The Relationship Between Fetal Growth, Adult Lifestyle Patterns and the Risk of Cardiovascular Diseases

Compelling evidence suggests that a healthy lifestyle may reduce the risk of cardiovascular diseases (CVDs). Knowledge regarding the role of early-life factors in the association between dynamic patterns of lifestyle and CVDs is limited. This study aims to investigate whether fetal growth modifies the association between dynamic lifestyle patterns and the risk of CVDs in adulthood. Data were from the Stockholm Public Health Cohort. A total of 11,218 participants who completed at least two surveys during 2002-2021 and had birth information from the Medical Birth Register were included in this study. Information on lifestyle factors was collected using questionnaires. We defined a composite score of behavioral health metrics including four lifestyle factors, i.e., smoking, physical activity, fruits intake, and body mass index. Data on birth weight for gestational age and CVDs were obtained from nationwide population-based registers. Cox regression was performed to estimate hazard ratios (HR) and 95% confidence intervals (CI). Compared with the consistently poor level of lifestyle, the persistently good level of lifestyle was associated with a lower risk of CVDs; the fully adjusted HR (95% CI) was 0.74 (0.56-0.98). The associations between composite lifestyles and CVDs were mainly driven by body mass index (HR = 0.47, 95% CI = 0.34-0.65) and smoking (HR = 0.68, 95% CI = 0.49-0.97). Although the CVD risk reduction associated with lifestyle improvements appeared to vary by birth weight for gestational age, this modifying effect did not reach statistical significance. The findings imply that improvement of lifestyle is crucial for the prevention of CVDs, and restricted fetal growth does not modify this association.