Effect of Exposure to Famine during Early Life on Risk of Metabolic Syndrome in Adulthood: A Meta-Analysis

Qin, Lulu; Luo, Biao; Gao, Fan; Feng, Xiang-Lin; Liu, Jiahe

doi:10.1155/2020/3251275

Cited by 20 publications

(23 citation statements)

References 45 publications

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“…Compared with a non-exposed group, early-life famine exposure significantly increased the risk of MetS in women only. 88 However, most studies were conducted in China where families may have preferentially allocated food and other resources to sons at the expense of daughters during the famine due to a culture of ‘son preference’. 89 Malnutrition severity may thus explain increased NCD risk in women.…”

Section: Discussionmentioning

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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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: Discussionmentioning

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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“…The Chinese famine from 1959 to 1961 is considered to be one of the largest and most severe famines, which provides an opportunity to explore the association between fetal famine exposure and health outcomes. Previous studies indicated that exposure to famine during early life may increase obesity, hypertension, diabetes and other diseases in adulthood [10][11][12][13]16,19,20,[22][23][24][25][26]28,30,32,33,[36][37][38][39][40][41][42]. Regarding obesity, some studies focused their attention on the fetal exposure to famine and BMI or WC in some regions of China or foreign countries [13,19,20,30,31,38,42].…”

Section: Introductionmentioning

confidence: 99%

Fetal Exposure to Chinese Famine Increases Obesity Risk in Adulthood

Song

Wang

Chen

et al. 2020

IJERPH

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Fetal exposure to famine may have long-term consequences in adulthood. The purpose of the present study was to explore the association between famine exposure in fetal life (Chinese famine in 1959–1961) and obesity risk in adulthood. A total of 8054 subjects (3422 male, 4632 female) were recruited from the cross-sectional 2010–2012 China National Nutrition and Health Survey (CNNHS). The subjects born in 1960 and 1961 were selected as the exposed group, while the subjects born in 1963 were selected as the unexposed group. Multiple linear or logistic regression was performed to examine the association between fetal exposure to famine and risk of obesity (body mass index (BMI), waist circumference (WC), obesity, central obesity) adjusting for gender, education level, economic status, physical exercise, sedentary time, smoking, drinking, the intake of livestock and poultry and the intake of cereal and beans. Compared with the unexposed group, WC increased by 0.52 cm after adjusting the covariates (p = 0.021) and females in the exposed group had a significantly higher prevalence of central obesity with an odds ratio (OR) of 1.15 (1.01,1.31) after adjusting the confounders (p = 0.030). WC increased by 0.71 cm, 1.21 cm after adjusting the covariates compared with the unexposed group among the total subjects and the female subjects in urban areas (p = 0.021, p = 0.001). The female subjects had a significantly higher prevalence of obesity and central obesity, with ORs of 1.34 (1.04,1.71) (p = 0.022), 1.28 (1.07,1.53) (p = 0.008) respectively. Our results suggest that fetal exposure to the Chinese famine increased obesity risk in adulthood, and the association was stronger in female and urban subjects.

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“…Therefore, they failed to recognize methodological problems discussed above, especially uncontrolled age differences between famine births and post-famine births in Chinese famine studies. [6][7][8][9][10][11][12] This shows how meta-analysis of observational studies would generate misleading results unless careful examination of study methods is carried out. 21,22 It is important to keep in mind using meta-analysis as an exploratory and comparative tool rather than a tool of producing 'precise' results especially for observational studies.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, multiple meta-analyses have been conducted to summarize long-term impacts of the Chinese famine and other famines on health outcomes. [6][7][8][9][10][11][12] These individual studies and meta-analyses claimed increased risks of adverse health outcomes with prenatal famine exposure. Many reviews and commentaries therefore concluded that famine exposure is a major driver for the current T2D epidemic in China and will contribute to an increased risk of T2D in future generations.…”

Section: Introductionmentioning

confidence: 99%

Early-life exposure to the Chinese famine of 1959-61 and type 2 diabetes in adulthood: a systematic review and meta-analysis

Lumey

2022

Preprint

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Background The Chinese famine of 1959-61 has been widely interpreted as an important driver of current and future type 2 diabetes (T2D) epidemics. We conducted a systematic review and meta-analysis of prenatal famine exposure and type 2 diabetes (T2D) in China to summarize study characteristics, examine impacts of control selections and other selected characteristics on study results, identify other characteristics influencing results, and formulate recommendations for future studies. Methods We searched English and Chinese databases for studies that examined the relationship between T2D and prenatal exposure to the Chinese famine up to February 8th, 2022. From included studies, we extracted information on the number of T2D cases and populations at risk among individuals born during the famine (famine births), before the famine (pre-famine births), and after the famine (post-famine births). We compared the risk of T2D in famine births to different controls: post-famine births, pre- and post-famine births combined, and pre-famine births. Heterogeneity across studies was assessed, and random-effects models were used to calculate summary estimates. Meta-regressions were used to examine the relationship between effect estimates and age differences. Subgroup analyses were performed based on selected characteristics, including participants' sex, age, T2D measurement, famine intensity, residence, and publication language. Findings In total, 23 studies met our inclusion criteria. Sample sizes ranged from below 300 to over 350,000. All studies defined famine exposure based on participants' date of birth, and 18 studies compared famine births to controls of post-famine births to estimate famine effects on T2D. Famine and post-famine births had an age difference of three years and over in each study. Using post-famine births as controls, a random-effects model shows an increased risk of T2D (OR 1.50, 95% CI 1.34-1.68) among famine births. In contrast, a marginally increased risk of T2D (OR 1.12, 95% CI 1.02-1.24) can be observed using pre- and post-famine births combined as controls, and a decreased risk (OR 0.89, 95% CI 0.79-1.00) using pre-famine births as controls. Studies with larger age differences between comparison groups had larger famine effects. Effect estimates comparing famine births to pre- and post-famine births combined depend on none of above selected characteristics. Studies showed a large variation in sampling sources, famine intensity assessment, and confounding adjustment. Interpretation Current estimates of a positive relation between prenatal exposure to the Chinese famine and adult T2D are mainly driven by uncontrolled age differences between famine births and post-famine controls. Marginal or no effects remain after controlling for the differences in most Chinese famine studies. It remains an open question to what extent the famine is related to current T2D patterns in China. Studies with more rigorous methods including age-balanced controls and robust famine intensity measures will be needed to quantify this relationship. Funding None.

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Effect of Exposure to Famine during Early Life on Risk of Metabolic Syndrome in Adulthood: A Meta-Analysis

Cited by 20 publications

References 45 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

Fetal Exposure to Chinese Famine Increases Obesity Risk in Adulthood

Early-life exposure to the Chinese famine of 1959-61 and type 2 diabetes in adulthood: a systematic review and meta-analysis

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