Exposure to the Chinese famine in early life and the risk of hyperglycemia and type 2 diabetes in adulthood

  1. Frank B Hu (nhbfh{at},4
  1. 1 National Institute for Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, China
  2. 2 Department of Nutrition, Harvard School of Public Health, USA
  3. 3 Division of Human Nutrition, Wageningen University, The Netherlands
  4. 4Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, USA
  5. 5 Departments of Epidemiology and Pediatrics, Erasmus MC, Rotterdam, The Netherlands


Objective– Early developmental adaptations in response to undernutrition may play an essential role in the susceptibility to type 2 diabetes, particularly for those experiencing a ‘mismatched rich nutritional environment’ in later life. We examined the associations of exposure to the Chinese famine (1959-1961) during fetal life and childhood with the risk of hyperglycemia and type 2 diabetes in adulthood.

Research design and methods– We used the data of 7,874 rural adults born between 1954 and 1964 in the selected communities from the cross-sectional 2002 China National Nutrition and Health Survey. Hyperglycemia was defined as fasting plasma glucose ≥6.1mmol/L and/or 2-h plasma glucose ≥7.8 mmol/L and/or clinically diagnosed as type 2 diabetes previously.

Results– Prevalences of hyperglycemia among adults in non-exposed, fetal exposed, early-childhood, mid-childhood and late-childhood exposed cohorts were 2.4%, 5.7%, 3.9%, 3.4% and 5.9%, respectively. In severely affected famine areas, fetal-exposed subjects had an increased risk of hyperglycemia compared to non-exposed subjects (Odds ratio=3.92; 95%CI: 1.64-9.39; P=0.002); this difference was not observed in less severely affected famine areas (Odds ratio=0.57; 95%CI: 0.25-1.31; P=0.185); the odds ratios were significantly different between the severe and less severe famine areas (P for interaction =0.001). In severely affected famine areas, fetal-exposed subjects who followed an affluent/western dietary pattern (Odds ratios=7.63; 95%CI: 2.41-24.1; P=0.0005) or had a higher economic status in later life experienced a substantially elevated risk of hyperglycemia (Odds ratios=6.20; 95%CI: 2.08-18.5; P=0.001).

Conclusions– Fetal exposure to severe Chinese famine increases the risk of hyperglycemia in adulthood. This association appears to be exacerbated by a nutritional ‘rich’ environment in later life.


    • Received March 19, 2010.
    • Accepted June 24, 2010.