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PubMed2004

Intrauterine famine exposure and body proportions at birth: the Dutch Hunger Winter.

BACKGROUND: Fetal programming of adult disease may be a long-term effect of fetal nutrition. Expected short-term effects include changes in body size and proportions at birth. The specific responses of fetal growth to acute undernutrition at varying points in pregnancy are still unclear. METHODS: We abstracted all birth records of infants born in two midwife training schools in the western Netherlands between 1 October 1944 and 31 March 1946, and compared infants whose mothers were exposed to the Dutch famine of 1944-1945 during specific trimesters of pregnancy with control infants born in 1943. We considered birthweight (BWT), crown-to-heel length (CHL), head circumference (HC), and ratio and regression-adjusted measures of these parameters. RESULTS: BWT, CHL, and HC declined with famine exposure late in pregnancy. Changes in WT for CHL paralleled changes in WT alone in size and direction. Results for HC were inconsistent, varying by choice of body size adjustor (WT or CHL), and by method of adjustment (ratio or regression). BWT, CHL, and HC did not change with first trimester famine exposure. CONCLUSION: Even under famine conditions, birth size and body proportions vary only with late pregnancy exposure. HC for body size has the added disadvantage that late pregnancy exposure effects vary drastically with choice of measure. We do not recommend the use of birth size or body proportions as a proxy for fetal nutritional status in the study of adult disease.

Birth Weight↗
PubMed2002

Emergency relief during Europe's famine of 1817 anticipated crisis-response mechanisms of today.

Humanitarian professionals continue to seek best practice guidelines for famine relief. Many emergency interventions in developing countries draw on recent lessons from the 20th century, although attention has also been paid to historical experiences such as the 19th century evolution of India's Famine Codes and responses to Ireland's famine of the 1840s. This presentation goes further back in time to examine public responses to the pan-European famine of 1816-1817. It finds that many of the experimental actions set in place at that time contributed to a growing public acceptance of the role of government action in times of crisis, while establishing a variety of viable approaches that continue to be used today.

Emergencies↗
PubMedDate not supplied

Caloric restriction reduces age at menopause: the effect of the 1944-1945 Dutch famine.

OBJECTIVE: To assess the effect of caloric restriction, as endured during the 1944-1945 Dutch famine, on the age at which natural menopause occurs and to identify specific vulnerable age periods in which caloric restriction has the largest effect. DESIGN: This was a population-based cohort study conducted in Utrecht, the Netherlands. Between 1983 and 1986, 9,471 women aged 40 to 73 years at the time of interview were classified regarding their exposure to the famine. Age at natural menopause was obtained from all available data, retrospectively as well as prospectively. We estimated differences in mean age at natural menopause between famine exposure categories (not, moderately, and severely exposed), with adjustment for smoking, parity, socioeconomic status, body mass index, age at menarche, and year of birth. RESULTS: Women experienced natural menopause on average 0.36 years earlier (95% CI: -0.60, -0.11) when severely exposed to the famine and 0.06 years earlier (95% CI: -0.22, 0.09) when moderately exposed compared with the unexposed women. This effect was particularly pronounced in those severely exposed from 2 to 6 years of age: -1.83 years (95% CI: -3.03, -0.63). CONCLUSIONS: Our findings suggest that caloric restriction decreases age at natural menopause. Early childhood seems to be a particularly sensitive age period for this effect.

Adult↗
PubMed2006

The Dutch Famine of 1944-1945: a pathophysiological model of long-term consequences of wasting disease.

PURPOSE OF REVIEW: The tragic circumstances of the Dutch Hunger Winter of 1944-1945 created a unique opportunity to study the relation between exposure to prenatal famine and health in adult life. This review addresses the literature on the effects of maternal malnutrition during the different periods of gestation and childhood on health in adult life. RECENT FINDINGS: Exposure to famine during gestation resulted in increases in impaired glucose tolerance, obesity, coronary heart disease, atherogenic lipid profile, hypertension, microalbuminuria, schizophrenia, antisocial personality and affective disorders. Exposure to famine during childhood resulted in changes in reproductive function, earlier menopause, changes in insulin-like growth factor-I and increases in breast cancer. SUMMARY: Exposure to famine during gestation and childhood has life-long effects on health, and these effects vary depending on the timing of exposure as well as evolution of the recovery period.

