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At least 19 recordsLinked to original sources
PubMed2000

The relationship between maternal and offspring birth weights after maternal prenatal famine exposure: the Dutch Famine Birth Cohort Study.

We examined the impact of famine-induced changes in maternal birth weight (MBW) on the association between MBW and offspring birth weight (OBW). Women born before, during, and after the Dutch Famine of 1944-1945 were interviewed at ages 41 to 46 years. Women (n = 582) and their children (n = 1,111) were included in the analysis if both mother and child were singleton and the child was not delivered preterm. Mean birth weight (BW) of women with first-trimester exposure (n = 110) was 154 g higher (p = 0.008), and mean BW of women with third-trimester exposure (n = 138) was 251 g lower (p < 0.001) than mean BW of unexposed women (n = 302). First-born offspring of women with first-trimester exposure were 72 g heavier (95% confidence interval [CI], -57 to 201; p = 0.27), and offspring of women with third-trimester exposure were 43 g lighter (95% CI, -170 to 79; p = 0.47) than offspring of unexposed women. Among unexposed women, each 100 g increase in MBW was associated with 25 g (95% CI, 12 to 37) increase in OBW (adjusted for maternal age, smoking, weight, and height and offspring sex). This association was attenuated in famine-exposed women (first-trimester change in OBW = 20 g per 100 g MBW; 95% CI, -1 to 41; third-trimester change in OBW = 14 g per 100 g MBW; 95% CI, -9 to 37). When MBW and trimester of maternal famine exposure were considered in a joint model, there was no independent effect of trimester of maternal famine exposure on OBW. Associations were less consistent for later-born offspring. We conclude that maternal prenatal famine exposure does not affect the association between maternal and offspring BW. Trimester of exposure was not a determinant of OBW, other than through its effect on MBW. Nevertheless, acute famine may impact on second-generation BW distributions indirectly, through its effect on the distribution of MBW.

Acute Disease↗
PubMed1995

Famine, third-trimester pregnancy weight gain, and intrauterine growth: the Dutch Famine Birth Cohort Study.

Data from the Dutch Famine Birth Cohort Study were analyzed to assess the influence of acute famine on the relation of maternal weight gain to birth weight, length, and ponderal index. Records were examined for 734 women receiving at least one month of prenatal care and delivering live-born singleton females at the University of Amsterdam Teaching Hospital between August 1944 and April 1946. This period preceded, encompassed, and followed the Hunger Winter, a severe famine. After adjusting for covariates, weight loss or low to moderate (< or = 0.5 kg/week) weight gain was strongly associated with (p < 0.001 for each model) with offspring birth weight, length, and ponderal index and with trimester of famine exposure. At weight gains greater than 0.5 kg/week further weight gain was not associated with birth size. Among women losing weight or gaining < or = 0.5 kg/week the association between third-trimester weight change and birth weight among mother-daughter pairs exposed to famine in early or mid-pregnancy was stronger than the association observed among the unexposed cohort or among those exposed only late in pregnancy. Our results suggest that acute maternal nutritional deprivation affects fetal growth only below a threshold and that, conversely, even after a famine period offspring birth size does not respond in a linear fashion to ad libitum maternal feeding.

Adult↗
PubMed2004

Famine intensity and magnitude scales: a proposal for an instrumental definition of famine.

Ambiguities in current usage of the term "famine" have had tragic implications for response and accountability in a number of recent food crises. This paper proposes a new approach to defining famine based on the use of intensity and magnitude scales, where "intensity" refers to the severity of the crisis at a given location and point in time, while "magnitude" describes the aggregate impact of a crisis. The scales perform three operations on "famine": first, moving from a binary conception of "famine/no famine" to a graduated, multi-level definition; second, disaggregating the dimensions of intensity and magnitude; and third, assigning harmonised "objective" criteria in place of subjective, case-by-case judgements. If adopted, the famine scales should contribute to more effective and proportionate responses, as well as greater accountability in future food crises.

Benchmarking↗
PubMed1997

In utero exposure to famine and subsequent fertility: The Dutch Famine Birth Cohort Study.

