Famine exposure in the young and the risk of type 2 diabetes in adulthood.
The developmental origins hypothesis proposes that undernutrition during early development is associated with an increased type 2 diabetes risk in adulthood. We investigated the association between undernutrition during childhood and young adulthood and type 2 diabetes in adulthood. We studied 7,837 women from Prospect-EPIC (European Prospective Investigation Into Cancer and Nutrition) who were exposed to the 1944-1945 Dutch famine when they were between age 0 and 21 years. We used Cox proportional hazards regression models to explore the effect of famine on the risk of subsequent type 2 diabetes in adulthood. We adjusted for potential confounders, including age at famine exposure, smoking, and level of education. Self-reported famine exposure during childhood and young adulthood was associated with an increased type 2 diabetes risk in a dose-dependent manner. In those who reported moderate famine exposure, the age-adjusted type 2 diabetes hazard ratio (HR) was 1.36 (95% CI [1.09-1.70]); in those who reported severe famine exposure, the age-adjusted HR was 1.64 (1.26-2.14) relative to unexposed women. These effects did not change after adjustment for confounders. This study provides the first direct evidence, using individual famine exposure data, that a short period of moderate or severe undernutrition during postnatal development increases type 2 diabetes risk in adulthood.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands. a.abeelen@umcutrecht.nl
Annet F M
AF
van Abeelen
Sjoerd G
SG
Elias
Patrick M M
PM
Bossuyt
Diederick E
DE
Grobbee
Yvonne T
YT
van der Schouw
Tessa J
TJ
Roseboom
Cuno S P M
CS
Uiterwaal
D000293:Adolescent; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003924:Diabetes Mellitus, Type 2; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D044342:Malnutrition / Q000150:complications*; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D012306:Risk; D013217:Starvation / Q000150:complications* / Q000453:epidemiology; D047789:World War II; D055815:Young Adult