Table 2

Summary of studies examining effects of early life famine exposure on non-communicable diseases (NCDs) outcomes

StudyCountry and populationExposure age group in years (sample size)Outcome(s)Key findings*Risk-of-bias score
(IV/EV)†
Great Chinese Famine (1959–1961)
Chen et al63China, adults>40 years0–9 years (n=1799)
10–37 years (n=1064)		Visceral adipose dysfunction (VAD)↑ VAD (women 0–9 years)· / ·
Huang et al35China, women~50 years0–1.5 years (n=1035)
1.5–2.5 years (n=743)		Hypertension, body mass index (BMI)↑ Hypertension (0–1.5 years)
↑ BMI (1.5–2.5 years)		· / ·
Li et al44China, adults~45 years0–2 years (n=1654)
3–5 years (n=1588)
6–8 years (n=1673)		Hyperglycaemia, type 2 diabetes (T2D)↑ Fasting plasma glucose
↑ Hyperglycaemia (6–8 years)		· / ·
Li et al58China, adults~45 years0–2 years (n=1654)
3–5 years (n=1588)
6–8 years (n=1673)		Metabolic syndrome (MetS)↑ MetS (0–2 years)· / ·
Liu et al19China, adults 35–74 years0–9 years (n=n/r)
10–17 years (n=n/r)		Obesity↑ Obesity– / ·
Liu et al40China, adults 45–53 years0–3 years (n=455)Hypertension↔ Hypertension– / –
Meng et al51China, adults~45 years1–3 years (n=31 363)T2D, obesity↔ T2D, obesity
↓ Abdominal obesity		· / ·
Shi et al36China, adults~55 years0–2 years (n=1149)
3–5 years (n=1217)
6–8 years (n=1250)		Cardiovascular disease (CVD)↑CVD (with hypertension and famine exposure)· / ·
Sun et al48China, adults~55 years1–3 years (n=1297)
4–6 years (n=1476)
7–10 years (n=1499)		Hyperglycaemia, T2D↑ Hyperglycaemia (women)
↓ T2D (men 1–3 years, 7–10 years)		– / –
Wang et al45China, adults~60 years1–3 years (n=1932)
3–5 years (n=1712)
5–7 years (n=1953)		T2D, hyperglycaemia↑ T2D, hyperglycaemic (women 3–5 years, 5–7 years)· / –
Wang et al46China, adults 52–93 years0–9 years (n=1911)
10–37 years (n=1188)		T2D↑ T2D (women, 0–9 years)· / ··
Wang et al97China, adults 52–93 years0–9 years (n=1778)
10–37 years (n=1076)		Non-alcoholic fatty liver disease (NAFLD)↑ NAFLD (women, 0–9 years)·/··
Wang et al47China, adults 52–77 years0–9 years (n=1140)
10–33 years (n=706)		T2D↑ T2D (0–9 years)·/··
Wang et al59China, adults 52–93 years0–9 years (n=1776)
10–37 years (n=1053)		MetS↑ MetS (women, 0–9 years)·/··
Wang et al98China, women 52–93 years0–9 years (n=1679)
10–37 years (n=1003)		Chronic kidney disease (CKD)↔ CKD·/··
Wang et al37China, adults~50 years0–2 years (n=3126)Hypertension, obesity↑ Hypertension
↔ Obesity		·/··
Wang et al37China, adults~50 years1–3 years (n=4563)Overweight, obesity↑ Weight/BMI (women)
↑ Obesity (women)		– / –
Wang et al38China, adults~50 years0–1 years (n=338)
2–6 years (n=457)		Hypertension↑ Hypertension (0–1 years)· / ·
Wang et al56China, adults~50 years0–1 years (n=536)
2–6 years (n=597)		Dyslipidaemia↑ Low-density lipoprotein cholesterol (women)– /·
Wang et al60China, adults~50 years0–1 years (n=269)
2–6 years (n=717)		MetS↑ MetS (0–1 years)– /·
Woo et al30China, adults>65 yearsAge in childhood n/s (n=2222)NCDs, blood pressure, BMI↑ BMI, myocardial infarction
↔ T2D, hypertension		·/ –
Xin et al57China, adults,~60 years3–12 years (n=2132)
13–20 years (n=1140)		Dyslipidaemia↑ Dyslipidaemia– / –
Yao et al55China, adults,~60 years2–4 years (n=206)Dyslipidaemia↔ Dyslipidaemia– / –
Yu et al39China, adults~60 years0–3 years (n=2115)
3–5 years (n=1941)
5–7 years (n=2248)		Hypertension↑ Hypertension· / –
