The effect of Chinese famine exposure in early life on dietary patterns and chronic diseases of adults

Zhou, Jingjiao; Sheng, Jie; Fan, Yong; Zhu, Xinglin; Tao, Qi; Liu, Kaiyong; Hu, Chunqiu; Ruan, Luzhang; Yang, Linsheng; Tao, Fangbiao; Wang, Sufang

doi:10.1017/s1368980018003440

Cited by 20 publications

(27 citation statements)

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“… 21 41 54 55 Three Chinese studies found increased risk of dyslipidaemia after childhood famine exposure between 0 and 12 years, with one also reporting an effect in the adolescent group (13–20 years). 50 56 57 A study of Leningrad Siege survivors found higher high-density lipoprotein (HDL) in exposed participants (p=0.008) but no difference in triglycerides compared with controls. 34 Only one Chinese study stratified analyses by sex and it found an increased risk of dyslipidaemia in women only.…”

Section: Resultsmentioning

confidence: 99%

“…Zhou et al50 China, adults45-60 years 0-2 years (n=160) 3-5 years (n=173) 6-8 years (n=141) NCDs ↑ T2D (0-2 years, 3-5 years) ↑ Hypercholesterolaemia (0-2 years) -/ -Dutch Hunger Winter (1944-1945) Idris et al 29 Netherlands, women~70 years 0-9 years (n=93) 10-18 years (n=54) Coronary artery calcifications, valve calcification ↑ Coronary calcium score (10-18 years) ↔ Valve calcification • / Portrait et al 31 Netherlands, adults 60-76 years 0-1 years (n=81) 1-5 years (n=293) 6-10 years (n=244) 11-14 years (n=181) Heart diseases, peripheral arterial diseases (PAD), T2D ↑ T2D, PAD (women, 11-14 years) • / • van Abeelen et al 27 Netherlands, women 49-70 years 0-9 years (n=n/r) 10-17 years (n=n/r) T2D ↑ T2D (0-9 years) • / • van Abeelen et al 28 Netherlands, women 49-70 years 0-9 years (n=2196) 10-17 years (n=1773) Coronary heart disease (CHD), stroke ↑ CHD (10-17 years) ↓ Stroke • / •Siege ofLeningrad (1941Leningrad ( -1944 …”

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confidence: 99%

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Severe malnutrition or famine exposure in childhood and cardiometabolic non-communicable disease later in life: a systematic review

et al. 2021

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IntroductionChild malnutrition (undernutrition) and adult non-communicable diseases (NCDs) are major global public health problems. While convincing evidence links prenatal malnutrition with increased risk of NCDs, less is known about the long-term sequelae of malnutrition in childhood. We therefore examined evidence of associations between postnatal malnutrition, encompassing documented severe childhood malnutrition in low/middle-income countries (LMICs) or famine exposure, and later-life cardiometabolic NCDs.MethodsOur peer-reviewed search strategy focused on ‘severe childhood malnutrition’, ‘LMICs’, ‘famine’, and ‘cardiometabolic NCDs’ to identify studies in Medline, Embase, Global Health, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. We synthesised results narratively and assessed study quality with the UK National Institute for Health and Care Excellence checklist.ResultsWe identified 57 studies of cardiometabolic NCD outcomes in survivors of documented severe childhood malnutrition in LMICs (n=14) and historical famines (n=43). Exposure to severe malnutrition or famine in childhood was consistently associated with increased risk of cardiovascular disease (7/8 studies), hypertension (8/11), impaired glucose metabolism (15/24) and metabolic syndrome (6/6) in later life. Evidence for effects on lipid metabolism (6/11 null, 5/11 mixed findings), obesity (3/13 null, 5/13 increased risk, 5/13 decreased risk) and other outcomes was less consistent. Sex-specific differences were observed in some cohorts, with women consistently at higher risk of glucose metabolism disorders and metabolic syndrome.ConclusionSevere malnutrition or famine during childhood is associated with increased risk of cardiometabolic NCDs, suggesting that developmental plasticity extends beyond prenatal life. Severe malnutrition in childhood thus has serious implications not only for acute morbidity and mortality but also for survivors’ long-term health. Heterogeneity across studies, confounding by prenatal malnutrition, and age effects in famine studies preclude firm conclusions on causality. Research to improve understanding of mechanisms linking postnatal malnutrition and NCDs is needed to inform policy and programming to improve the lifelong health of severe malnutrition survivors.