OBJECTIVES: We hypothesized that if prenatal caloric restriction due to nutritional deprivation had affected development of the organs responsible for producing and regulating female reproductive hormones, a woman's fertility would be impaired. METHODS: Women born in Amsterdam from August 1, 1944, through April 15, 1946, a period encompassing a severe 5-month famine, were identified (n = 700; 85% response rate). Date of birth and vital status of all offspring were ascertained by home interview between 1987 and 1991. Famine exposure was inferred from the mother's date of birth. RESULTS: Of the study participants, 74 (10.6%) had no children. The remainder reported 1334 off-spring (1294 singletons, 20 pairs of twins), of whom 14 were stillborn and 22 died in the first 7 days of life. There was no detectable effect of famine exposure on age at menarche, the proportion having no children, age at first delivery, or family size. An excess of perinatal deaths occurred among offspring of famine-exposed women, particularly those exposed in their third trimester. CONCLUSIONS: Acute famine exposure in utero appears to have no adverse consequences for a woman's fertility. The excess perinatal mortality in the second generation is unexplained and should be confirmed by other studies.

Adult↗
PubMed2006

Exposure to famine during gestation, size at birth, and blood pressure at age 59 y: evidence from the Dutch Famine.

We compared blood pressure of individuals (mean age 59 y) born in western Holland between January 1945 and March 1946 (mothers exposed to the Dutch Famine before or during gestation; n = 359) to blood pressure of unexposed individuals born before or conceived after the famine (n = 299) or same-sex siblings of subjects in series 1 or 2 (n = 313). Mean (SD) systolic and diastolic blood pressure were 140.3 (20.3) and 85.8 (11.0) mmHg, respectively; prevalence of hypertension (prior diagnosis of hypertension or with measured systolic/diastolic blood pressure above 140/90 mmHg) was 61.8%. Birth weight was inversely related to systolic (-4.14 mmHg per kg; 95% confidence interval (CI) -7.24, -1.03; p < 0.01) and diastolic (-2.09 mmHg per kg; 95% CI -3.77, -0.41; p < 0.05) blood pressure and to the prevalence of hypertension (odds ratio 0.67 per kg, 95% CI: 0.49, 0.93) (all age- and sex-adjusted). Any famine exposure of at least 10 weeks duration was associated with elevated systolic (2.77 mmHg; 95% CI 0.25, 5.30; p < 0.05) and diastolic (1.27 mmHg; 95% CI -0.13, 2.66; p = 0.08) blood pressure and with hypertension prevalence (odds ratio 1.44; 95% CI 1.04, 2.00; p < 0.05) in age- and sex-adjusted models. Exposure to famine during gestation may predispose to the development of hypertension in middle age.

Birth Weight↗
PubMed1975

The Dutch famine, 1944-1945, and the reproductive process. I. Effects on six indices at birth.

Prenatal exposure to the Dutch famine of 1944-1945 reduced postpartum maternal weight, birth weight, placental weight, length at birth, and head circumference at birth. These conclusions are based on maternities occurring in the famine area and exposed to famine during some part of gestation as compared both with maternities in nonfamine areas, and with maternities before and after the famine. Third trimester exposure accounted for the whole of the famine effects. Length of gestation was not affected by third trimester exposure, and did not mediate the effects on infant exposure, and did not mediate the effects on infant dimensions at birth. Effects were apparent only below a threshold value of official food rations of 1,500 cal daily average during the third trimester. (Calorie value for official food rations can be assumed to be lower than actual food intake.) Maternal weight declined 4.3% during the famine and rose 10.5% after the famine. Birth weight declined 9% during the famine, and rose 9% after the famine. Placental weight declined 15% during the famine, and rose 14% after the famine. Length at birth declined 2.5% during the famine, and rose 1.5% after the famine. Head circumference declined 2.7% during the famine, and rose 2.4% afterward.

Anthropometry↗
PubMed2001

Adult survival after prenatal exposure to the Dutch famine 1944--45.

