北京市41～47岁人群出生时发育指标与成年期糖耐量减低的关系

Association of Body Size at Birth with Impaired Glucose Tolerance during Their Adulthood for Men and Women Aged 41 to 47 Years in Beijing of China

目的 探讨中国人群中是否存在低出生指标与成年期非胰岛素依赖性糖尿病（ Ｎ Ｉ Ｄ Ｄ Ｍ）和糖耐量减低（ Ｉ Ｇ Ｔ） 的联系。方法 对１９４８ 年７ 月～１９５４ 年底在北京协和医院出生的６２８ 名单生子进行追访调查，摘录出生记录，并进行身体测量和标准口服葡萄糖耐量试验。结果 Ｎ Ｉ Ｄ Ｄ Ｍ 和 Ｉ Ｇ Ｔ患病率随出生体重、出生体重指数（ｐｏｎｄｅｒａｌ ｉｎｄｅｘ， Ｐ Ｉ） 和头围测量值的上升而下降。出生消瘦（ Ｐ Ｉ＜ ２４ｋｇ／ｍ３） 伴成年肥胖（ Ｂ Ｍ Ｉ≥７５ 百分位值） 组患病率最高（４３ ．８ ％ ） ；出生时脂肪较多（ Ｐ Ｉ≥２８ ｋｇ／ｍ３） 且成年消瘦（ Ｂ Ｍ Ｉ＜ ２５ 百分位值） 组患病率最低（８ ．３ ％ ） 。母亲孕早、晚期 Ｂ Ｍ Ｉ与子女成年期糖负荷后２ 小时血糖浓度呈负相关。此外，出生体重、 Ｐ Ｉ和头围还与空腹和糖负荷后２ 小时血浆胰岛素、３２３３ 裂解胰岛素原水平呈负相关。对调查对象目前的 Ｂ Ｍ Ｉ、生活习惯和经济水平进行调整后，上述出生指标与成年期糖耐量和胰岛素间的联系依然存在。结论 中国人群中存在低出生指标与成年期 Ｎ Ｉ Ｄ Ｄ Ｍ 和 Ｉ Ｇ Ｔ的联系，其机制可能是通过母亲孕前低 Ｂ Ｍ Ｉ导致胎儿营养不良，产生胰岛?

Objective To explore if there was relationship between small body size at birth and type 2 diabetes and impaired glucose tolerance(IGT)during adulthood in China.Methods Six hundred and twenty eight singletons born in the Peking Union Medical College Hospital in Beijing during July 1948 to the end of 1954 were followed up and their medical records at birth were abstracted.Anthropometry and standard oral glucose tolerance test were carried out for all of them.Plasma insulin level was measured with radioimmunoassay for them.Results Prevalence of type 2 diabetes and IGT decreased with the increase in their birth weight,Ponderal index(PI)and head circumference at birth(for trend test,χ 2=6.7, P =0.01;χ 2=4.8, P =0.03;and χ 2=5.8, P =0.02;respectively),with the highest of 43.8% in those with thin body size (PI<24 kg/m 3)at birth and obesity (BMI<75 percentile)during adulthood,and the lowest of 8.3% in those with more fat at birth(PI≥28 kg/m 3)and keeping relatively thin (BMI<25th percentile)during adulthood.BMI of mothers in their early and late pregnancy correlated reversely with blood glucose levels two hours after sugar load for their children in adulthood.In addition,body weight,PI and head circumference at birth correlated reversely with their plasma insulin levels fasting and two hours after sugar load and levels of 32 33 split pro insulin during their adulthood.After adjustment for current BMI,lifestyle and economic status,body size at birth mentioned above still associated with their glucose tolerance and level of plasma insulin during adulthood.Conclusion There was relationship between small body size at birth and prevalence of type 2 diabetes and IGT during adulthood.Prevalence of type 2 diabetes and IGT depended on the synergic effect of thin body size at birth and obesity during adulthood.