Hypertension, Diabetes and Overweight: Looming Legacies of the Biafran Famine

Abstract

BackgroundSub-Saharan Africa is facing rapidly increasing prevalences of cardiovascular disease, obesity, diabetes and hypertension. Previous and ongoing undernutrition among pregnant women may contribute to this development as suggested by epidemiological studies from high income countries linking undernutrition in fetal life with increased burden of non-communicable diseases in later life. We undertook to study the risks for hypertension, glucose intolerance and overweight forty years after fetal exposure to famine afflicted Biafra during the Nigerian civil war (1967–1970).Methods and FindingsCohort study performed in June 27–July 31, 2009 in Enugu, Nigeria. Adults (n = 1,339) born before (1965–67), during (1968–January 1970), or after (1971–73) the years of famine were included. Blood pressure (BP), random plasma glucose (p-glucose) and anthropometrics, as well as prevalence of hypertension (BP>140/90 mmHg), impaired glucose tolerance (IGT; p-glucose 7.8–11.0 mmol/l), diabetes (DM; p-glucose ≥11.1 mmol/l), or overweight (BMI>25 kg/m2) were compared between the three groups. Fetal-infant exposure to famine was associated with elevated systolic (+7 mmHg; p<0.001) and diastolic (+5 mmHg; p<0.001) BP, increased p-glucose (+0.3 mmol/L; p<0.05) and waist circumference (+3cm, p<0.001), increased risk of systolic hypertension (adjusted OR 2.87; 95% CI 1.90–4.34), IGT (OR 1.65; 95% CI 1.02–2.69) and overweight (OR 1.41; 95% CI 1.03–1.93) as compared to people born after the famine. Limitations of this study include the lack of birth weight data and the inability to separate effects of fetal and infant famine.ConclusionsFetal and infant undernutrition is associated with significantly increased risk of hypertension and impaired glucose tolerance in 40-year-old Nigerians. Prevention of undernutrition during pregnancy and in infancy should therefore be given high priority in health, education, and economic agendas.

Nutritional Characteristics of the Dairy Cow During Early Gestation and Subsequent Growth and Cardiac Measurements of Her Offspring

“…Wither height in calves at one month of age was positively correlated to mean concentration of glucose. Maternal undernutrition in early pregnancy may cause hypertension in offspring as human adults (Hult et al, 2010;Ravelli et al, 1976) as well as metabolic syndrome (impaired glucose tolerance, hypertension and increased triglycerides) in humans (Barker et al, 1993;Boney et al, 2005;De Rooij et al, 2007;Yarbrough et al, 1998). It is yet to be determined if concentration of glucose in the dam during early gestation might impact calves as they grow and join the lactating herd or whether a method of compensation takes place instead.…”

Child survival revolutions revisited – lessons learned from Bangladesh, Nicaragua, Rwanda and Vietnam

“…It should be noted that even children conceived or born at the time of the famine continued to have increased mortality risks during the first few years of life 16. There is also accumulating evidence of chronic disease risks associated with intrauterine exposure to famine, as demonstrated by studies of the Dutch famine in 1944–1945 17, the Chinese famine in 1959–1961 18 and the Biafra famine in 1968–1970 19.…”

Mini-review: Obesity in Caribbean Youth

“…Seminal papers by Hult and colleagues (29) at the Karolinska Institute in Sweden, and Fung (30) at Wheaton College in Illinois have shown that malnutrition in early gestation causes greater susceptibility to obesity. Regardless of ethnicity or geographic location, the researchers always observed the effects of famine and the resultant obesity.…”