Associations between early-life food deprivation during World War II and risk of hypertension and type 2 diabetes at adulthood

Abstract

Guy fagherazzi 2,5* the Developmental origins of Health and Disease (DoHaD) framework suggests that early-life experiences affect long-term health outcomes. We tested this hypothesis by estimating the long-run effects of exposure to World War II-related food deprivation during childhood and adolescence on the risk of suffering from hypertension and type 2 diabetes at adulthood for 90,226 women from the French prospective cohort study E3N. We found that the experience of food deprivation during earlylife was associated with a higher risk of developing type 2 diabetes (+0.7%, 95% CI: 0.073-1.37%) and hypertension (+2.6%, 95% CI: 0.81-4.45%). Effects were stronger for individuals exposed at younger ages. Exposed individuals also achieved lower levels of education, slept less, and were more frequently smokers than unexposed individuals. These results are compatible with both the latency and the pathway models proposed in the DoHaD framework which theorise the association between early life exposure and adult health through both a direct link and an indirect link where changes in health determinants mediate health outcomes. Based on the relationship between experience and the biology and psychology of development, the Life Course Health Development (LCHD) and the Developmental Origins of Health and Disease (DOHaD) framework suggest that risk factors, protective factors, and early-life experiences affect individuals' long-term health and disease outcomes. Although exposure to particular environments and experiences appear to influence health development at all stages, it has been suggested that exposure to environmental insults during childhood and adolescence has particularly powerful and long-lasting consequences on health due to the persistence of bio-behavioural attributes that are acquired early in life 1-4. Many studies examined the relationship between early living conditions and health in later life using cohorts exposed to historical events as a natural experiment. Concerning developed countries, several papers have investigated the impact on health of WWII events, particularly the 1944-45 Dutch famine 5-10 , and the 1941-44 Leningrad siege 11,12 , and reported a higher incidence of breast cancer, type 2 diabetes, cardiovascular disease, stroke, and hypertension among cohorts exposed to famine during childhood or adolescence. However, in most studies the health outcomes were self-reported, thus subject to errors and reporting bias compared with other sources of information, such as medical records or laboratory measurements 13-15. In addition, many authors were unable to distinguish the direct effects of early life conditions from potential indirect effects mediated through changes in health behaviours and other health determinants, since such information is rarely available. Accounting for such mediating effects appears to be important; indeed, for example, hardship during childhood can have immediate adverse effects on schooling decisions and outcomes 16 , and thus affect health outcomes through reduced achi...

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