Birth weight and later life adherence to unhealthy lifestyles in predicting type 2 diabetes: prospective cohort study [通过出生体重和长期不健康生活方式预测2型糖尿病：前瞻性队列研究]

• 分享：

BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h3672 (Published 21 July 2015)
Cite this as: BMJ 2015;351:h3672

Authors
Yanping Li, research scientist, Sylvia H Ley, research associate, Deirdre K Tobias, instructor, Stephanie E Chiuve, assistant professor, Tyler J VanderWeele, professor, Janet W Rich-Edwards, associate professor, Gary C Curhan, professor, Walter C Willett, professor, JoAnn E Manson, professor, Frank B Hu, professor, Lu Qi, associate professor

Abstract
Objectives: To prospectively assess the joint association of birth weight and established lifestyle risk factors in adulthood with incident type 2 diabetes and to quantitatively decompose the attributing effects to birth weight only, to adulthood lifestyle only, and to their interaction.

Design: Prospective cohort study.

Setting: Health Professionals Follow-up Study (1986-2010), Nurses’ Health Study (1980-2010), and Nurses’ Health Study II (1991-2011).

Participants: 149 794 men and women without diabetes, cardiovascular disease, or cancer at baseline.

Main outcome measure: Incident cases of type 2 diabetes, identified through self report and validated by a supplementary questionnaire. Unhealthy lifestyle was defined on the basis of body mass index, smoking, physical activity, alcohol consumption, and the alternate healthy eating index.

Results: During 20-30 years of follow-up, 11 709 new cases of type 2 diabetes were documented. The multivariate adjusted relative risk of type 2 diabetes was 1.45 (95% confidence interval 1.32 to 1.59) per kg lower birth weight and 2.10 (1.71 to 2.58) per unhealthy lifestyle factor. The relative risk of type 2 diabetes associated with a combination of per kg lower birth weight and per unhealthy lifestyle factor was 2.86 (2.26 to 3.63), which was more than the addition of the risk associated with each individual factor, indicating a significant interaction on an additive scale (P for interaction<0.001). The attributable proportions of joint effect were 22% (95% confidence interval 18.3% to 26.4%) to lower birth weight alone, 59% (57.1% to 61.5%) to unhealthy lifestyle alone, and 18% (13.9% to 21.3%) to their interaction.

Conclusion: Most cases of type 2 diabetes could be prevented by the adoption of a healthier lifestyle, but simultaneous improvement of both prenatal and postnatal factors could further prevent additional cases.