儿童早期饥荒经历与成年期心血管病的关联

沈丽娟; 马声; 王欢; 邹志勇

doi:10.16835/j.cnki.1000-9817.2023.06.030

儿童早期饥荒经历与成年期心血管病的关联

doi: 10.16835/j.cnki.1000-9817.2023.06.030

北京大学公共卫生学院/儿童青少年卫生研究所，北京 100191

基金项目:

国家自然科学基金青年科学基金项目 81402692

详细信息

作者简介:
沈丽娟(1996-)，女，云南曲靖人，在读硕士，主要研究方向为生命早期营养与青少年健康

通讯作者:
邹志勇，E-mail：harveyzou2002@bjmu.edu.cn

利益冲突声明 所有作者声明无利益冲突。
中图分类号: B844.1 R714.252
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出版历程
- 收稿日期: 2023-02-09
- 修回日期: 2023-03-18
- 网络出版日期: 2023-06-28
- 刊出日期: 2023-06-25

Association of famine exposure in early childhood with cardiovascular diseases in adulthood

School of Public Health/Institute of Child and Adolescent Health, Peking University, Beijing(100191), China

摘要

摘要: 目的探讨儿童早期饥荒经历与成年期心血管病的关联，为研究生命早期健康的影响因素提供实证依据。方法 2022年7—10月在北京、陕西等部分高校在线发放问卷，共招募1 294名在校大学生，对其2 169名祖父/祖母10岁前饥荒经历和当前健康状况进行调查并完成在线问卷。采用多因素Logistic回归分析儿童不同时期饥荒经历与成年期心血管病的关联。结果 981名祖父/祖母(45.2%)自我报告有经医生诊断的心血管病。调整年龄、收入、吸烟状况、饮酒状况、体质量指数、体力活动水平、膳食质量得分和饥荒严重程度等混杂变量后，与无饥荒经历相比，胎儿期、幼儿期、学龄前期和学龄期饥荒经历与成年期患心血管病均有正相关[OR值(95%CI)分别为1.89(1.10~3.26)，1.63(1.01~2.64)，1.71(1.06~2.77)，1.69(1.04~2.72)，P值均 < 0.05]。采用年龄平衡对照组校正后，幼儿期和学龄前期饥荒经历仍与成年期冠心病[OR值(95%CI)=1.99(1.25~3.17)，1.49(1.01~2.19)]和脑卒中[(OR值(95%CI)=2.08(1.13~3.82)，1.95(1.25~3.04)]相关有统计学意义(P值均 < 0.05)。在低体力活动的研究对象中，胎儿期、幼儿期、学龄前期和学龄期饥荒经历与成年期患心血管病的风险增加有关(P值均 < 0.05)。结论儿童早期尤其是幼儿期和学龄前期饥荒经历可能增加成年期患冠心病、脑卒中的风险，尤其在不健康生活方式人群中更显著。应重视生命早期重要发育阶段的营养，倡导健康生活方式，有助于心血管病的预防。
- 生活变动事件 /
- 心血管疾病 /
- 回归分析 /
- 学生
Abstract: Objective To explore the association between exposure to famine in early childhood and cardiovascular diseases in later life, and to provide empirical evidence for studying the influencing factors of early life health. Methods From July to October 2022, 1 294 college students were recruited from several universities in Beijing and Shaanxi provinces to investigate the famine-exposed experience before the age of 10 and the current health status of their 2 169 paternal grandparents and complete the online questionnaire. Multiple Logistic regression was used to estimate the association between famine exposure and adult cardiovascular diseases. Results A total of 981(45.2%) paternal grandparents reporting cardiovascular diseases diagnosed by a doctor. After adjusting for potential confounding variables including age, income, smoking, drinking, body mass index, physical activity, diet quality score, and famine severity, the associations between exposure to famine during fetal, infancy, preschool and school age group and cardiovascular diseases were statistically significant, compared to non-exposed group[OR(95%CI)=1.89(1.10-3.26), 1.63(1.01-2.64), 1.71(1.06-2.77), 1.69(1.04-2.72), P < 0.05]. After adjusting for age-balanced control group, famine exposure during infancy and preschool age were statistically significantly associated with coronary heart disease [OR(95%CI)=1.99(1.25-3.17), 1.49(1.01-2.19)] and stroke [OR(95%CI)=2.08(1.13-3.82), 1.95(1.25-3.04)](P < 0.05). Participants who were lacking physical activity in all famine-exposed groups were associated with an increased risk of cardiovascular diseases in adulthood (P < 0.05). Conclusion Exposure to famine during not only the fetal and infant stage but also the preschool age was associated with an increased risk of coronary heart disease and stroke in adulthood, especially for individuals with unhealthy lifestyle. Therefore, emphasizing nutrition during the important developmental stages of early life and advocating for a healthy lifestyle can help prevent cardiovascular disease.
- Life change events /
- Cardiovascular diseases /
- Regression analysis /
- Students
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图 1 以年龄平衡对照组为参考的儿童早期饥荒经历与成年期心血管病关联