Early life events may affect adult survival. We studied the effect of prenatal exposure to the Dutch famine 1944--45 on survival among 2254 people born in Amsterdam. Mortality up to age 50 was highest among those born before the famine (15.2%) and among those exposed to famine in late gestation (14.6%). It was lower among those exposed in mid- (11.2%) or early gestation (11.5%), and was lowest among those conceived after the famine (7.2%). These differences were caused by effects on mortality in the first year after birth and were mainly related to nutrition and infections. There was no effect of exposure to famine on mortality after the age of 18. The hazard ratio was 1.4 [0.8, 2.3] for those born before the famine, 1.1 [0.5, 2.3] for those exposed in late gestation, 0.8 [0.3, 1.8] for those exposed in mid-gestation and 1.1 [0.5, 2.5] in those exposed in early gestation compared with those conceived after the famine. We could not demonstrate effects of prenatal exposure to famine on cause-specific mortality after the age of 18. Because prenatal exposure to famine is linked to cardiovascular risk factors and disease, increased cardiovascular mortality in the future may be expected.

Adult↗
PubMed2004

Breast cancer risk after caloric restriction during the 1944-1945 Dutch famine.

BACKGROUND: Data from animal models suggest that caloric restriction may reduce the risk of breast cancer, although not all dietary regimens produce similar effects. We examined whether caloric restriction imposed as a consequence of the 1944-1945 Dutch famine reduced the risk of breast cancer in women participating in a Dutch breast cancer screening program. METHODS: Between 1983 and 1986, approximately 15 000 women, aged 2 to 33 years during the 1944-1945 Dutch famine, responded to a questionnaire about their famine experience. A famine exposure score, graded as absent, moderate, or severe exposure, was derived from answers regarding hunger, cold, and weight loss. During follow-up until January 2000, 585 women with incident breast cancer were identified by the regional cancer registry. The relationship between famine exposure and breast cancer risk was assessed by weighted Cox regression models, in which person-years lived for the entire cohort was extrapolated from data from a random sample of 15% of the cohort. RESULTS: Women who were severely exposed to the famine had a statistically significantly higher risk of breast cancer (hazard ratio [HR] = 1.48, 95% confidence interval [CI] = 1.09 to 2.01) than women who were not exposed. Women who were moderately exposed to the famine had a 13% increased risk of breast cancer (HR = 1.13, 95% CI = 0.92 to 1.38; P(trend) = 0.016). The association between famine exposure and breast cancer risk was stronger for women who were exposed between the ages of 2 and 9 years (severely exposed versus unexposed: HR = 2.01, 95% CI = 0.92 to 4.41) than for women who were exposed at older ages. CONCLUSIONS: The risk of breast cancer was increased in women who were severely exposed to a short but severe famine decades earlier. This result is compatible with data from the few animal studies investigating effects of short-term, transient caloric restriction.

Adolescent↗
PubMed1997

No increased mortality in later life for cohorts born during famine.

Nutrition early in life may influence adult mortality. The fetal-origins hypothesis suggests that nourishment before birth and during the individual's infancy programs the development of risk factors for several important diseases of middle and old age. The present study was designed to evaluate the impact of extreme nutritional deprivation in utero and during infancy and early childhood on mortality in later life. The authors analyzed the survival of the cohorts born in Finland during the severe 1866-1868 famine and during the 5 years immediately preceding and 5 years immediately following the famine. The study included 331,932 individuals born prior to the famine, 161,744 born during the famine, and 323,321 born after the famine. The authors assessed survival by cohorts from birth to age 17 years and from age 17 to 40, 60, and 80 years, as well as average length of life after age 80 years. Survival from birth to age 17 years was significantly lower in cohorts born before and during the famine than in the cohorts born after the famine (males, 0.566 vs. 0.671, a difference of 0.105 (95% confidence interval (CI) 0.102-0.108); females, 0.593 vs. 0.692, a difference of 0.099 (95% CI 0.096-0.102)). At subsequent ages, including old age, mortality was practically identical in the famine-born cohorts and in the five cohorts born before and after the crisis. For both males and females, survival from 17 to 80 years and mean remaining lifetime at age 80 years were very similar across the 13 cohorts studied. These findings suggest that, although cohorts subjected to prolonged and extreme nutritional deprivation in utero and during infancy and early childhood suffer an immediate rise in mortality, after the crisis has passed, they carry no aftereffects that influence their survival in later life.

