Early famine exposure and adult disease risk based on a 10-year prospective study of Chinese adults

Abstract

ObjectiveTo comprehensively examine the potential impacts of prenatal experience of the Chinese Great Famine on chronic disease risks in the middle age.MethodsThis study included 92 284 participants aged 39–51 years from China Kadoorie Biobank born around the famine period and without major chronic diseases at baseline. We categorised participants into non-famine births (born between 1 October 1956 and 30 September 1958, and 1 October 1962 and 30 September 1964) and famine births (born between 1 October 1959 and 30 September 1961). The outcomes were incident cardiovascular disease, cancer and respiratory system disease. Cox regression was used to estimate adjusted HR and 95% CI for famine exposure. Subgroup analyses were performed according to baseline characteristics.ResultsDuring a median 10.1 years of follow-up, we identified 4626 incident ischaemic heart disease (IHD) cases, 7332 cerebrovascular disease cases, 3111 cancer cases and 16 081 respiratory system disease cases. In the whole population, prenatal famine exposure was not statistically associated with the risks of developing any chronic diseases in adulthood. However, for urban participants, compared with non-famine births, famine births had a higher risk of cerebrovascular disease (HR 1.18; 95% CI 1.09 to 1.28); such association was not shown for rural participants (p for interaction <0.001). Also, we observed the associations of prenatal famine exposure with IHD (HR 1.15; 95% CI 1.05 to 1.26) and cerebrovascular disease (HR 1.13; 95% CI 1.05 to 1.21) in participants with lower physical activity level, but not in those with higher ones (all p for interaction=0.003).ConclusionOur findings indicate that prenatal exposure to the Chinese famine might be associated with an increased cardiovascular risk and such risk may be modified by adult lifestyle.

Early life malnutrition is a problem that may be fixed by improving later-life lifestyle: never too late to mend

“…Although no intervention study has been designed specifically to answer these questions, observation from interaction analysis conducted by Meng et al present some data for optimistic recommendations. Specifically, these authors show that high physical activity level in adulthood may be able to mitigate the adverse effects of prenatal famine exposure on the development of ischaemic heart disease and stroke 1. Put simply, a healthy dietary pattern adopted even in adulthood may be helpful for mitigating the adverse effects of prenatal famine exposure.…”

“…In other words, can we correct the mistakes made by our parents by improving our lifestyle later in life? In their Heart paper, Meng et al 1. probably gave us some hints to that question.…”

Maternal Undernutrition Modulates Neonatal Rat Cerebrovascular Structure, Function, and Vulnerability to Mild Hypoxic-Ischemic Injury via Corticosteroid-Dependent and -Independent Mechanisms

“…The US Department of Agriculture estimates that in 2019, at least 870 million people worldwide regularly experienced food insecurity, including 35 million in the United States [ 1 ], and these numbers likely will increase due to the COVID-19 pandemic [ 2 ]. This food insecurity, and the nutritional insufficiency it causes, can lead to numerous detrimental physiological consequences, particularly in pregnant mothers and their offspring [ 3 , 4 ]. Frequently, undernourished mothers give birth to infants that initially appear healthy but develop multiple metabolic and cardiovascular disease profiles in middle age, as first reported by David Barker [ 5 ].…”

“…Fetal programming also affects the brain and cerebrovascular circulation resulting in altered brain structure with increased risk for learning disabilities and cognitive dysfunction [ 4 , 18 ]. In addition, fetal programming also appears to increase the risk for cerebrovascular disease in offspring from food-restricted mothers [ 3 , 19 ].…”

Heartbeat: When should patients consider implantable cardiac defibrillator deactivation?

“…The cardiovascular risk associated with being born during a famine period are not trivial. In a study by Meng and colleagues5 of over 92 000 participants currently aged 39–51 years, urban (but not rural) participants born during a famine period had a higher risk of cerebrovascular disease (HR 1.18; 95% CI 1.09 to 1.28). In participants with lower levels of physical activity, prenatal famine exposure was associated with a higher risk of ischaemic heart disease (HR 1.15; 95% CI 1.05 to 1.26) and cerebrovascular disease (HR 1.13; 95% CI 1.05 to 1.21).…”