21 6 1 9 9 9 1 2 A CTA A CAD EM IA E M ED IC INA E S IN ICA E V o l. 21, N o. 6 D ecem ber, 1999 # 3 3 3 3 3 3 3 3 α (, 100005) 628 1948 1954 (CHD ) (Β= - 010018, P < 0101) ; (P I),, (P I 24 kggm 3 ) OR (odds ratio) P I> 28 kggm 3 519 ; ( IGT ) P I ( ) (, P < 0101) (T G) P I ( P < 0101, P < 0101, P < 0105), (HDL 2C) ( P < 0105, P < 0101) CHD (TC) (LDL 2C), T G HDL 2C R 851. 1 R 541. 4 R 714. 51,, (CHD ), g CHD [ 1 3 ] [ 4 ], 1 1948 1954 1 921,, 725 (38% ), 628 (87% ) α M RC, Southamp ton U niversity ; 3 ; 3 3 ; #, :, 100020
6 467 : (B IP), (ponderal index P I, : kggm 3 ) : (FG) (F IS) (TC) (HDL 2C) (LDL 2C) (T G) 11 ( FG= 817 mm o lgl ), 617 (O GT T ), 120 m in, 616 O GT T M edgen ix TC HDL 2C T G, LDL 2C F riedew ald (ECG) : 5 m in, ECG26511 12 D inam ap TM 8100 3, (SBP) (DBP) 3, (BM I) (% W HR ) CM S W eigh ting Equ ip L TD,, 10 1 : RO SE, (, ) CHD (CHD Index) :, ECG Q gq S (121, 12 2), RO SE,, ECG ST 2T (421, 422 ), CHD Index : W HO, 2 h 1111 mm o lgl (DM ), 718 1110 mm o lgl ( IGT ) < 718 mm o lgl (N GT ) : SBP 160 mm H g DBP 95 mm H g, : (1 = 715 g ) (< 5 g ) (5 15 g ) ( 15 g ) T G, t L og istic, SPSSgPC 810 CHD, BM I 2 628, 1 (3102 488) g (4912 215) cm (3119 118) cm, (P > 0105) CHD index CHD Index 2840 g, (n= 11) (3150 g), (n= 617) (P < 0101) L ogistic 2
468 21 1 628 (x θ s) Table 1 Body m easurem ents in adulthood and at birth fo r 628 subjects M en (n= 309) W om en (n= 319) st ne mer usae mtl ud A A ge H eigh t (cm ) W eigh t (kg) Body m ass index (kggm 2 ) W aistgh ip ratio (% ) % of current cigarette smokers % of heavy drinkers 45. 1 1. 4 172. 5 6. 1 73. 4 10. 4 24. 6 3. 1 89. 8 5. 8 72 13 45. 2 1. 3 160. 5 5. 3 60. 1 8. 5 23. 3 3. 1 79. 6 5. 0 2 0 ezis htri B B irthw eight (g) C row n2heel length (cm ) Ponderal index (kggm 3 ) H ead circum ference (cm ) B iparietal diam eter (cm ) P lacental w eight (g) Gestation (days) 3196 438 49. 7 2. 0 25. 9 2. 0 32. 1 1. 4 9. 2 0. 5 524 102 279 14 3094 442 49. 1 1. 9 26. 1 2. 4 31. 7 1. 4 9. 1 0. 5 518 93 281 14 2 L ogistic Table 2 R esults by m ultivariate logistic regression analysis V ariables Β S E of Β X 2 P W aistgh ip ratio (% ) 0. 0804 0. 0791 1. 0311 0. 3 Sex 3-0. 8412 1. 1472 0. 5419 0. 5 Gestation (day) - 0. 0006 0. 0205 0. 0009 1 Fasting insulin (pmo lgl) 1. 0305 0. 5604 3. 3813 0. 066 IGT 3 3-0. 2581 0. 7255 0. 1266 0. 7 Systo lic BP (mmh g) 0. 0467 0. 0181 6. 6698 < 0. 001 B irth w eight (g) - 0. 0018 0. 0008 4. 9784 0. 026 D ependent variable= CHD index (0= negative, 1= po sitive) ; 3 1= m ale, 2= fem ale; 3 3 0= N GT, 1= IGT; Β: partial regression P I 3 4 SBP DBP P I ( P < 0105, P < 01001), SBP B IP ( P < 0101) IGT 2 h, IGT P I 3 4, F IS 2 h ( P < 01001, P < 0105, P < 0101)
6 469 3 Table 3 T he relationsh ip of co ronary risk facto rs and birth w eigh t B irth w eigh t (kg) To tal P 3 R isk facto rs 2. 5 (n= 44) - 3. 0 (n= 184) - 3. 5 (n= 284) > 3. 5 (n= 115) (n= 627) Fo r trend Systo lic BP (mmh g) 128 125 125 122 124 0. 02 D iasto lic BP (mmh g) 78 75 75 74 75 0. 04 Fasting gluco se (mmo lgl ) 5. 5 5. 4 5. 3 5. 3 5. 4 0. 04 120 m in Gluco se (mmo lgl ) 7. 1 6. 8 6. 5 6. 3 6. 6 0. 02 Fasting insulin (pmo lgl ) 43. 9 44. 6 43. 2 38. 1 42. 7 < 0. 01 120 m in Insulin (pmo lgl ) 263 261 223 215 235 0. 02 T G (mmo lgl ) 1. 46 1. 31 1. 24 1. 15 1. 26 < 0. 01 TC (mmo lgl ) 5. 10 4. 88 4. 93 4. 79 4. 90 0. 3 LDL 2C (mmo lgl ) 3. 03 2. 91 2. 90 2. 81 2. 90 0. 1 HDL 2C (mmo lgl ) 1. 38 1. 36 1. 41 1. 44 1. 40 0. 03 3 A djusted fo r sex and BM I; BP: blood p ressure; T G: triglyceride; TC: to tal cho lestro l; LDL 2C: low density lipop ro tein cho lestero l; HDL 2C: h igh density lipop ro tein cho lestero l 4 P I IGT OR Table 4 O dds ratio s fo r hypertension and IGT acco rding to w eigh t and ponderal index at birth B irth size B irthw eight (kg) H ypertension OR 3 (95% C I) IGT OR 3 (95% C I ) 2. 