Adolescent↗
PubMed1987

The phenomenon of famine.

Famines are sustained, extreme shortages of food among discrete populations sufficient to cause high rates of mortality. Signs and symptoms of prolonged food deprivation include loss of fat and subcutaneous tissue, depression, apathy, and weakness, which progress to immobility and death of the individual, often from superimposed respiratory or other infections. The social consequences of famines are disruption from mass migrations of people in search of food, breakdown of social behavior, abandonment of cooperative effort, loss of personal pride and sense of family ties, and finally a struggle for individual survival. Famines have been common ever since the development of agriculture made human settlements possible. Food shortages due to crop failures caused by natural disasters including poor weather, insect plagues, and plant diseases; crop destruction due to warfare; and enforced starvation as a political tool are by no means the only causative factors. Many of the worst famines have been due to poor distribution of existing food supplies, either because of inequities that result in a lack of purchasing power on the part of the poor or because of political interference with normal distribution or relief movements of food. Europe and Asia, which in the past experienced frequent severe famines, sometimes with deaths in the hundreds of thousands or millions, have now largely eliminated famines through social and technological change. However, in Africa, political and social factors have destroyed the capacity of many populations to survive drought-induced variations in local food supplies and prices. Thus, famines are due to varying combinations of inadequacy of food supplies for whatever reason and the inability of populations to acquire food because of poverty, civil disturbances, or political interference. Despite the role of natural causes, the conclusion is inescapable that modern famines, like most of those in history, are man-made.

Demography↗
PubMed2005

Rates of adult schizophrenia following prenatal exposure to the Chinese famine of 1959-1961.

CONTEXT: Schizophrenia is a common major mental disorder. Intrauterine nutritional deficiency may increase the risk of schizophrenia. The main evidence comes from studies of the 1944-1945 Dutch Hunger Winter when a sharp and time-limited decline in food intake occurred. The most exposed cohort conceived during the famine showed a 2-fold increased risk of schizophrenia. OBJECTIVE: To determine whether those who endured a massive 1959-1961 famine in China experienced similar results. DESIGN, SETTING, AND PARTICIPANTS: The risk of schizophrenia was examined in the Wuhu region of Anhui, one of the most affected provinces. Rates were compared among those born before, during, and after the famine years. Wuhu and its surrounding 6 counties are served by a single psychiatric hospital. All psychiatric case records for the years 1971 through 2001 were examined, and clinical and sociodemographic information on patients with schizophrenia was extracted by researchers who were blinded to the nature of exposure. Data on number of births and deaths in the famine years were available, and cumulative mortality was estimated from later demographic surveys. MAIN OUTCOME MEASURES: Evidence of famine was verified, and unadjusted and mortality-adjusted relative risks of schizophrenia were calculated. RESULTS: The birth rates (per 1000) in Anhui decreased approximately 80% during the famine years from 28.28 in 1958 and 20.97 in 1959 to 8.61 in 1960 and 11.06 in 1961. Among births that occurred during the famine years, the adjusted risk of developing schizophrenia in later life increased significantly, from 0.84% in 1959 to 2.15% in 1960 and 1.81% in 1961. The mortality-adjusted relative risk was 2.30 (95% confidence interval, 1.99-2.65) for those born in 1960 and 1.93 (95% confidence interval, 1.68-2.23) for those born in 1961. CONCLUSION: Our findings replicate the Dutch data for a separate racial group and show that prenatal exposure to famine increases risk of schizophrenia in later life.

Adult↗
PubMed2006

Cortisol responses to psychological stress in adults after prenatal exposure to the Dutch famine.