Breast Neoplasms↗
PubMed1998

The changing nature of conflict and famine vulnerability: the case of livestock raiding in Turkana District, Kenya.

The context of famine in Turkana has changed in recent years as the role played by livestock raiding in contributing to famine has increased. External responses to famine in Turkana have largely been drought driven, for example, food assistance and livestock restocking programmers, which have failed to meet the real needs of herders. The role of armed conflict in the form of raiding has been overlooked as a common feature of societies facing famine and food insecurity. The traditional livelihood-enhancing functions of livestock raiding are contrasted with the more predatory forms common today. The direct impact of raiding on livelihood security can be devastating, while the threat of raids and measures taken to cope with this uncertainty undermine herders' livelihood strategies. Self-imposed restrictions on mobility negatively affect the vegetation of both grazed and ungrazed pastures and restrict the available survival strategies. Predatory raiding leads to a collapse in the moral economy. Some implications of this for relief and development policy are considered, including approaches to conflict resolution.

Animal Husbandry↗
PubMed1994

The prevention and mitigation of famine: policy lessons from Botswana and Sudan.

Botswana and Sudan experienced consecutive years of drought in the 1980s. Sudan faced a large decline in food entitlement and nutritional deterioration, which translated into famine in 1984/85. Botswana, on the other hand, nearly compensated income losses and averted nutritional deterioration and famine-related deaths. There are important lessons to learn from the famine prevention experience of Botswana. Its strategy for dealing with drought and famine combines policies of steady economic growth with supplementary poverty alleviation and drought relief programs. To provide continuity and stabilization of market operations in times of distress, the country channels sufficient food through market chains, provides price support to preempt market collapse and augments the income of consumers through public income transfer programs to prevent demand failure. In addition, it maintains a responsive and accountable political system and a decentralized participatory administrative structure. While Sudan should develop policies that are compatible with its own environment, it is crucial that it recognizes the critical role of public action in promoting growth, alleviating poverty, and providing timely relief responses in times of anticipated growth failure.

Botswana↗
PubMed1994

An examination of the 1990-91 famine in Sudan.

Shortly before and during the harvest of 1990, a series of warnings were issued by concerned international and UN agencies that Sudan would experience a very poor harvest followed by an acute food shortage over the period 1990-91. The 1990 harvest was estimated to be similar to that obtained in 1984. After the very poor harvest in 1984, Sudan experienced a major famine during which deaths may have numbered in the hundreds of thousands. There were fears that this experience might be repeated in 1990-91. By the time of the subsequent 1991 harvest, it was clear to all that a severe food crisis had been experienced. There were severe shortages of water and food and very high malnutrition rates of children were noted by UNICEF across a wide range of areas. Despite these adverse indications, starvation deaths were probably numbered in thousands, rather than hundreds of thousands. Famine mortality, which may include deaths from famine associated disease, was similarly low. The initial predictions, it now seems, may have over-estimated famine mortality almost one hundred times. Several potential explanations of the over-estimate are examined. These include prediction errors, government and donor responses to the drought such as food aid and immunization, and traditional community and household level coping strategies in times of food shortage.

Disasters↗
PubMed2003

A study of resilience in young Ethiopian famine survivors.

We studied resilience related to childhood experiences of famine in Ethiopia. We sought an understanding of how young Ethiopians survived and coped with the devastating effects of famine. Participant observations and in-depth interviews at an orphanage in Addis Ababa with eight boys and girls (ages 18 to 23), survivors from famine catastrophe in Ethiopia 1984-1985, were conducted. Significant resilience factors identified were faith and hope, having a living relative, and having memories of one's past roots. Exposure to famine and multiple early losses may have long-term effects on an individual's capacity to maintain resilience. We discuss how an understanding of resilience can be applied in different cultural settings. Future research on resilience in Africa is suggested to increase our knowledge base of this concept.

Adaptation, Psychological↗
PubMed1997

Genetic drift and gene flow in post-famine Ireland.