Yu et al61China, adults~60 years0–3 years (n=1940)
3–5 years (n=1741)
5–7 years (n=2010)		MetS↑ MetS (women)· / –
Zhang et al49China, adults~55 years0–3 years (n=1582)Hyperglycaemic, T2D↑ Hyperglycaemia (women)· / ·
Zheng et al99China, adults~55 years0–2 years (n=1344)MetS↑ MetS (women)· / –
Zheng et al62China, women~55 years0–2 years (n=2403)NAFLD↑ NAFLD· / –
Zheng et al41China, adults~55 years0–2 years (n=95)Thyroid function↓ Free thyroxine
↑ Thyroid stimulating hormone		– / –
Zhou et al50China, adults 45–60 years0–2 years (n=160)
3–5 years (n=173)
6–8 years (n=141)		NCDs↑ T2D (0–2 years, 3–5 years)
↑ Hypercholesterolaemia (0–2 years)		– / –
Dutch Hunger Winter (1944–1945)
Idris et al29Netherlands, women~70 years0–9 years (n=93)
10–18 years (n=54)		Coronary artery calcifications, valve calcification↑ Coronary calcium score (10–18 years)
↔ Valve calcification		· / –
Portrait et al31Netherlands, adults 60–76 years0–1 years (n=81)
1–5 years (n=293)
6–10 years (n=244)
11–14 years (n=181)		Heart diseases, peripheral arterial diseases (PAD), T2D↑ T2D, PAD (women, 11–14 years)· / ·
van Abeelen et al27Netherlands, women 49–70 years0–9 years (n=n/r)
10–17 years (n=n/r)		T2D↑ T2D (0–9 years)· / ·
van Abeelen et al28Netherlands, women 49–70 years0–9 years (n=2196)
10–17 years (n=1773)		Coronary heart disease (CHD), stroke↑ CHD (10–17 years)
↓ Stroke		· / ·
Siege of Leningrad (1941–1944)
Koupil et al33Russia, adults 40–70 years1–5 years (n=81)
6–8 years (n=287)
9–15 years (n=739)
16–25 years (n=813)		CVD risk factors and mortality↑ Hypertension (men 6–25 years)
↑ Ischaemic heart disease mortality (men 6–8 years)
↑ Cerebrovascular disease mortality (men 9–15 years)		· / ·
Rotar et al34Russia, adults 64–81 years0–1 years (n=50)
1–10 years (n=210)		Cardiovascular health, telomere length↔ CVD, organ damage
↓ Telomere length		· / –
Sparen et al32Russia, men 64 – 83 years6–8 years, 9–15 years, 16–26 years (total n=1406)CVD risk factors and mortality↑ BP (9–15 years)
↑ Ischaemic heart disease mortality, stroke (9–15 years)		·· / ·
German occupation of Channel Islands (1944–1945)
Head et al22England, adults~70 years8–22 years (n=225)CVD↑ CVD– / –
Head et al54England, adults~70 years8–22 years (n=87)Cholesterol levels↔ Cholesterol levels– / –
Holodomor famine (1932–1933)
Khalangot et al26Ukraine, adults>44 yearsAge in childhood n/s (n=62)Glucose tolerance↓ T2D· / ·
Vaiserman et al18Ukraine, adults~70 years0–3 years (n=n/r)T2D↔ T2D· / ·
Post-monsoon famine in Bangladesh (1974–1975)
Finer et al21Bangladesh, adults~30 years1–2 years (n=81)Glucose tolerance, epigenetics↔ Glucose tolerance
↕ Epigenetics		· / ·
Biafran civil war (1967–1970)
Hult et al17Nigeria, adults~40 years0–3 years (n=246)Hypertension, glucose tolerance, BMI↑ Blood pressure
↔ Glucose tolerance, BMI		· / –

  • Acceptable IV and EV Embedded Image Poor IV or EV Embedded Image Poor IV and EV Embedded Image.

  • *Symbols for effect direction: ↑ increased; ↓ decreased; ↕ mixed (indicate statistically significant results were reported, defined as p<0.05); ↔ none (indicates no statistically significant result was reported). If no age group is indicated beside the finding, then all age groups were affected.

  • †The scoring system used in the risk-of-bias assessment is described in the Methods section.