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 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
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The association between famine exposure and increased insulin resistance was not observed in the Leningrad Siege Study.
“However, this association was not observed in another famine cohort study, the Leningrad Siege Study (55).”
From Globalization of Diabetes (2011) · cites this paper as [55]
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- Authors
- Stanner, S. A., Bulmer, K., Andrès, C., Lantseva, O. E., Borodina, V, Poteen, V. V., & Yudkin, J. S.
- Affiliations
- Whittington Hospital (GB)
- Research Institute of Obstetrics and Gynecology named after D.O. Ott (RU)
- Corresponding author
- Stanner, S A
- ORCID
- Yudkin, J S
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 1997-11-22
- Volume
- 315
- Issue
- 7119
- Pages
- 1342-1348
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC2127836
- OpenAlex
- W2047372093
- Cited by
- 545
- References
- 43
- Citations by year
- 2026: 6 · 2025: 13 · 2024: 11 · 2023: 9 · 2022: 30 · 2021: 21 · 2020: 15 · 2019: 23 · 2018: 16 · 2017: 21 · 2016: 17 · 2015: 17 · 2014: 29 · 2013: 31 · 2012: 24
- FWCI
- 13.33
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
- Locations
- BMJ (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Physiology › Dietary Effects on Health
- Keywords
- famine, Siege of Leningrad, coronary risk factors, diabetes mellitus, glucose tolerance, insulin, von Willebrand factor, blood pressure, obesity, adult height, maternal diet, coagulation factors, lipids, urinary albumin excretion rate, sex differences, skinfold thickness
- MeSH terms
- Birth Weight, Body Height, Coronary Disease, Cross-Sectional Studies, Diabetes Mellitus, Female, Follow-Up Studies, Humans, Male, Middle Aged, Nutrition Disorders, Pregnancy, Pregnancy Complications, Prenatal Exposure Delayed Effects, Risk Factors, Russia, Cohort Studies
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