This study examines the genetic impact of the Great Famine (1846-1851) on the regional genetic structure of Ireland. The Great Famine resulted in a rapid decrease in population size throughout Ireland in a short period of time, increasing the possibility of genetic drift. Our study is based on migration and anthropometric data collected originally in the 1930s from 7211 adult Irish males. These data were subdivided into three time periods defined by year of birth: 1861-1880, 1881-1900, and 1901-1920. Within each time period the data were further subdivided into six geographic regions of Ireland. Estimates of Wright's FST were calculated from parent-offspring migration data and from 17 anthropometric variables (10 head measures, 7 body measures). Over time, the average population size decreased, but average rates of migration increased. The estimates of FST at equilibrium from migration matrix analysis suggest that the net effect of these opposite effects is a reduction in among-group variation. Closer examination shows that within each time period the rate of convergence to equilibrium is slow, meaning that the expected levels of genetic homogeneity revealed from migration matrix analysis are not likely to be seen over short intervals of time. Estimates of FST from anthropometric data show either relatively little change in microdifferentiation or some increase, depending on which variables are analyzed. Investigation of a simple model of demographic and genetic change shows that, given the demographic changes in post-Famine Ireland, FST could in theory increase, decrease, or remain the same over short intervals of time. Overall, the Great Famine appears to have had minimal impact on the genetic structure of Ireland on a regional level. Comparison with studies focusing on local genetic structure shows the opposite. It appears that the level of genetic impact depends strongly on the level of analysis; local populations are affected to a greater extent by demographic shifts than regional populations. We also provide formulas for the standard errors of FST from metric traits and related statistics.

Adolescent↗
PubMed1995

Emigration and living standards in Ireland since the Famine.

"Ireland experienced dramatic levels of emigration in the century following the Famine of 1845-1849. The paper surveys the recent cliometric literature on post-Famine emigration and its effects on Irish living standards. The conclusions are that the Famine played a significant role in unleashing the subsequent emigration; and that emigration was crucial for the impressive increase in Irish living standards which took place during the next 100 years."

Conservation of Natural Resources↗
PubMed1996

Using middle upper arm circumference to assess severe adult malnutrition during famine.

OBJECTIVES: To examine the use of middle upper arm circumference measurement (MUAC [cm]) and body mass index measurement (BMI [kg/m2]) in the screening of severely malnourished adults during famine. DESIGN: Nonrandomized cohort study, correlating measurements of MUAC and BMI. SETTING: The Concern Worldwide adult feeding center in the village of Ayod in south Sudan. The area has experienced several years of war, leading to severe famine during early 1993. PARTICIPANTS: A total of 98 adult inpatients belonging to the Nuer tribe. Criteria for entry into the study were prior admission to the feeding center and the ability to stand and have a BMI measured. MAIN OUTCOME MEASURES: A comparison of the ease of use of MUAC and BMI assessments, and a correlation of MUAC and BMI measurements. RESULTS: An MUAC measurement was easier to perform on severely malnourished adults than BMI assessment. For MUAC, the patient could be standing, sitting, or, in extreme cases, lying. For BMI, patients were required to stand. Measuring BMI requires a height board, weighing scales, and mathematical calculations; to measure MUAC, only a tape measure is required. A correlation between measurements of MUAC and BMI was demonstrated (r=0.88; 95% confidence interval, 0.82-0.92 P<.001). The proportions of the population and the actual individuals identified as malnourished by the 2 indicators were similar. CONCLUSIONS: The MUAC measurement reflects adult nutritional status as defined by BMI. During famine, MUAC may be better suited to screening admissions to adult feeding centers than BMI. Studies to assess the capacity of MUAC cutoffs to predict mortality in severe adult malnutrition are needed.

Adult↗
PubMed2000

Short-term prognosis in severe adult and adolescent malnutrition during famine: use of a simple prognostic model based on counting clinical signs.

