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Does Malnutrition in Utero Determine Diabetes and Coronary Heart Disease in Adulthood? Results from the Leningrad Siege Study, a Cross Sectional Study

S. A. Stanner, K. Bulmer, C. Andrès, O. E. Lantseva, V. Borodina, V. V. Poteen and J. S. Yudkin
BMJ: British Medical Journal
Vol. 315, No. 7119 (Nov. 22, 1997), pp. 1342-1348
Published by: BMJ
Stable URL: http://www.jstor.org/stable/25176300
Page Count: 7
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Does Malnutrition in Utero Determine Diabetes and Coronary Heart Disease in Adulthood? Results from the Leningrad Siege Study, a Cross Sectional Study
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Abstract

Objective: To investigate the relation between decreased maternal food intake and risk factors for coronary heart disease in adult life. 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.

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