The Chinese famine of 1959-1961 was the largest in human history. We used data on 35,025 women born in 1957-1963 to assess the impact of famine exposure on height, BMI, and hypertension at ~32 y of age. The data were from the China-U.S. Collaborative Project for Neural Tube Defect Prevention. The famine varied in intensity across provinces and counties and affected rural areas disproportionately. We used a measure of famine intensity at the county level based on the size of birth year cohorts in a difference-in-difference model, which compared each cohort to the unexposed 1963 cohort, after correcting for age and time trends, and estimated impact for the average level of intensity across counties. The impact was confined to rural areas, but this could be due to small sample sizes in urban areas. Height was reduced in the 1958 and 1959 cohorts by 1.7 and 1.3 cm, respectively. This corresponded to exposures during 0.5-3.5 y for the 1958 cohort and late pregnancy and 0-2.5 y for the 1959 cohort. BMI increased by 0.92 kg/m(2) in the 1957 cohort, exposed from 1.5 to 4.5 y, but decreased by 0.3 kg/m(2) in the 1960-1961 cohorts, exposed during pregnancy and infancy. Famine exposure was associated with a 3-fold increase in the odds of hypertension for the 1958 cohort. In general, postnatal exposure during the first 2-3 y of life reduced height and increased BMI and hypertension, whereas exposure during pregnancy and infancy reduced BMI.