title: Elevated levels of protein in urine in adulthood after exposure to the Chinese famine of 1959-61 during gestation and the early postnatal period.
abstract: BACKGROUND
  Animal models have suggested that undernutrition during gestation and the early postnatal period may adversely affect kidney development and compromise renal function. As a natural experiment, famines provide an opportunity to test such potential effects in humans. We assessed whether exposure to the Chinese famine of 1959-1961 during gestation and early postnatal life was associated with the levels of proteinuria among female adults three decades after exposure to the famine.
  
  
  METHODS
  We measured famine intensity using the cohort size shrinkage index and we constructed a difference-in-difference model to compare the levels of proteinuria, measured with a dipstick test of random urine specimens, among Chinese women (n = 70 543) whose exposure status to the famine varied across birth cohorts (born before, during or after the famine) and counties of residence with different degrees of famine intensity.
  
  
  RESULTS
  Famine exposure was associated with a greater risk [odds ratio (OR) = 1.54; 95% confidence interval (CI): 1.04, 2.28; P = 0.029) of having higher level of proteinuria among women born during the famine years (1959-61) compared with the unexposed post famine-born cohort (1964-65) in rural samples. No association was observed among urban samples. Results were robust to adjustment for covariates.
  
  
  CONCLUSIONS
  Severe undernutrition during gestation and the early postnatal period may have long-term effects on levels of proteinuria in humans, but the effect sizes may be small.
authors.affiliation: George Washington University - Department of Global Health, Washington, District of Columbia, United States, UC Berkeley School of Public Health - Health Services & Policy Analysis, Berkeley, California, United States, University of Maryland School of Public Health, College Park, Maryland, United States and Emory University - Hubert Department of Global Health, Atlanta, Georgia, United States chenghuang@gwu.edu.
authors.forename: Cheng
authors.initials: C
authors.lastname: Huang
authors.affiliation: George Washington University - Department of Global Health, Washington, District of Columbia, United States, UC Berkeley School of Public Health - Health Services & Policy Analysis, Berkeley, California, United States, University of Maryland School of Public Health, College Park, Maryland, United States and Emory University - Hubert Department of Global Health, Atlanta, Georgia, United States.
authors.forename: Chaoran
authors.initials: C
authors.lastname: Guo
authors.affiliation: George Washington University - Department of Global Health, Washington, District of Columbia, United States, UC Berkeley School of Public Health - Health Services & Policy Analysis, Berkeley, California, United States, University of Maryland School of Public Health, College Park, Maryland, United States and Emory University - Hubert Department of Global Health, Atlanta, Georgia, United States.
authors.forename: Catherine
authors.initials: C
authors.lastname: Nichols
authors.affiliation: George Washington University - Department of Global Health, Washington, District of Columbia, United States, UC Berkeley School of Public Health - Health Services & Policy Analysis, Berkeley, California, United States, University of Maryland School of Public Health, College Park, Maryland, United States and Emory University - Hubert Department of Global Health, Atlanta, Georgia, United States.
authors.forename: Shuo
authors.initials: S
authors.lastname: Chen
authors.affiliation: George Washington University - Department of Global Health, Washington, District of Columbia, United States, UC Berkeley School of Public Health - Health Services & Policy Analysis, Berkeley, California, United States, University of Maryland School of Public Health, College Park, Maryland, United States and Emory University - Hubert Department of Global Health, Atlanta, Georgia, United States.
authors.forename: Reynaldo
authors.initials: R
authors.lastname: Martorell
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D005260:Female; D048070:Fetal Nutrition Disorders / Q000453:epidemiology*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007228:Infant Nutrition Disorders / Q000453:epidemiology*; D007231:Infant, Newborn; D044342:Malnutrition / Q000453:epidemiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology*; D011507:Proteinuria / Q000453:epidemiology*; D012424:Rural Population / Q000706:statistics & numerical data; D013217:Starvation / Q000453:epidemiology*; D014505:Urban Population / Q000706:statistics & numerical data
keywords: Barker hypothesis; famine; maternal undernutrition; natural experiment; proteinuria; renal function