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

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

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Acknowledgements

This work was supported by the Ministry of Science and Technology of China (No. 2022YFC2505202), the National Natural Science Foundation of China (Nos. 81970691 and 82170819), Shanghai Outstanding Academic Leaders Plan (No. 20XD1422800), Shanghai Medical and Health Development Foundation (No. DMRFP_I_01), Clinical Research Plan of SHDC (No. SHDC2020CR3064B), Science and Technology Committee of Shanghai (No. 20Y11905100), and Key Medical Subject of Jiading District, Shanghai (No. 2020-jdyxzdzk-01).

Electronic Supplementary Material

Supplementary material is available in the online version of this article at https://doi.org/10.1007/s11684-023-1023-9 and is accessible for authorized users.

Compliance with ethics guidelines

Conflicts of interest 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, and Jieli Lu declare no conflict of interest.

The study was approved by the Committee on Human Research at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine and the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was obtained from all patients for being included in the study.

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