Early-life famine exposure, adulthood obesity patterns, and risk of low-energy fracture

doi:10.1007/s11684-023-1023-9

Front. Med.

2024, Vol. 18

Issue (1) : 192-203 https://doi.org/10.1007/s11684-023-1023-9

Early-life famine exposure, adulthood obesity patterns, and risk of low-energy fracture

Hongyan Qi, Chunyan Hu, Jie Zhang, Lin Lin, Shuangyuan Wang, Hong Lin, Xiaojing Jia, Yuanyue Zhu, Yi Zhang, Xueyan Wu, Mian Li, Min Xu, Yu Xu, Tiange Wang, Zhiyun Zhao, Weiqing Wang, Yufang Bi, Meng Dai(

), Yuhong Chen(

), Jieli Lu(

)

Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People’s Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

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Abstract

Malnutrition in early life increases the risk of osteoporosis, but the association of early-life undernutrition combined with adulthood obesity patterns with low-energy fracture remains unknown. This study included 5323 community-dwelling subjects aged ≥40 years from China. Early-life famine exposure was identified based on the participants’ birth dates. General obesity was assessed using the body mass index (BMI), and abdominal obesity was evaluated with the waist-to-hip ratio (WHR). Low-energy fracture was defined as fracture occurring after the age of 40 typically caused by falls from standing height or lower. Compared to the nonexposed group, the group with fetal, childhood, and adolescence famine exposure was associated with an increased risk of fracture in women with odds ratios (ORs) and 95% confidence intervals (CIs) of 3.55 (1.57–8.05), 3.90 (1.57–9.71), and 3.53 (1.05–11.88), respectively, but not in men. Significant interactions were observed between fetal famine exposure and general obesity with fracture among women (P for interaction = 0.0008). Furthermore, compared with the groups with normal BMI and WHR, the group of women who underwent fetal famine exposure and had both general and abdominal obesity had the highest risk of fracture (OR, 95% CI: 3.32, 1.17–9.40). These results indicate that early-life famine exposure interacts with adulthood general obesity and significantly increases the risk of low-energy fracture later in life in women.

Keywords famine obesity body mass index waist-to-hip ratio low-energy fracture

Corresponding Author(s): Meng Dai,Yuhong Chen,Jieli Lu

About author:

Li Liu and Yanqing Liu contributed equally to this work.

Just Accepted Date: 22 September 2023 Online First Date: 31 October 2023 Issue Date: 22 April 2024

Cite this article:

Hongyan Qi,Chunyan Hu,Jie Zhang, et al. Early-life famine exposure, adulthood obesity patterns, and risk of low-energy fracture[J]. Front. Med., 2024, 18(1): 192-203.

URL:

https://academic.hep.com.cn/fmd/EN/10.1007/s11684-023-1023-9
https://academic.hep.com.cn/fmd/EN/Y2024/V18/I1/192

Tab.1 Characteristics of the study participants according to famine exposure

Tab.2 ORs (95% CIs) for low-energy fracture in relation to famine exposure in early life among the 5323 participants

Fig.1 Prevalence of low-energy fracture according to famine exposure and BMI or WHR. (A) Prevalence of fractures among different famine exposure groups stratified by BMI. (B) Prevalence of fractures among different famine exposure groups stratified by WHR.

Tab.3 ORs (95% CIs) for low-energy fracture in relation to famine exposure compared with specific age-balanced controls

	Age-balanced group†	Fetal exposure (1959–1962)	P for interaction	Age-balanced group‡	Childhood exposure (1949–1958)	P for interaction
BMI at baseline^a, kg/m²
Whole cohort*
< 24.0	1.00 (ref)	0.77 (0.40–1.50)	0.0098	1.00 (ref)	1.71 (1.25–2.35)	0.033
24.0–27.9	0.82 (0.49–1.36)	1.75 (0.98–3.11)		1.12 (0.89–1.58)	1.25 (0.88–1.76)
≥ 28.0	1.22 (0.62–2.39)	3.06 (1.58–5.94)		1.30 (0.86–1.97)	1.33 (0.85–2.07)
Men**
< 24.0	1.00 (ref)	2.09 (0.70–6.25)	0.4838	1.00 (ref)	1.97 (1.03–3.75)	0.0696
24.0–27.9	1.36 (0.57–3.27)	1.91 (0.67–5.41)		1.30 (0.68–2.50)	1.15 (0.58–2.26)
≥ 28.0	1.01 (0.30–3.43)	1.07 (0.20–5.64)		0.92 (0.38–2.24)	1.15 (0.58–2.26)
Women***
< 24.0	1.00 (ref)	0.52 (0.21–1.28)	0.0008	1.00 (ref)	1.56 (1.08–2.26)	0.2802
24.0–27.9	0.56 (0.28–1.14)	1.80 (0.88–3.68)		0.98 (0.65–1.48)	1.24 (0.83–1.86)
≥ 28.0	1.37 (0.60–3.12)	4.49 (2.13–9.46)		1.36 (0.85–2.19)	1.60 (0.96–2.66)
WHR at baseline^b
Whole cohort*
Men < 0.90, women < 0.85	1.00 (ref)	1.17 (0.63–2.15)	0.2845	1.00 (ref)	1.56 (1.11–2.19)	0.9097
Men 0.90–0.94, women 0.85–0.89	0.86 (0.51–1.47)	1.55 (0.85–2.81)		1.17 (0.81–1.70)	1.03 (0.70–1.52)
Men ≥ 0.95, women ≥ 0.90	0.61 (0.33–1.14)	1.19 (0.59–2.38)		1.03 (0.70–1.52)	1.60 (1.11–2.31)
Men**
< 0.90	1.00 (ref)	1.31 (0.43–3.934)	0.9155	1.00 (ref)	1.89 (0.97–3.66)	0.5556
0.90–0.94	1.38 (0.54–3.49)	3.13 (1.09–9.02)		2.83 (1.43–5.57)	1.71 (0.81–3.61)
≥ 0.95	1.41 (0.52–3.83)	1.64 (0.46–5.86)		1.95 (0.90–4.23)	2.90 (1.36–6.18)
Women ***
< 0.85	1.00 (ref)	1.14 (0.54–2.39)	0.1263	1.00 (ref)	1.36 (0.91–2.03)	0.5332
0.85–0.89	0.69 (0.36–1.32)	1.23 (0.59–2.55)		0.75 (0.48–1.19)	0.80 (0.51–1.26)
≥ 0.90	0.36 (0.16–0.82)	1.05 (0.45–2.46)		0.74 (0.47–1.17)	1.23 (0.81–1.87)

Tab.4 Multivariable-adjusted ORs (95% CIs) for the association between adult BMI or WHR and low-energy fracture in accordance with famine exposure in early life compared with specific age-balanced controls

Tab.5 Multivariable-adjusted ORs (95% CIs) for joint association of general and abdominal obesity with the risk of low-energy fracture in accordance with specific age-balanced controls and famine-exposed groups

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