Association Between Early Life Famine Exposure And Metabolic Dysfunction-associated Fatty Liver Disease In Adulthood Of The Han,bai And Yi Ethnic Groups In Yunnan

Metabolic dysfunction-associated fatty liver disease(MAFLD)is a new definition of non-alcoholic fatty liver disease(NAFLD),published in March 2020 by the international fatty liver expert panel.MAFLD is the most common chronic liver disease,affecting nearly one-third of the global population.As MAFLD increases the risk of cardiovascular disease,chronic kidney disease and malignancy,the burden of MAFLD will be increasing and MAFLD have become a growing global health problem.The pathogenesis of MAFLD is still unclear,and currently known risk factors associated with MAFLD include gender,metabolic abnormalities,genes,and genetic susceptibility.In addition,the Developmental Origins of Health and Disease(DOHa D)hypothesis suggests that exposure to famine in early life may be another risk factor for MAFLD in adulthood,However,there are few studies at home and abroad on the influence of famine in early life on the risk of MAFLD in adults.Objective:This study explored the relationship between famine exposure in early life and the risk of MAFLD in adulthood of the Han,Bai and Yi ethnic groups in Yunnan,aiming to provide a reference for the prevention and control of MAFLD.Methods:A total of 18558 subjects born between 1939 and 1978 were included in this study.They came from the baseline survey population of the China Multi-Ethnic Cohort(CMEC)Study in Yunnan.Questionnaire survey,physical measurement and clinical biochemical index measurement were carried out on the research subjects.The diagnosis criteria of MAFLD met the Clinical Practice Guidelines for the Diagnosis and Management of MAFLD published by the European Association for the Study of the Liver.Subjects were divided into 4 groups according to their age at the time of the famine: fetal-exposed(birth years 1959-1961),childhood-exposed(birth years 1949-1958),adolescence-exposed(birth years 1943-1949)and nonexposed(birth years 1962-1978 and 1939-1943),and nonexposed as the control group.SPSS 26.0 statistical software was used for data processing and analysis.The t test,one-way analysis of variance and x2 test were used to analyze and compare the characteristics of the population.Logistic regression analysis was used to explore the relationship between famine exposure in early life and the risk of MAFLD in adulthood,and further stratified analysis was carried out according to gender and ethnicity.Results:1.In the total population,the prevalence rates of MAFLD were 20.5%,21.4%,17.1% and 14.7% in the nonexposed group,fetal-exposed group,childhood-exposed group and adolescence-exposed,respectively.2.Total population: After adjusting for other potential confounding factors,exposure to famine during fetal(OR=1.89,95%CI: 1.30-2.74)and childhood(OR=1.59,95%CI: 1.13-2.23)was associated with an increased risk of adult MAFLD compared with the nonexposed group.3.Gender-stratified analysis: In males,adjusting for potential confounders,compared to the nonexposed group,famine exposure in fetal(OR=3.41,95%CI:1.81-6.44)increased the risk of MAFLD in adulthood.But no association was found between early-life famine exposure and risk of MAFLD among women.4.Ethnic-stratified analysis: After adjusting for other potential confounding factors,compared with the famine unexposed group,the Bai ethnic group was more likely to be affected during the fetal(OR=3.18,95%CI: 1.50-6.75)and childhood(OR=2.29,95%CI: 1.22-4.29)exposure to famine increases the risk of MAFLD in adulthood,but no association between early life famine exposure and risk of MAFLD was found in the Han nationality and Yi ethnic group.Conclusions:The results of this study show that exposure to famine during fetal and childhood increases the risk of MAFLD in adulthood,and this association is particularly evident in the Bai ethnic group;In addition,fetal exposure to famine also increases the risk of adult MAFLD in males.The study suggests that it is necessary to enhance the nutrition knowledge level of residents,advocate the concept of healthy life,and pay attention to improve the nutritional status of pregnant women and children in early years.