title: Prenatal malnutrition and adult schizophrenia: further evidence from the 1959-1961 Chinese famine.
abstract: OBJECTIVE
  Evidence from the 1944-1995 Dutch Hunger Winter and the 1959-1961 Chinese famines suggests that those conceived or in early gestation during famines, have a 2-fold increased risk of developing schizophrenia in adult life. We tested the hypothesis in a second Chinese population and also determined whether risk differed between urban and rural areas.
  
  
  METHODS
  The risk of schizophrenia was examined in Liuzhou prefecture of Guangxi autonomous region. Rates were compared among those conceived before, during, and after the famine years. Based on the decline in birth rates, we predicted that those born in 1960 and 1961 would have been exposed to the famine during conception or early gestation. All psychiatric case records in Liuzhou psychiatric hospital for the years 1971 through 2001 were examined and clinical/sociodemographic data extracted by psychiatrists blind to exposure status. Data on births and deaths in the famine years were also available, and cumulative mortality was estimated from later demographic surveys. Evidence of famine was verified, and results were adjusted for mortality. Relative risks (RRs) for schizophrenia were calculated for the region as a whole and for urban and rural areas separately.
  
  
  RESULTS
  Mortality-adjusted RR for schizophrenia was 1.5 (1960) and 2.05 (1961), respectively. However, the effect was exclusively from the rural areas RR = 1.68 (1960) and RR = 2.25 (1961).
  
  
  CONCLUSIONS
  We observe a 2-fold increased risk of schizophrenia among those conceived or in early gestation at the height of famine with risk related to severity of famine conditions.
authors.affiliation: Bio-X Life Science Research Center, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai 200030, PR China.
authors.forename: Ming-Qing
authors.initials: MQ
authors.lastname: Xu
authors.forename: Wen-Sheng
authors.initials: WS
authors.lastname: Sun
authors.forename: Ben-Xiu
authors.initials: BX
authors.lastname: Liu
authors.forename: Guo-Yin
authors.initials: GY
authors.lastname: Feng
authors.forename: Lan
authors.initials: L
authors.lastname: Yu
authors.forename: Lawrence
authors.initials: L
authors.lastname: Yang
authors.forename: Guang
authors.initials: G
authors.lastname: He
authors.forename: Pak
authors.initials: P
authors.lastname: Sham
authors.forename: Ezra
authors.initials: E
authors.lastname: Susser
authors.forename: David
authors.initials: D
authors.lastname: St Clair
authors.forename: Lin
authors.initials: L
authors.lastname: He
mesh_terms: D000328:Adult; D001723:Birth Rate; D002681:China; D003430:Cross-Sectional Studies; D004190:Disasters; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D044342:Malnutrition / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D009026:Mortality; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D012306:Risk; D012424:Rural Population / Q000706:statistics & numerical data; D012559:Schizophrenia / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D013217:Starvation / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D016019:Survival Analysis; D014505:Urban Population / Q000706:statistics & numerical data