction was detected only in BMI strata (P for interaction=0.0018). Significant interactions have been detected between number of ICVHMs and famine exposure on the risk of diabetes (P for interaction=0.0005). The increased risk was observed in fetal-exposed participants with 1 or less ICVHMs (RR, 1.59; 95% CI, 1.24-2.04), but not in those with 2 or more ICVHMs.


The increased risk of diabetes associated with famine exposure appears to be modified by the presence of ICVHMs.


The research reported in this publication was supported by the National Basic Research Program of China (973 Program) (award no. 2015CB553601); the Ministry of Science and Technology of the People’s Republic of China (award nos. 2016YFC1305600, 2016YFC1305202, 2016YFC1304904, 2017YFC1310700); and the National Natural Science Foundation of China (award nos. 81700764, 81670795, 81621061, and 81561128019).



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