Does malnutrition in utero determine diabetes and coronary heart disease in adulthood? Results from the Leningrad siege study, a cross sectional study
BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7119.1342 (Published 22 November 1997) Cite this as: BMJ 1997;315:1342
- S A Stanner, project coordinator (sstanner{at}med.ucl.ac.uk)1,
- K Bulmer, research techniciana,
- C Andrès, research techniciana,
- O E Lantseva, endocrinologistb,
- V Borodina, biologistb,
- V V Poteen, professor of medicinea,
- J S Yudkin, professor of medicineb
- a Department of Medicine, University College London Medical School, Whittington Hospital, London N19 3UA
- b Ott Institute of Obstetrics and Gynaecology, Russian Academy of Medical Science, St Petersburg, Russia
- Correspondence to: Ms Stanner
- Accepted 26 August 1997
Abstract
Objective: To investigate the relation between decreased maternal food intake and risk factors for coronary heart disease in adult
Design: Cross sectional study.
Subjects: 169 subjects exposed to malnutrition in utero (intrauterine group) during the siege of Leningrad (now St Petersburg) in 1941-4; 192 subjects born in Leningrad just before rationing began, before the siege (infant group); and 188 subjects born concurrently with the first two groups but outside the area of the siege (unexposed group).
Setting: Ott Institute of Obstetrics and Gynaecology, St Petersburg.
Main outcome measures: Development of risk factors for coronary heart disease and diabetes mellitus—obesity, blood pressure, glucose tolerance, insulin concentrations, lipids, albumin excretion rate, and clotting factors.
Results: There was no difference between the subjects exposed to starvation in utero and those starved during infant life in: (a) glucose tolerance (mean fasting glucose: intrauterine group 5.2(95% confidence interval 5.1 to 5.3), infant group 5.3 (5.1 to 5.5), P=0.94; mean 2 hour glucose: intrauterine group 6.1 (5.8 to 6.4), infant group 6.0 (5.7 to 6.3), P=0.99);(b) insulin concentration; (c) blood pressure; (d)lipid concentration; or (e) coagulation factors. Concentrations of von Willebrand factor were raised in the intrauterine group (156.5 (79.1 to 309.5)) compared with the infant group (127.6 (63.9 to 254.8); P<0.001), and female subjects in the intrauterine group had a stronger interaction between obesity and both systolic (P=0.01) and diastolic (P=0.04) blood pressure than in the infant group. Short adult stature was associated with raised concentrations of glucose and insulin 2 hours after a glucose load—independently of siege exposure. Subjects in the unexposed group had non-systematic differences in subscapular to triceps skinfold ratio, diastolic blood pressure, and clotting factors compared with the exposed groups.
Conclusions:Intrauterine malnutrition was not associated with glucose intolerance, dyslipidaemia, hypertension, or cardiovascular disease in adulthood. Subjects exposed to malnutrition showed evidence of endothelial dysfunction and a stronger influence of obesity on blood pressure.
Key messages
Relations between intrauterine growth and adult disease such as diabetes and cardiovascular disease have been linked to poor nutrition during pregnancy
In this study, however, intrauterine exposure to malnutrition was not associated with glucose intolerance
Intrauterine malnutrition did not affect insulin concentration, blood pressure, or concentration of lipids or coagulation factors
Concentration of von Willebrand factor, a marker of endothelial damage, was raised in the subjects exposed to intrauterine malnutrition
Obesity and blood pressure were more strongly related in subjects exposed to intrauterine malnutrition than in subjects either unexposed to malnutrition or exposed to malnutrition only as infants
Footnotes
- Accepted 26 August 1997