DOES MALNUTRITION IN-UTERO DETERMINE DIABETES AND CORONARY HEART-DISEASE IN ADULTHOOD - RESULTS FROM THE LENINGRAD SIEGE STUDY, A CROSS-SECTIONAL STUDY

Objective: To investigate the relation between decreased maternal food intake and risk factors for coronary heart disease in adult life. Des ign: Cross sectional study. Subjects: 169 subjects exposed to malnutri tion in utero (intrauterine group) during the siege of Leningrad (now St Petersburg) in 1941-4; 192 subjects born in Leningrad just before r ationing began, before the siege (infant group); and 188 subjects born concurrently with the first two groups but outside the area of the si ege (unexposed group). Setting: Ott Institute of Obstetrics and Gynaec ology, St Petersburg. Main outcome measures: Development of risk facto rs for coronary heart disease and diabetes mellitus-obesity, blood pre ssure, glucose tolerance, insulin concentrations, lipids, albumin excr etion rate, and clotting factors. Results: There was no difference bet ween the subjects exposed to starvation in utero and those starved dur ing infant life in: (a) glucose tolerance (mean fasting glucose: intra uterine 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 c oncentration; (c) blood pressure; (d) lipid concentration; or (e) coag ulation factors. Concentrations of von Willebrand factor were raised i n the intrauterine group (156.5 (79.1 to 309.5)) compared with the inf ant group (127.6 (63.9 to 254.8); P < 0.001), and female subjects in t he intrauterine group had a stronger interaction between obesity and b oth systolic (P = 0.01) and diastolic (P = 0.04) blood pressure than i n the infant group. Short adult stature was associated with raised con centrations of glucose and insulin 2 hours after a glucose load-indepe ndently of siege exposure. Subjects in the unexposed group had non-sys tematic differences in subscapular to triceps skinfold ratio, diastoli c blood pressure, and clotting factors compared with the exposed group s. Conclusions: Intrauterine malnutrition tvas not associated with glu cose intolerance, dyslipidaemia, hypertension, or cardiovascular disea se in adulthood. Subjects exposed to malnutrition showed evidence of e ndothelial dysfunction and a stronger influence of obesity on blood pr essure.