Figure 1. Associations between famine exposure and cardiovascular diseases with age-balanced control

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表 1 调查对象基本特征构成在不同饥荒经历组间比较

Table 1. Basic characteristics of study participants according to famine exposure groups

特征	选项	未经历(n=86)	胎儿期(n=174)	幼儿期(n=653)	学龄前期(n=619)	学龄期(n=637)	合计(n=2 169)
教育水平	文盲	25(29.1)	52(29.9)	205(31.4)	195(31.5)	198(31.1)	675(31.1)
	小学或初中	44(51.2)	93(53.4)	333(51.0)	319(51.5)	334(52.4)	1 123(51.8)
	高中及以上	17(19.8)	29(16.7)	115(17.6)	105(17.0)	105(16.5)	371(17.1)
家庭经济水平	低收入	6(7.0)	20(11.5)	80(12.3)	67(10.8)	68(10.7)	241(11.1)
	中等收入	62(72.1)	123(70.7)	464(71.1)	448(72.4)	441(69.2)	1 538(70.9)
	高收入	18(20.9)	31(17.8)	109(16.7)	104(16.8)	128(20.1)	390(18.0)
饥荒严重程度^*	重度	46(53.5)	99(56.9)	338(51.8)	375(60.6)	360(56.5)	1 218(56.2)
	轻中度	40(46.5)	75(43.1)	315(48.2)	244(39.4)	277(43.5)	951(43.8)
吸烟状况^*	从不吸烟	71(82.6)	145(83.3)	473(72.4)	474(76.6)	455(71.4)	1 618(74.6)
	已戒烟	9(10.5)	15(8.6)	127(19.4)	82(13.2)	95(14.9)	328(15.1)
	当前吸烟	6(7.0)	14(8.0)	53(8.1)	63(10.2)	87(13.7)	223(10.3)
饮酒状况	从不	56(65.1)	104(59.8)	362(55.4)	360(58.2)	351(55.1)	1 233(56.8)
	偶尔	20(23.3)	40(23.0)	132(20.2)	138(22.3)	156(24.5)	486(22.4)
	经常	10(11.6)	30(17.2)	159(24.3)	121(19.5)	130(20.4)	450(20.7)
体力活动	无	27(31.4)	49(28.2)	157(24.0)	143(23.1)	157(24.6)	533(24.6)
	偶尔	28(32.6)	70(40.2)	284(43.5)	256(41.4)	260(40.8)	898(41.4)
	经常	31(36.0)	55(31.6)	212(32.5)	220(35.5)	220(34.5)	738(34.0)
膳食质量得分^*	0	0	1(0.6)	4(0.6)	2(0.3)	0	7(0.3)
	1	2(2.3)	1(0.6)	11(1.7)	16(2.6)	12(1.9)	42(1.9)
	2	8(9.3)	36(20.7)	117(17.9)	83(13.4)	63(9.9)	307(14.2)
	3	18(20.9)	36(20.7)	109(16.7)	113(18.3)	127(19.9)	403(18.6)
	4	28(32.6)	38(21.8)	194(29.7)	205(33.1)	229(35.9)	694(32.0)
	5	18(20.9)	42(24.1)	131(20.1)	119(19.2)	120(18.8)	430(19.8)
	6	9(10.5)	19(10.9)	72(11.0)	67(10.8)	68(10.7)	235(10.8)
	7	3(3.5)	1(0.6)	11(1.7)	10(1.6)	14(2.2)	39(1.8)
	8	0	0	4(0.6)	4(0.6)	4(0.6)	12(0.6)
BMI/(kg·m^-2)	< 18.5	9(10.5)	27(15.5)	85(13.0)	96(15.5)	79(12.4)	296(13.6)
	18.5~ < 24.0	51(59.3)	112(64.4)	428(65.5)	398(64.3)	397(62.3)	1 386(63.9)
	24.0~ < 28.0	17(19.8)	28(16.1)	97(14.9)	91(14.7)	118(18.5)	351(16.2)
	≥28.0	9(10.5)	7(4.0)	43(6.6)	34(5.5)	43(6.8)	136(6.3)
注：()内数字为构成比/%；*P < 0.05。