CONTEXT: In the setting of famine, infection is likely to cause mortality among severely malnourished persons. Although clinical signs are likely to be useful prognostic indicators in this setting, use of a clinical assessment model has not been studied. OBJECTIVE: To examine the use of clinical signs in the prediction of short-term mortality in severely malnourished adults and adolescents during famine. DESIGN: Retrospective cohort study. SETTING: Concern Worldwide Adult Therapeutic Feeding Center in Baidoa, Somalia. PATIENTS: Data from the clinical records of 383 adult and adolescent inpatients admitted to the center between November 1992 through March 1993 who were aged 15 years or older and had a body mass index (BMI) of 13.5 kg/m(2) or less or any signs of edematous malnutrition. MAIN OUTCOME MEASURES: Association of mortality with presence or absence of 8 clinical signs (edema, hydration, ascites, dysentery, diarrhea, anemia, chest infection, and ability to stand) and BMI at admission, and sensitivity and specificity of models including a count of clinical signs and BMI in the prediction of mortality at the center. RESULTS: Ninety-one patients (23.8%) died, with a median time to death of 8 days from admission. Of the 8 clinical signs, severe edema (unadjusted odds ratio [OR], 2.45; 95% confidence interval [CI], 1.41-4.27), apparent dehydration (unadjusted OR, 2. 73; 95% CI, 1.60-4.66), and inability to stand (unadjusted OR, 2.96; 95% CI, 1.40-6.26) were independently associated with mortality. The most useful clinical model was that based on the presence of any 1 of these 3 signs, with a sensitivity of 77% and a specificity of 59%. Ability of admission BMI to predict mortality was less than random. CONCLUSIONS: Models based on clinical signs predicted death better than BMI. Simple counts of clinical signs performed as well as more complex models based on the addition of ORs. Counting relevant clinical signs is an easy and effective prognostic tool in severe adult and adolescent malnutrition during famine; however, it is not sensitive enough for use as a screening tool. JAMA. 2000;284:621-626

Adolescent↗
PubMed2001

Changing the way we address severe malnutrition during famine.

This year, yet again, saw widespread food insecurity and famine across the horn of Africa. Again, humanitarian agencies set up operations to implement various relief programmes. Nutritional interventions included general ration distribution to the whole of an affected population; blanket supplementary feeding to all members of an identified risk group; and targeted dry supplementary feeding centres for moderately malnourished and therapeutic feeding centres for the severely malnourished. As is usual in emergencies, many of the therapeutic feeding centres were hard to set up and did not achieve an adequate coverage of all the severely malnourished. This combination of delays and low coverage meant that many therapeutic feeding centres achieved little overall impact on mortality. I believe that the present focus on therapeutic feeding centres as the sole mode of treating severely malnourished people during famine is inappropriate and often counter-productive. A new concept of community-based therapeutic care is necessary to complement therapeutic feeding centres' interventions if famine relief programmes are to address the plight of the severely malnourished in an efficient and effective manner. During an emergency, the community-based therapeutic care approach could quickly provide good coverage and appropriate treatment for large numbers of severely malnourished people. The principles behind community-based therapeutic care are, however, developmental, empowering communities to cope more effectively with crisis and with transition back to normality. This is very different to the therapeutic feeding centres' approach that disempowers communities, requires very large amounts of external staff and resources, and undermines the infrastructure. Although emergency community-based therapeutic care programmes could be large-scale and implemented quickly, they could also evolve into developmental Hearth model nutritional programmes without changing their conceptual basis. Conversely, Hearth programmes, although largely sustainable, could in times of crisis quickly scale-up into rapid effective emergency interventions. Creating such a continuum between emergency and developmental approaches has long been a holy grail of humanitarianism.

Africa↗
PubMed2003

New variant famine: AIDS and food crisis in southern Africa.

Southern Africa is undergoing a food crisis of surprising scale and novelty. The familiar culprits of drought and mismanagement of national strategies are implicated. However, this crisis is distinct from conventional drought-induced food shortages with respect to those vulnerable to starvation, and the course of impoverishment and recovery. We propose that these new aspects to the food crisis can be attributed largely to the HIV/AIDS epidemic in the region. We present evidence that we are facing a new variant famine. We have used frameworks drawn from famine theory to examine the implications. HIV/AIDS has created a new category of highly vulnerable households--namely, those with ill adults or those whose adults have died. The general burden of care in both AIDS-affected and non-AIDS-affected households has reduced the viability of farming livelihoods. The sensitivity of rural communities to external shocks such as drought has increased, and their resilience has declined. The prospects for a sharp decline into severe famine are increased, and possibilities for recovery reduced.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Breast cancer and the brain: a neurodevelopmental hypothesis to explain the opposing effects of caloric deprivation during the Dutch famine of 1944-1945 on breast cancer and its risk factors.

