Long term mortality after starvation during the Leningrad siege

Editor—In their study of survivors of the Leningrad siege Sparén et al present no evidence for a causal link between starvation around the age of puberty and later cardiovascular disease.¹

Figure 1.

They allocate subjects to age groups 8 years or younger, 9-15 years, and 16-26 years on the basis of the entire 29 month siege. However, Pavlov's data show that there was only a three month window (November 1941 to January 1942) during which energy and nutritional intakes were extremely low.²

In Russia in 1941 pubertal changes would have not been likely much before the age of 12. More importantly, from their 12th birthday boys were classed as adult dependants rather than children and in consequence their rations were cut substantially over this period. Therefore, linking para-pubertal starvation and later morbidity would rely on identifying specific outcome differences between those aged 12-15 over the winter of 1941-2 and other age groups.

Despite throwaway allusions that stress might have contributed to cardiovascular changes, the authors effectively dismiss this since they state repeatedly that their analysis indicates an effect of starvation. But persistent stress is well known to raise sympathetic tone and cortisol secretion, with long term increase in blood pressure; 2.5 years under siege bombardment definitely constitutes a stressful environment. In addition, Pavlov mentions that boys aged 12 or over were assigned to defence duties such as bomb disposal.

In the absence of supporting data, it seems redundant to suggest nutritional involvement in any increased cardiovascular morbidity.