title: Exposure to Famine at a Young Age and Unhealthy Lifestyle Behavior Later in Life.
abstract: BACKGROUND
  A healthy diet is important for normal growth and development. Exposure to undernutrition during important developmental periods such as childhood and adolescence can have effects later in life. Inhabitants of the west of the Netherlands were exposed to severe undernutrition during the famine in the last winter of the second World War (1944-1945).
  
  
  OBJECTIVE
  We investigated if exposure of women to the Dutch famine during childhood and adolescence was associated with an unhealthy lifestyle later in life.
  
  
  METHODS
  We studied 7,525 women from the Prospect-EPIC cohort, recruited in 1993-97 and aged 0-18 years during the Dutch famine. An individual famine score was calculated based on self-reported information about experience of hunger and weight loss. We investigated the association between famine exposure in early life and four lifestyle factors in adulthood: smoking, alcohol consumption, physical activity level and a Mediterranean-style diet.
  
  
  RESULTS
  Of the 7,525 included women, 46% were unexposed, 38% moderately exposed and 16% severely exposed to the Dutch famine. Moderately and severely exposed women were more often former or current smokers compared to women that did not suffer from the famine: adjusted prevalence ratio 1.10 (95% CI: 1.05; 1.14) and 1.18 (1.12; 1.25), respectively. They also smoked more pack years than unexposed women. Severely exposed women were more often physically inactive than unexposed women, adjusted prevalence ratio 1.32 (1.06; 1.64). Results did not differ between exposure age categories (0-9 and 10-17 years). We found no associations of famine exposure with alcohol consumption and no dose-dependent relations with diet.
  
  
  CONCLUSIONS
  Exposure to famine early in female life may be associated with higher prevalence of smoking and physical inactivity later in life, but not with unhealthy diet and alcohol consumption.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.|National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
authors.forename: Heidi P
authors.initials: HP
authors.lastname: Fransen
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.|School of Public Health, Imperial College London, London, United Kingdom.
authors.forename: Petra H M
authors.initials: PH
authors.lastname: Peeters
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Joline W J
authors.initials: JW
authors.lastname: Beulens
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
authors.forename: Jolanda M A
authors.initials: JM
authors.lastname: Boer
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.|National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
authors.forename: G Ardine
authors.initials: GA
authors.lastname: de Wit
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: N Charlotte
authors.initials: NC
authors.lastname: Onland-Moret
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Yvonne T
authors.initials: YT
authors.lastname: van der Schouw
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.|School of Public Health, Imperial College London, London, United Kingdom.|Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands.|Dt. of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: H Bas
authors.initials: HB
authors.lastname: Bueno-de-Mesquita
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
authors.forename: Jeljer
authors.initials: J
authors.lastname: Hoekstra
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Sjoerd G
authors.initials: SG
authors.lastname: Elias
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Anne M
authors.initials: AM
authors.lastname: May
mesh_terms: D000428:Alcohol Drinking / Q000453:epidemiology*; D005247:Feeding Behavior; D005260:Female; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D013217:Starvation / Q000453:epidemiology*; D047789:World War II