RESUMO
Latin America is experiencing an epidemic of cardiovascular disease and type-2 diabetes mellitus. The rise in life-expectancy and increasingly rapid urbanization have resulted in a greater prevalence of overweight, obesity and metabolic syndrome. In Latin America, there is a high level of susceptibility to the development of insulin resistance and low-grade inflammation at relatively low levels of abdominal obesity. This susceptibility is associated with the adaptive response of the fetus to deficient fetal nutrition, which results in a loss of anatomical structures such as nephrons, cardiomyocytes and pancreatic beta cells. These adaptations may prove detrimental if food becomes abundant again after birth. In Latin America, the high prevalence of maternal and fetal malnutrition could mean that the resulting fetal adaptations may contribute to an increased risk of cardiometabolic disease. The socioeconomic differences that exist between developed and underdeveloped countries may be reflected in different biological adaptations, which could invalidate the diagnostic criteria and preventive and therapeutic approaches that have been recommended on the basis of research carried out in populations with different characteristics. Clinical studies are needed to evaluate the effectiveness of interventions recommended for preventing and aiding recovery from cardiometabolic disease in Latin America.
Assuntos
Transtornos da Nutrição Fetal/epidemiologia , Cardiopatias/epidemiologia , Cardiopatias/etiologia , Doenças Metabólicas/epidemiologia , Doenças Metabólicas/etiologia , Adulto , Feminino , Humanos , Inflamação/patologia , América Latina/epidemiologia , GravidezRESUMO
OBJECTIVES: We examined the effects of early life exposure to poor nutrition and infectious diseases on adult heart disease and diabetes using season of birth as an indicator to help disentangle the effects on health of early life exposure from effects associated with other childhood conditions. METHODS: Using data from 60- to 74-year-old Puerto Ricans who lived in rural areas during childhood (n = 1,457), we estimated the effects of seasonal exposure during late gestation on the probability of diabetes and heart disease, controlling for adult obesity and other childhood conditions (health, socioeconomic status, knee height). RESULTS: We found (a) strong associations between exposure and heart disease; (b) weaker associations between exposure and diabetes, although significant negative interaction effects between exposure and having a family member with diabetes suggest the possibility of either strong gene-environment or early adult-environment interactions; (c) virtually no attenuation of effects of self-reported childhood health with controls for exposure. DISCUSSION: Timing of birth may reveal conditions experienced perinatally that affect adult heart disease and diabetes. The results suggest that examination of the effects of season of birth on these chronic conditions among older Puerto Rican adults and among older adults from similar populations deserves deeper scrutiny.