5 3. 1 (1. 1, 9. 0) 2. 5 (1. 1, 5. 6) - 3. 0 1. 6 (0. 7, 3. 8) 1. 7 (1. 0, 3. 1) - 3. 5 1. 1 (0. 5, 2. 5) 1. 0 (0. 6, 1. 8) > 3. 5 1. 0 1. 0 Ponderal index (kggm 3 ) 24 5. 9 (1. 9, 18. 5) 1. 8 (1. 0, 3. 4) - 26 4. 1 (1. 4, 12. 3) 1. 3 (0. 8, 2. 3) - 28 2. 4 (0. 8, 7. 6) 0. 9 (0. 5, 1. 5) > 28 1. 0 1. 0 3 A djust fo r sex and BM I; OR : odds ratio 3 T G P I ( P < 0101, P < 0105) ; HDL 2C ( P < 0101) TC LDL 2C
470 21 3 CHD RO SE ECG, CHD index,, CHD index IGT CHD,, IGT T G HDL 2C CHD,, [ 1 3, 5 ], P I,,,, ;,,,,,,,,,,,, CHD,,, CHD, CHD, CHD [ 4 ], CHD CHD,, CHD [ : Barker DJP, L aw Catherine, O smond C live, Stein C laudia, Cox V anessa ; ( ) ( ) ( ) ] 1 Barker DJP. Fetal o rigins of co ronary heart disease. BM J, 1995, 311: 171 174 2 L aw CM, de Sw iet M,O smond C, et al. Initiation of hypertension in utero and its amp lification th rough2
6 471 out life. BM J, 1993, 306: 24 27 3 H ales CN,Barker DJP, C lark PM S, et al. Fetal and infant grow th and impaired gluco se to lerance at age 64. BM J, 1991, 303: 1019 1022 4 W u Zhao su, Yao Chonghua, Zhao Dong, et al. M ultip rovincial monito ring of trends and determ inants in cardiovascular disease (Sino2M ON ICA p ro ject) 2g. R esult of risk facto r monito ring. Ch in J Cardio l, 1997, 25: 6 11 5 R ich EJ, StampferM,M anson J, et al. B irthw eigh t breastfeeding and the risk of co ronary heart disease in nurses health study. Am J Ep idem io l, 1995, 141: S78 The Rela tion of Feta l Growth and the B iolog ica l R isk Factors of Coronary Heart D isea se M i J ie # Zhang Konglai L iu Shanying Xu Kongjian L iu Jun, et a l (D epartm ent of Ep idem io logy, Institute of Basic M edical Sciences, CAM S and PUM C, Beijing 100005) Objective To exam ine the relation sh ip betw een fetal grow th and the b io logical risk fac2 to rs of co ronary heart disease (CHD ) in adu lt life in Ch ina. M ethods Fo llow up study of 628 m en and w om en w ho w ere singleton bo rn du ring 1948 1954 w ho se b irth size w ere m ea2 su red in detail. Results D ecreasing b irth w eigh t increased the p robab ility of m yocardial is2 chaem ic sym p tom related to CHD (Β= - 010018, P < 0101). T he O dds ratio (OR ) related to hyperten sion increased w ith decreasing b irth w eigh t and ponderal index (P I, kggm 3 ). T he OR w ere 519 in peop le w ho se P I w ere 24 kggm 3 o r less com pare to peop le w ho se P I w ere m o re than 28 kggm 3. T he OR related to im paired gluco se to lerance ( IGT ) also increased w ith de2 creasing b irth w eigh t and P İ In su lin resistance, rep resen ted by fast in su lin, ro se w ith de2 creasing b irth w eigh t and head circum ference (fo r trend, all P < 0101). Serum T G concen tra2 tion sign ifican tly ro se w ith decreasing b irth w eigh t, P I and head circum ference (fo r trend, P < 0101, P < 0101, P < 0105), w h ile HDL 2C ro se w ith increasing b irth w eigh t and head cir2 cum ference (fo r trend, P < 0105, P < 0101). A ll above m en tioned relation s betw een b irth size and the level of risk facto rs du ring adu lthood w ere indep enden t of gesta t ion and adu lt lifestyle. Conclusion s In Ch ina, low b irth m easu rem en ts w h ich rep resen t the fetal grow th retardation m igh t con tribu te to the p resen t of b io logical risk facto rs of co ronary heart disease du ring adu lthood, such as hyperten sion, diabetes, in su lin resistance, h igh serum triglyceride and low HDL 2C. Key words fetal grow th; birth size; co ronary heart disease; risk facto r; fo llow 2up study α (1998203217 ) α # Co rresponding autho r