Prenatal Famine Exposure Doubled Risk for Adult T2D

TOPLINE:

Prenatal exposure to extreme food deprivation led to a more than twofold increased likelihood of developing type 2 diabetes (T2D) in adulthood, an analysis of the man-made Holodomor (death by hunger) famine shows.

METHODOLOGY:

• Researchers examined the long-term connection between prenatal famine and adult T2D using the setting of the man-made Ukrainian Holodomor famine.
• In 1932-1933, Ukrainian food supplies were deliberately thwarted by Soviet interventions, leading to about 4 million excess deaths in the short term.
• Researchers integrated data from more than 10 million reconstructed births from 1930 to 1938; 128,225 T2D cases diagnosed from 2000 to 2008 in the Ukraine’s national diabetes registry; and excess mortality during the famine.

TAKEAWAY:

• Among the births, 51.8% were men and 48.2% were women; 14.5% were born in regions with extreme famine; 38.8% in regions with very severe famine; 22.2% in regions with severe famine; and 24.4% in regions with no famine.
• There was a dose-response relationship between the severity of famine exposure and an increase in adult T2D risk.
• Relative to pre- or post-famine births in the same region, births from January to June 1934 in regions with extreme famine showed a 2.15-fold increase in T2D; regions with very severe famine had a 1.93-fold increase; regions with severe famine had a 1.48-fold increase; and regions with no famine showed no T2D increase.
• Notably, infants exposed to famine in mid- or late gestation or in the first years of life showed no increase in T2D.

IN PRACTICE:

The study “highlights the importance of raising awareness about the potential long-term health effects of early-life adversities,” the authors wrote.

SOURCE:

The study, led by L.H. Lumey, MD, PhD, of Columbia University Medical Center, New York City, was published online on August 8 in Science.

LIMITATIONS:

The study had several limitations. The severity of famine exposure was estimated at the province level because measures at the individual level are not available. T2D cases in the national register were reported by current residence, and cases among individuals who left Ukraine or died before 2000 would not have been counted. The diabetes register cannot be used to reliably determine T2D prevalence in Ukraine because cases are underreported. No information on lifestyle characteristics or behaviors was available.

DISCLOSURES:

This work was supported by the Ukraine State complex program Diabetes Mellitus, Holodomor Research and Education Consortium in Canada, NIDI-NIAS Fellowship of the Royal Netherlands Academy of Sciences, National Institute of Aging, and MAPA: Digital Atlas of Ukraine, Harvard Ukrainian Research Institute. The authors declared that they have no competing interests.