London School of Hygiene & Tropical Medicine

Exposure to famine in early life is linked to a greater risk of non-communicable diseases (NCDs) in later-life, according to new research published in PLoS Global Public Health.

Those who had been exposed to famine before the age of 18 faced a higher risk of NCDs compared to those unexposed.

NCDs included diabetes, cancer, heart disease, stroke, memory-related diseases and arthritis, among others.

The risk of NCDs for individuals exposed to famine in-utero or in the ‘first 1,000 days’ of life was approximately 90% greater than for those who were unexposed to famine. Those exposed to famine before the age of 10 (in pre-school and primary school) had a 50% increased risk of NCDs in later life while individuals exposed to famine in adolescence (10-18 years) had an 8% increased risk. In contrast, individuals exposed to famine over the age of 18 had a decreased risk of NCDs in later life compared to unexposed individuals.

The research team, led by PhD student Mengling Cheng and colleagues from the University of Lausanne, Switzerland, and the London School of Hygiene & Tropical Medicine (LSHTM), found that effects were similar for individuals moderately and severely exposed to famine.

Dr Marko Kerac, Associate Professor in Global Child Health and Nutrition at LSHTM, and study co-author, said: “These results highlight the importance of preventing and treating child malnutrition. With conflict, climate crisis and post-COVID economic crises still causing major shocks worldwide, this is more important now than ever. Such work should never be seen as cost: it is an investment which not only prevents child deaths in the short-term but plays a key role in adult health long-term.”

Both child undernutrition and NCDs are major global health issues, with World Health Organization figures attributing NCDs to 74% (41 million) of all deaths globally.

This study aimed to understand the link between exposure to the Chinese famine of 1959-1961 and NCDs 50 years later. The Chinese famine of 1959-1961 is the largest famine in human history, causing almost 30 million premature deaths.

The team analysed data collected through the China Health and Retirement Longitudinal Study which took place from 2011-2018 and included both urban and rural residents. They adopted a life course perspective, focusing on a wide period of life from in-utero until adulthood (24-40 years). 11,094 participants were included who had been exposed to famine at different life stages and at differing levels of severity.

Participants were categorized into seven life stages at famine exposure: in-utero, ‘first 1,000 days’ infants, pre-school children (3-5 years), primary school children (6-9 years), adolescents (10-18 years), young adults (19-23 years), and adults (24-40 years).

14 NCDs were included in the study: hypertension, dyslipidemia, diabetes, cancer, lung disease, liver disease, heart disease, stroke, kidney disease, digestive disease, psychiatric problems, memory-related diseases, arthritis, and asthma.

The study findings reveal that exposure to famine at different life stages affects individuals differently, with the greatest risk of NCDs linked to those who had been exposed earlier in life. This demonstrates the importance of protecting nutrition throughout the early life stages from in-utero until young adulthood to tackle later-life NCDs. The ‘first 1,000 days’ of life is a particularly vulnerable period of rapid development that plays a crucial role in long-term health. These findings justify the need for effective nutrition during this period and make the case for long-term investment in nutrition across the life course.

Mengling Cheng, Marie Skłodowska-Curie PhD student at the University of Lausanne and Swiss School of Public Health, Switzerland, who led the study, said: “Our findings emphasise the importance of life course perspective in undernutrition prevention/treatment programmes. The current focus of global nutrition programmes on the in-utero and the ‘first 1,000 days’ of life is important, but given evidence for continuing risks, older children and adolescents also matter and should be included .”

The research team recognise that measurements of famine exposure and severity were based on retrospective self-reported experiences and therefore may not accurately capture the severity of famine experience.

Read the paper.