Early life famine exposure, ideal cardiovascular health metrics, and risk of incident diabetes: Findings from the 4C study

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 ChenMeng Dai, Di Zhang, Zhengnan Gao, Guixia Wang, Feixia Shen, Zuojie Luo, Li Chen, Yanan Huo, Zhen Ye, Xulei Tang, Yinfei Zhang, Chao Liu, Youmin Wang, Shengli Wu, Tao Yang, Huacong Deng, Donghui Li, Shenghan Lai, Zachary T. Bloomgarden, Lulu Chen, Jiajun Zhao, Yiming Mu, Guang Ning, Weiqing Wang

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


OBJECTIVE We aim to investigate the impact of ideal cardiovascular health metrics (ICVHMs) on the association between famine exposure and adulthood diabetes risk. RESEARCH DESIGN AND METHODS 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 three famine exposure groups according to the birth year, including nonexposed (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. RESULTS During a mean follow-up of 3.6 years, the cumulative incidence of diabetes was 4.2%, 6.0%, and 7.5% in nonexposed, fetal-exposed, and childhood-exposed participants, respectively. Compared with nonexposed participants, fetal-exposed but not childhood-exposed participants had increased risks of diabetes, with multivariable-adjusted risk ratios (RRs) (95% CIs) of 1.17 (1.05–1.31) and 1.12 (0.96– 1.30), respectively. Increased diabetes riskswere observed in fetal-exposed individuals with nonideal dietary habits, nonideal 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 5 0.0018). Significant interactions have been detected between number of ICVHMs and famine exposure on the risk of diabetes (P for interaction 5 0.0005). The increased risk was observed in fetal-exposed participants with one or fewer ICVHMs (RR 1.59 [95% CI 1.24–2.04]), but not in those with two or more ICVHMs. CONCLUSIONS The increased risk of diabetes associated with famine exposure appears to be modified by the presence of ICVHMs.

Original languageEnglish
Pages (from-to)1902-1909
Number of pages8
JournalDiabetes Care
Issue number8
StatePublished - Aug 2020


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