Challenges of connecting points

The Chinese famine of 1959-1961 was widely interpreted as an important factor contributing to the subsequent epidemics of type 2 diabetes (type 2 diabetes), but by re-examining 17 Chinese researchers affiliated with the Columbia School of Public Health and the medical center. from the University of Leiden, found little evidence of this badociation. The document is published in Nature Reviews Endocrinology.

"Most Chinese studies were limited to the use of appropriate age-appropriate controls," said L. H. Lumey, MD, professor of epidemiology at the Columbia Mailman School. "Therefore, establishing a strong link between antenatal famine and T2D in future studies in China will require significant improvements in the design and execution of studies."

To demonstrate the limitations of the Chinese studies, the researchers re-badyzed the published data using multiple control groups. With the controls balanced according to age, no increase in T2D.

Lumey and his colleagues further determined that studying only pre-famine births as controls might suggest a "protective" effect of famine on future health outcomes. Studies on Dutch famine and Chinese starvation show that an increase in body size in adulthood has important implications for T2DM after prenatal starvation. "However, our Dutch famine studies have not yet determined whether changes in DNA methylation in exposed individuals during pregnancy could have" intergenerational "effects on grandchildren. , important enough to explain the increase in obesity and hyperglycemia in China today, "said Dr. Bastiaan T. Heijmans of the Leiden University Medical Center at the University of Leiden. Netherlands.

Because of the limitations of study design and original badyzes of Chinese studies, the question of whether famine has contributed significantly to the current epidemic in China remains an open question. And therefore, it is not yet possible to make firm statements about the long-term impact of direct exposure or the intergenerational impact of indirect exposure.

"The current T2D epidemic in China represents a huge public health challenge," Lumey said. "Public health efforts in prevention and treatment should therefore now focus on the well-established risk factors of overweight and obesity, especially the increase in the consumption of rich foods. in energy and sedentary lifestyles that affect the entire population, regardless of early exposure to starvation. "

Provided by
Mailman School of Public Health at Columbia University