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表 2 儿童早期饥荒经历与成年期心血管病的关联[OR值(95%CI)，n=2 169]

Table 2. Associations between famine exposure and cardiovascular diseases[OR(95%CI), n=2 169]

饥荒经历	高血压		冠心病		脑卒中		合计
饥荒经历	未调整	调整后	未调整	调整后	未调整	调整后	未调整	调整后
胎儿期	1.37(0.79~2.37)	1.49(0.85~2.60)	2.10(0.76~5.81)	2.15(0.78~5.96)	3.68(0.82~16.55)	3.52(0.78~15.89)	1.79(1.05~3.07)^*	1.89(1.10~3.26)^*
幼儿期	1.03(0.63~1.67)	1.07(0.65~1.75)	2.52(1.00~6.40)^*	2.56(1.01~6.51)^*	1.51(0.72~3.20)	4.18(1.00~17.43)^*	1.62(1.01~2.60)^*	1.63(1.01~2.64)^*
学龄前期	1.13(0.70~1.84)	1.23(0.75~2.01)	2.03(0.80~5.19)	2.13(0.83~5.46)	1.44(0.68~3.06)	5.05(1.21~21.04)^*	1.62(1.01~2.61)^*	1.71(1.06~2.77)^*
学龄期	1.34(0.83~2.17)	1.37(0.84~2.23)	1.59(0.62~4.09)	1.62(0.63~4.16)	1.40(0.66~2.94)	3.60(0.86~15.09)	1.69(1.05~2.71)^*	1.69(1.04~2.72)^*
注：*P < 0.05。

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表 3 儿童早期饥荒经历与成年期心血管病关联的分层分析[OR值(95%CI)]

Table 3. Stratified analyses of associations between famine exposure and cardiovascular diseases[OR(95%CI)]

饥荒经历	BMI分组		体力活动水平		膳食质量
饥荒经历	正常	超重/肥胖	低	高	低	中	高
胎儿期	1.60(0.80~3.20)	2.19(0.76~6.28)	2.16(1.10~4.26)^*	1.47(0.59~3.69)	1.51(0.26~8.88)	2.15(1.13~4.07)^*	2.20(0.51~9.53)
幼儿期	1.67(0.90~3.07)	1.11(0.47~2.66)	2.05(1.12~3.73)^*	1.03(0.46~2.29)	1.99(0.38~10.39)	1.65(0.94~2.89)	1.62(0.50~5.31)
学龄前期	1.41(0.76~2.61)	1.63(0.68~3.91)	1.92(1.05~3.51)^*	1.35(0.61~3.00)	3.09(0.59~16.25)	1.61(0.92~2.81)	1.42(0.43~4.71)
学龄期	1.32(0.71~2.44)	2.09(0.88~4.93)	2.05(1.12~3.75)^*	1.19(0.54~2.63)	3.84(0.72~20.48)	1.63(0.94~2.85)	0.98(0.29~3.25)
注：*P < 0.05；将BMI和体力活动水平编码为二分类变量——正常体重与超重/肥胖，高体力活动(≥3次/周或≥1.5 h/周)与低体力活动(≤2次/周或 < 1.5 h/周)；将膳食质量得分编码为3组——低膳食质量(0~2分)、中膳食质量(3~5分)与高膳食质量(6~8分)。

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