Most studies on calorie deprivation and cancer risk in rodents show reductions in tumor occurrence. However, the few human studies on calorie restriction are conflicting. An overview is given of results in the DOM (diagnostic onderzoek mammacarcinoom) cohorts among women exposed to the Dutch Famine of 1944-1945. Opposing effects were found on risk factors (shortening of leg length, later menarche, and earlier menopause), whereas urinary estrogens and plasma insulin-like growth factor (IGF)-1 and IGF binding protein-3 were increased, as was breast cancer itself. Exposure between 2 and 10 y old was an unexpected window of susceptibility to the effects of calorie deprivation. The effects of famine exposure were most clearly seen in women who never gave birth. These opposing observations can be explained by a neurodevelopmental hypothesis on set-point shifts at the level of the diencephalons/hypothalamus, either directly or from rebound effects. Such a mechanism reflects old evolutionary adaptation systems in lower and higher organisms to cope with periods of stress and famine by adjusting, for example, reproductive functions. These effects in exposed women may later also affect their unexposed offspring. This hypothesis provides several testable, hormone-mediated corollaries on the relationships between the role of calories in a Westernized lifestyle and human cancer risk. The underlying developmental perspective, as opposed to a risk factor approach, can explain why certain ages, even before breast development, are especially sensitive to effects of large fluctuations in calories. The observations presented may have implications for preventive strategies such as promoting moderation of calorie intake to curb cancer risks.

Adult↗
PubMed1993

Social crisis and epidemic disease in the famines of nineteenth-century India.

The onset of famine in nineteenth-century India resulted in the breakdown of normal social relations and produced a series of often dysfunctional behavioural responses. Survival strategies like the use of 'famine foods' and migration in search of food and work facilitated the spread of such epidemic diseases as cholera, dysentery, malaria, and smallpox. Although many of these diseases are not normally thought of as having a synergistic relationship with malnutrition and hunger, they were linked to it (as the Madras famine of 1876-78 illustrates) through abnormal social and environmental conditions created by drought and an extreme crisis of substance.

Disease Outbreaks↗
PubMed1999

Blood pressure in adults after prenatal exposure to famine.

BACKGROUND: Many studies have shown that low birth weight is associated with high blood pressure. The composition of the diet of pregnant women has also been found to affect blood pressure in their children. We assessed the effect of prenatal exposure to the Dutch famine of 1944-1945, during which the caloric intake from protein, fat and carbohydrate was proportionally reduced, on blood pressures in adults now aged about 50 years. METHODS AND RESULTS: We measured blood pressures at home and in the clinic among people born at term in one hospital in Amsterdam, The Netherlands, between November 1 1943 and February 28 1947, for whom we had detailed birth records. Blood pressures of people exposed to famine during late (n = 120), mid-(n = 109) or early gestation (n = 68) were compared with those of people born in the year before or conceived in the year after the famine (unexposed subjects, n = 442). No effect of prenatal exposure on systolic and diastolic blood pressure was observed. The mean systolic blood pressure taken in the clinic in those exposed in late gestation, and adjusted for sex and age, was 1.3 mmHg higher than in the unexposed group (95% confidence interval -1.9 to 4.4). The mean systolic blood pressure differed by -0.6 mmHg (95% confidence interval -3.9 to 2.7) for those exposed in mid-gestation and -1.7 mmHg (95% confidence interval -5.6 to 2.2) for those exposed in early gestation. People who were small at birth had higher blood pressures. A 1 kg increase in birth weight was associated with a decrease of 2.7 mmHg (95% confidence interval 0.3 to 5.1) in systolic blood pressure. Analyses of blood pressures measured at home gave similar results. CONCLUSION: High blood pressure was not linked to prenatal exposure to a balanced reduction of macronutrients in the maternal diet. However, it was linked to reduced fetal growth. We postulate that it might be the composition rather than the quantity of a pregnant woman's diet that affects her child's blood pressure in later life.

Adult↗