July 18, 2022EClinicalMedicine47 citationsOpen Access
Associations of birth weight and later life lifestyle factors with risk of cardiovascular disease in the USA: A prospective cohort study
Structured PICO
Does lower birth weight interact with unhealthy adult lifestyle factors to increase the risk of incident cardiovascular disease?
P
Population
157,899 adults in the USA (20,169 men from the Health Professionals Follow-up Study, 52,380 women from the Nurses' Health Study, and 85,350 women from the Nurses' Health Study II) who reported birth weight and updated data on adult body weight, smoking status, physical activity, and diet. Excluded participants with a diagnosis of CHD or stroke at baseline.
I
Intervention
Lower birth weight categories (e.g., <2.5 kg, 2.5-3.15 kg) and unhealthy adult lifestyle factors (time-varying BMI ≥25 kg/m2, current smoking, bottom 60% of DASH diet score, physical activity <30 minutes/day, non-moderate alcohol consumption).
C
Comparator
Middle category of birth weight (3.16-3.82 kg) and healthy adult lifestyle factors.
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Outcome
Incident cases of cardiovascular disease (CVD), defined as a combined endpoint of fatal and nonfatal coronary heart disease (CHD) and stroke.composite
Lower birth weight is independently associated with increased cardiovascular disease risk and interacts synergistically with unhealthy adult lifestyle factors to further elevate coronary heart disease risk in women.
Abstract
Background: Low birth weight has been associated with a greater risk of cardiovascular disease (CVD). However, the interaction between low birth weight and adult lifestyle factors on the risk of CVD remains unclear. Methods: We included 20,169 men from the Health Professionals Follow-up Study (HPFS, 1986-2016), 52,380 women from the Nurses' Health Study (NHS, 1980-2018), and 85,350 women from the Nurses' Health Study II (NHS II, 1991-2017) in the USA who reported birth weight and updated data on adult body weight, smoking status, physical activity, and diet every 2-4 years. Incident cases of CVD, defined as a combined endpoint of fatal and nonfatal coronary heart disease (CHD) and stroke, were self-reported and confirmed by physicians through reviewing medical records. Findings: for linear trend <0.001). Additionally, we found an additive interaction between decreasing birth weight and unhealthy lifestyles on the risk of CHD among women, with a pooled relative excess risk due to interaction of 0.06 (95% CI: 0.04-0.08). The attributable proportions of the joint effect were 23.0% (95% CI: 11.0-36.0%) for decreasing birth weight alone, 67.0% (95% CI: 58.0-75.0%) for unhealthy lifestyle alone, and 11.0% (95% CI: 5.0-17.0%) for their additive interaction. Lower birth weight was associated with a greater stroke risk only among women, which was independent of later-life lifestyle factors. Interpretation: Lower birth weight may interact synergistically with unhealthy lifestyle factors in adulthood to further increase the risk of CHD among women. Funding: The National Institutes of Health grants.