Huang C, Li Z, Narayan K M Venkat, Williamson D F, Martorell R
1Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta GA, USA.
2The National Center for Maternal and Infant Health, Department of Health Care Epidemiology, Beijing University Health Science Center, Beijing, China.
J Dev Orig Health Dis. 2010 Dec;1(6):412-8. doi: 10.1017/S2040174410000504.
The Chinese Famine of 1959-1961 caused up to 30 million deaths. It varied in intensity across China and affected rural areas disproportionately. Data from the China-U.S. Collaborative Project for Neural Tube Defect Prevention on 31, 449 women (born 1957-1963) and their offspring birth size were recorded in 1993-1996. We used a measure of famine intensity at county level based on the size of famine-born cohorts relative to cohorts preceding and following the famine in a difference-in-difference model that compared offspring birth size of pre-famine (1957-1958; exposed between 0.5 and 4.5 years), famine (1959-1961; prenatal and up to 2.5 years) and post-famine (1962; some exposed in early pregnancy) cohort groups to that of the unexposed 1963 cohort. The model corrected for age and cohort trends and estimated associations between maternal famine exposure and offspring birth size for the average level of famine intensity across counties, and included adjustment for clustering. In rural areas and in pre-famine and famine cohorts, exposure to famine was associated with larger weight (69 g; 95% CI 30, 108), length (0.3 cm; 95% CI -0.0, 0.5) and birth body mass index (0.1 kg/m2; 95% CI 0.0, 0.2). In urban areas, however, exposure to famine was not associated with offspring birth size. Our findings in rural areas suggest that severe and prolonged famine leads to larger newborn size in the offspring of mothers exposed to famine in utero and during the first few years of life; less severe famine in urban areas however, appeared to have no impact. The markedly increased mortality in rural areas may have resulted in the selection of hardier mothers with greater growth potential, which becomes expressed in their offspring.
1959 - 1961年的中国饥荒导致多达3000万人死亡。饥荒在中国各地的严重程度不同，对农村地区的影响尤为严重。中美神经管缺陷预防合作项目收集了1993 - 1996年间31449名女性（出生于1957 - 1963年）及其后代出生时情况的数据。我们在双重差分模型中，根据饥荒时期出生队列相对于饥荒前后队列的规模，采用县级层面的饥荒严重程度指标，比较了饥荒前（1957 - 1958年；暴露时间为0.5至4.5年）、饥荒期间（1959 - 1961年；孕期及出生后2.5年内）和饥荒后（1962年；部分在孕早期暴露）队列组后代的出生情况与未暴露的1963年队列组。该模型校正了年龄和队列趋势，并估计了各县饥荒严重程度平均水平下母亲饥荒暴露与后代出生情况之间的关联，同时考虑了聚类调整。在农村地区以及饥荒前和饥荒期间的队列中，饥荒暴露与出生体重增加（69克；95%置信区间30，108）、身长增加（0.3厘米；95%置信区间 - 0.0，0.5）和出生体重指数增加（0.1千克/平方米；95%置信区间0.0，0.2）相关。然而，在城市地区，饥荒暴露与后代出生情况无关。我们在农村地区的研究结果表明，严重且持续的饥荒会导致子宫内及生命最初几年暴露于饥荒的母亲所生后代出生时体型更大；而城市地区不太严重的饥荒似乎没有影响。农村地区死亡率显著上升可能导致选择了更具生长潜力、更强壮的母亲，这种优势在她们的后代中得以体现。