Experimental studies in animals show that prenatal undernutrition leads to lifelong alterations in the activity of the hypothalamic-pituitary-adrenal (HPA) axis. Some studies have shown associations between low birth weight and an increased HPA response to psychological stress. We tested the hypothesis that prenatal exposure to the Dutch 1944-1945 famine leads to an elevated HPA response to psychological stress in adult life. We measured salivary cortisol responses to a psychological stress protocol among 694 adults who were born as term singletons in Amsterdam, the Netherlands, around the time of the 1944-1945 Dutch famine. We compared cortisol profiles of participants exposed to famine during late (n=120), mid (n=100), or early gestation (n=62) to profiles of participants unexposed to famine during gestation (n=412). The mean increase in cortisol concentrations from baseline was 30% (95% CI 23-37). There were no statistically significant differences in the mean profile of cortisol response to the psychological stress protocol between participants exposed and unexposed to famine in utero. The mean sex and BMI adjusted difference in cortisol response for those exposed compared to those unexposed was -6% (95% CI: -15 to 2). The cortisol profiles of those exposed in late (-4% [95% CI: -16 to 7]), mid (-9% [95% CI: -22 to 3]) or early gestation (-4% [95% CI: -20 to 10]) did not differ from the profile of those unexposed to famine. We conclude that prenatal exposure to famine does not seem to be associated with the response of the HPA axis to psychological stress. However, the stress protocol we have used may have been unsuccessful in inducing a strong enough HPA axis activation to be able to detect famine related differences.

Cohort Studies↗
PubMed2002

Why do people die in famines? Evidence from three island populations.

There is surprisingly little consensus about what people die of during famines. In this paper, the causes of the increases in mortality during the Greek famine of 1941-43 are examined. The focus of the study is three island populations: Syros, Hios, and Mykonos. Death registration for these islands was not disrupted during the famine and the records give cause for death, certified by a doctor. Archival material and hospital records are utilized to assess public health during the famine. The findings point to the overwhelming importance of starvation for increased mortality during the famine and the virtual absence of either significant epidemics of infectious diseases or a breakdown in the public health system. The paper concludes by comparing the findings for the Greek famine with those for other famines. A model that attempts to explain the different courses that famine mortality can take is proposed.

Death↗
PubMed1996

Social contract and deterring famine: first thoughts.

The links between certain kinds of political systems and protection against famine are investigated in this paper. The starting-point is a critique of Amartya Sen's observation that famines are unknown in countries with a free press and competitive elections. This holds true only in India because of a unique political history in which freedom from famine became a right, upon which political legitimacy was founded: an anti-famine 'social contract'. The rise and decline of anti-famine systems in Africa is charted. Major reasons for decay include neo-liberalism and the international humanitarian system, both of which undermine relationships of domestic political accountability that underpin effective famine prevention. A number of politically regressive tendencies in 'actually existing humanitarianism' are identified that work against any nascent anti-famine social contracts in Africa. This is possible because famine prevention has not been established as a right in Africa.

Africa↗
PubMed2005

The 1944-1945 Dutch famine and subsequent overall cancer incidence.

Caloric restriction seems to be the most potent dietary intervention to protect against a variety of cancers in animals. We investigated whether overall cancer risk is affected in humans after exposure to a brief famine, followed by a period of abundance. We used data of approximately 15,000 women who were exposed at various degrees to the 1944-1945 Dutch famine at ages between 2 and 33 years. Between 1983 and 1986, these women were asked about their individual experiences of famine exposure ("absent," "moderate," or "severe exposure"). During follow-up until January 2000, 1,602 new cancer cases were identified by the regional cancer registry. We assessed the relation between famine and total cancer risk by weighted Cox regression models, in which a 15% random sample was used to represent person-years lived in the entire cohort. In these models, we adjusted for potential confounders. Overall cancer risk was increased in women having been severely famine exposed compared with women having been unexposed (hazard ratio, 1.25; 95% confidence interval, 1.01-1.55). Exclusion of breast cancer cases from our analyses showed that this increase in risk was largely driven by the previously reported increase in breast cancer risk: women who were severely exposed to the famine were at a 1.12 (95% confidence interval, 0.87-1.43) times increased risk of non-breast cancer compared with the unexposed. In conclusion, we found no indications that this brief famine has affected overall cancer risk, exclusive of breast cancer. Counteracting increased caloric intake following the famine, however, may have obscured any relation.

Adolescent↗