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

Severe malnutrition or famine exposure in childhood and cardiometabolic non-communicable disease later in life: a systematic review

et al. 2021

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“…Of these 71 articles, 24 were further excluded for various reasons (Appendix S1). Finally, 47 articles were included in the present meta‐analysis. The articles were published between 2006 and 2019, mostly published from 2014 onwards.…”

Section: Resultsmentioning

confidence: 99%

“…Foetal exposure to famine was associated with higher risks of T2DM (RR 1.37, 95% CI, 1.23‐1.52; Figure ), metabolic syndrome (RR 1.26, 95% CI, 1.07‐1.50; Figure ), hypertension (RR 1.30, 95% CI, 1.07‐1.57; Figure ), hyperglycaemia (RR 1.27, 95% CI, 1.11‐1.45; Figure ), dyslipidaemia (RR 1.48, 95% CI, 1.33‐1.66; Figure 2), obesity (RR 1.19, 95% CI, 1.02‐1.39; Figure ), overweight (RR 1.17, 95% CI, 1.07‐1.29; Figure ), coronary heart disease (RR 1.22, 95% CI, 1.00‐1.51; Figure ), and moderate‐to‐severe NAFLD (RR 1.66, 95% CI, 1.07‐2.57; Figure 3) . No association was observed for the risks of stroke (RR 1.21, 95% CI, 0.96‐1.52; Figure ) or mild NAFLD (RR 1.04, 95% CI, 0.64‐1.70; Figure 3) .…”

Section: Resultsmentioning

confidence: 99%

Foetal and childhood exposure to famine and the risks of cardiometabolic conditions in adulthood: A systematic review and meta‐analysis of observational studies

Hidayat

Shi

et al. 2020

Obesity Reviews

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Summary A systematic review and meta‐analysis of observational studies was performed to provide a deeper understanding of the associations between foetal and childhood exposure to famine and the risks of type 2 diabetes mellitus (T2DM), metabolic syndrome, hypertension, hyperglycaemia, dyslipidaemia, obesity, overweight, coronary heart disease, stroke, and nonalcoholic fatty liver disease (NAFLD) in adulthood. Both foetal and childhood exposure to famine were positively associated with the risks of T2DM (foetal exposure: RR 1.37, 95% CI, 1.23‐1.52; childhood exposure: RR 1.33, 95% CI, 1.08‐1.64), metabolic syndrome (RR 1.26, 95% CI, 1.07‐1.50; RR 1.24, 95% CI, 1.13‐1.35), hypertension (RR 1.30, 95% CI, 1.07‐1.57; RR 1.33, 95% CI, 1.02‐1.74), hyperglycaemia (RR 1.27, 95% CI, 1.11‐1.45; RR 1.25, 95% CI, 1.10‐1.42), dyslipidaemia (RR 1.48, 95% CI, 1.33‐1.66; RR 1.27, 95% CI, 1.12‐1.45), obesity (RR 1.19, 95% CI, 1.02‐1.39; RR 1.13, 95% CI, 1.00‐1.28), overweight (RR 1.17, 95% CI, 1.07‐1.29; RR 1.07, 95% CI, 1.00‐1.14), coronary heart disease (RR 1.22, 95% CI, 1.00‐1.51; RR 1.21, 95% CI, 1.09‐1.35), and moderate‐to‐severe NAFLD (RR 1.66, 95% CI, 1.07‐2.57; RR 1.68, 95% CI, 1.41‐1.99) in adulthood. No association was observed for the risks of stroke or mild NAFLD. Adjustments for age, alcohol, smoking, body mass index, and physical activity nullified some associations. The associations were generally stronger in women than in men. In summary, foetal and childhood exposure to famine may confer greater risks of developing certain cardiometabolic conditions in adulthood, particularly in women. The extent to which risks for cardiometabolic conditions are associated with early‐life famine appears to be determined by certain factors in adulthood.

