The Dutch famine of 1944-45: mortality and morbidity in past and present generations.

During the last months of the Second World War the Western Netherlands was affected by an acute famine, known as the Hunger Winter. Food intake from all sources was reduced to extremely low levels. The effect on mortality at all ages was very large and immediate. By making use of unpublished data from the Dutch Central Bureau of Statistics, estimates could be made of the changes in mortality by cause of death and age for both sexes. Mortality due to hunger was most common in the very young and the very old whereas the effects in males were more pronounced than in females. Hunger was a contributing factor to the increased mortality due to infectious diseases and diseases of the digestive system. In several follow-up studies on selected populations, long-term consequences of the famine could be studied. They related to reproductive outcomes of women who gave birth during the Hunger Winter, to birth weight, malformations, and perinatal mortalitiy of the newborn who were exposed to the famine during gestation, and to the long-term effects of the famine on the medical and psychological situation of infants born during the famine. Several studies on reproductive outcomes in the subsequent generation are also discussed.