Institute of Chinese Medical Sciences, University of Macau, Macau, Macau SAR.
University College Dublin, Dublin, Ireland.
BMJ Glob Health. 2024 Aug 29;9(8):e015355. doi: 10.1136/bmjgh-2024-015355.
Since the 1970s, influential literature has been using famines as natural experiments to examine the long-term health impact of prenatal famine exposure at the individual level. Although studies based on various famines have consistently shown that prenatal famine exposure is associated with an increased risk of type 2 diabetes (T2D), no studies have yet quantified the contribution of famines to later-life T2D at the population level. We, therefore, synthesised findings from the famines in Ukraine 1932-1933, the Western Netherlands 1944-1945 and China 1959-1961 to make preliminary estimates of T2D cases attributable to prenatal famine exposure. These famines were selected because they provide the most extensive and reliable data from an epidemiological perspective. We observed a consistent increase in T2D risk among prenatally exposed individuals in these famines, which translated into about 21 000, 400 and 0.9 million additional T2D cases due to prenatal famine exposure in Ukraine, Western Netherlands and China, respectively. The T2D increase related to famine exposure represented only around 1% of prevalent T2D cases in these countries. Our observations highlight the significant increase in later-life T2D risk among individuals with prenatal famine exposure but also the limited contribution of prenatal famine exposure to T2D epidemics at the population level.
自 20 世纪 70 年代以来，有影响力的文献一直将饥荒作为自然实验，在个体层面上研究产前饥荒暴露对长期健康的影响。尽管基于各种饥荒的研究一致表明，产前饥荒暴露与 2 型糖尿病（T2D）的风险增加有关，但尚未有研究在人群层面上量化饥荒对晚年 T2D 的贡献。因此，我们综合了乌克兰 1932-1933 年、荷兰西部 1944-1945 年和中国 1959-1961 年饥荒的数据，对归因于产前饥荒暴露的 T2D 病例进行了初步估计。选择这些饥荒是因为它们从流行病学角度提供了最广泛和最可靠的数据。我们观察到，在这些饥荒中，产前暴露的个体患 T2D 的风险持续增加，这意味着乌克兰、荷兰西部和中国分别有大约 21000、400 和 0.9 万例 T2D 病例可归因于产前饥荒暴露。与饥荒暴露相关的 T2D 增加仅占这些国家普遍存在的 T2D 病例的 1%左右。我们的观察结果突出了产前饥荒暴露个体晚年 T2D 风险的显著增加，但也表明产前饥荒暴露对人群层面 T2D 流行的贡献有限。
