Exposure to the 1959-1961 Chinese Famine and Risk of Non-Communicable Diseases in Later Life: a Life Course Perspective

Abstract

Introduction: Child undernutrition and later-life non-communicable diseases (NCDs) are major global health issues. Existing literature suggests that undernutrition/famine exposure in childhood has immediate and long-term adverse health consequences. However, many existing studies have theoretical and methodological limitations. To add to the literature and overcome some of these limitations, we adopted a life course perspective and used more robust methods to investigate the association between exposure to the 1959-1961 Chinese famine and later-life NCDs and if this association depends on: life stage (age) at exposure, severity of exposure, and sex. Methods: Secondary data analysis of the China Health and Retirement Longitudinal Study (2011-2018, N=11,094). We measured famine exposure and severity using self-reported experience, life stages using age at exposure, and health using the number of NCDs. We performed Poisson growth curve models. Results: First, compared with unexposed participants, those exposed before age of 18 had a higher risk of later-life NCDs, particularly if exposed in-utero (IRR=1.90, 95% CI [1.70, 2.12], p < .001) and in the first 1,000 days of life (IRR=1.86, 95% CI [1.73, 2.00], p < .001; for 0-6 months group, IRR=1.95, 95% CI [1.67, 2.29], p < .001). Second, the famine effects among participants moderately and severely exposed were similar (IRR = 1.18, 95% CI [1.09, 1.28], p < .001 and IRR = 1.24, 95% CI [1.17, 1.32], p < .001). Third, the famine effects did not differ between females and males (IRR = 0.98, 95% CI [0.90, 1.07], p = .703). Conclusion: In the life course of an individual, in-utero and the first 1,000 days are a particularly sensitive time period with marked long-term implications for NCDs if undernutrition/famine are experienced in this period. However, this window remains open until young adulthood. This highlights the need to invest more in both preventing and treating child/adolescent undernutrition to tackle the problem of later-life NCDs.

Insights from social‐ecological systems thinking for understanding and preventing famine

“…Following historic famines there can even be social transformation; for example, a famine in Ethiopia in 1973 that killed approximately 200,000 people was a driver of a revolution in 1974 that led to the fall of the imperial regime of Haile Selassie (de Waal, 2018, p. 118). In other circumstances, famine may result in transformation at smaller scales, such as pushing households into chronic poverty, with intergenerational effects on children (Cheng et al, 2023). The point is that rather than famine being an event or a process, it is part of the non‐linear dynamics and evolution of a social‐ecological system, and will shape the future trajectory of that system.…”

Accelerated biological aging six decades after prenatal famine exposure

“…An established natural-experiment design for investigating effects of early-life adversity on laterlife health is in-utero exposure to famine (7). In studies of the Dutch Hunger Winter (1944-5), Siege of Leningrad , Holodomor famine in Ukraine , and Great Chinese Famine , survivors of in-utero famine exposure exhibit higher burdens of multiple agingrelated diseases and have shorter lifespans as compared to unexposed individuals born before or after famine or in adjacent, unaffected regions (8)(9)(10)(11)(12)(13). Within the Fetal Origins and Developmental Origins of Health and Disease literatures, these observations are often interpreted as reflecting in-utero programming of risk for cardiovascular and metabolic disease later in life (4,14,15).…”