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“…This could imply that the impact of famine on adulthood overweight/obesity could be exacerbated by lifestyle factors including smoking, unhealthy diets, and sedentary lifestyles [31]. The study of Zhou J et al, (2019) in Chinese study observed that the joint effect between famine and harmful dietary pattern could have serious consequences on later-life health outcomes [58].…”

Section: Height Amentioning

confidence: 99%

Impact of early life famine exposure on adulthood anthropometry among survivors of the 1983–1985 Ethiopian Great famine: a historical cohort study

et al. 2021

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Background Nutritional insult in early life brings adaptive changes in body structure and functioning that could remain throughout the affected individual’s life course. The long term impact of early life famine exposure on adulthood anthropometric measurements has been recorded in previous studies. However, the results were contradictory. Hence, we extend this study to examine the impact of famine exposure during early life on adulthood’s anthropometry among survivors of the 1983–85 Ethiopian great famine. Methods A total of 1384 adult men and women survived from 1983 to 85 Ethiopian great famine were included in the study. Famine exposure status was classified into five groups: early life-exposed, prenatal-exposed, postnatal-exposed, adolescence-exposed, and non-exposed based on self-reported age and birthdate of the participants. Prenatal, post-natal, and adolescence exposed groups were considered as early life exposed. Following a standard procedure, anthropometric measurements were taken. A linear regression analysis was used to analyze the impact of famine exposure on adult anthropometric measurements adjusted for all possible covariates. The effect of famine exposure on overweight, general obesity, and abdominal obesity was examined using multinomial and binary logistic regression analysis. Result Compared to non-exposed groups, adult height was lower by 1.83 cm (β = − 1.83; 95% CI: − 3.05, − 0.58), 1.35 cm (β = − 1.35; 95% CI: − 2.56, − 0.14) and 2.07 cm (β = − 2.07 cm; 95% CI: − 3.31, − 0.80) among early life, prenatal and post-natal exposed groups, respectively. Likewise, famine exposure during early life (β = 0.02; 95% CI: 0.01, 0.03), prenatal (β = 0.03; 95% CI: 0.02, 0.03) and post-natal life (β = 0.02; 95% CI: 0.02, 0.03) was positively associated with increased waist to height ratio. However, none of the above exposures resulted in a significant association with body mass index (P > 0. 05). Additionally, exposure to famine during early stage of life was not associated with increased risk of overweight, general obesity and abdominal obesity in adults. Conclusion Decreased adult height and increased waist-to-height ratio were associated with early life exposure to famine, particularly prenatal and post-natal exposure. These results therefore underscore the significance of avoiding undernutrition in early life, which tends to be important for achieving once potential adult height and to minimize the increased risk of anthropometric markers of abdominal obesity such as waist to height ratio in later life.

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The effect of Chinese famine exposure in early life on dietary patterns and chronic diseases of adults

Cited by 20 publications

References 42 publications

Severe malnutrition or famine exposure in childhood and cardiometabolic non-communicable disease later in life: a systematic review

Severe malnutrition or famine exposure in childhood and cardiometabolic non-communicable disease later in life: a systematic review

Foetal and childhood exposure to famine and the risks of cardiometabolic conditions in adulthood: A systematic review and meta‐analysis of observational studies

Impact of early life famine exposure on adulthood anthropometry among survivors of the 1983–1985 Ethiopian Great famine: a historical cohort study

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