Table 2.
Summary of studies examining effects of early life famine exposure on non-communicable diseases (NCDs) outcomes
| Study | Country and population | Exposure age group in years (sample size) | Outcome(s) | Key findings* | Risk-of-bias score (IV/EV)† |
| Great Chinese Famine (1959–1961) | |||||
| Chen et al63 | China, adults>40 years | 0–9 years (n=1799) 10–37 years (n=1064) |
Visceral adipose dysfunction (VAD) | ↑ VAD (women 0–9 years) | · / · |
| Huang et al35 | China, women~50 years | 0–1.5 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 al44 | China, adults~45 years | 0–2 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 al58 | China, adults~45 years | 0–2 years (n=1654) 3–5 years (n=1588) 6–8 years (n=1673) |
Metabolic syndrome (MetS) | ↑ MetS (0–2 years) | · / · |
| Liu et al19 | China, adults 35–74 years | 0–9 years (n=n/r) 10–17 years (n=n/r) |
Obesity | ↑ Obesity | – / · |
| Liu et al40 | China, adults 45–53 years | 0–3 years (n=455) | Hypertension | ↔ Hypertension | – / – |
| Meng et al51 | China, adults~45 years | 1–3 years (n=31 363) | T2D, obesity | ↔ T2D, obesity ↓ Abdominal obesity |
· / · |
| Shi et al36 | China, adults~55 years | 0–2 years (n=1149) 3–5 years (n=1217) 6–8 years (n=1250) |
Cardiovascular disease (CVD) | ↑CVD (with hypertension and famine exposure) | · / · |
| Sun et al48 | China, adults~55 years | 1–3 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 al45 | China, adults~60 years | 1–3 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 al46 | China, adults 52–93 years | 0–9 years (n=1911) 10–37 years (n=1188) |
T2D | ↑ T2D (women, 0–9 years) | · / ·· |
| Wang et al97 | China, adults 52–93 years | 0–9 years (n=1778) 10–37 years (n=1076) |
Non-alcoholic fatty liver disease (NAFLD) | ↑ NAFLD (women, 0–9 years) | ·/·· |
| Wang et al47 | China, adults 52–77 years | 0–9 years (n=1140) 10–33 years (n=706) |
T2D | ↑ T2D (0–9 years) | ·/·· |
| Wang et al59 | China, adults 52–93 years | 0–9 years (n=1776) 10–37 years (n=1053) |
MetS | ↑ MetS (women, 0–9 years) | ·/·· |
| Wang et al98 | China, women 52–93 years | 0–9 years (n=1679) 10–37 years (n=1003) |
Chronic kidney disease (CKD) | ↔ CKD | ·/·· |
| Wang et al37 | China, adults~50 years | 0–2 years (n=3126) | Hypertension, obesity | ↑ Hypertension ↔ Obesity |
·/·· |
| Wang et al37 | China, adults~50 years | 1–3 years (n=4563) | Overweight, obesity | ↑ Weight/BMI (women) ↑ Obesity (women) |
– / – |
| Wang et al38 | China, adults~50 years | 0–1 years (n=338) 2–6 years (n=457) |
Hypertension | ↑ Hypertension (0–1 years) | · / · |
| Wang et al56 | China, adults~50 years | 0–1 years (n=536) 2–6 years (n=597) |
Dyslipidaemia | ↑ Low-density lipoprotein cholesterol (women) | – /· |
| Wang et al60 | China, adults~50 years | 0–1 years (n=269) 2–6 years (n=717) |
MetS | ↑ MetS (0–1 years) | – /· |
| Woo et al30 | China, adults>65 years | Age in childhood n/s (n=2222) | NCDs, blood pressure, BMI | ↑ BMI, myocardial infarction ↔ T2D, hypertension |
·/ – |
| Xin et al57 | China, adults,~60 years | 3–12 years (n=2132) 13–20 years (n=1140) |
Dyslipidaemia | ↑ Dyslipidaemia | – / – |
| Yao et al55 | China, adults,~60 years | 2–4 years (n=206) | Dyslipidaemia | ↔ Dyslipidaemia | – / – |
| Yu et al39 | China, adults~60 years | 0–3 years (n=2115) 3–5 years (n=1941) 5–7 years (n=2248) |
Hypertension | ↑ Hypertension | · / – |
| Yu et al61 | China, adults~60 years | 0–3 years (n=1940) 3–5 years (n=1741) 5–7 years (n=2010) |
MetS | ↑ MetS (women) | · / – |
| Zhang et al49 | China, adults~55 years | 0–3 years (n=1582) | Hyperglycaemic, T2D | ↑ Hyperglycaemia (women) | · / · |
| Zheng et al99 | China, adults~55 years | 0–2 years (n=1344) | MetS | ↑ MetS (women) | · / – |
| Zheng et al62 | China, women~55 years | 0–2 years (n=2403) | NAFLD | ↑ NAFLD | · / – |
| Zheng et al41 | China, adults~55 years | 0–2 years (n=95) | Thyroid function | ↓ Free thyroxine ↑ Thyroid stimulating hormone |
– / – |
| Zhou et al50 | China, adults 45–60 years | 0–2 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 al29 | Netherlands, women~70 years | 0–9 years (n=93) 10–18 years (n=54) |
Coronary artery calcifications, valve calcification | ↑ Coronary calcium score (10–18 years) ↔ Valve calcification |
· / – |
| Portrait et al31 | Netherlands, adults 60–76 years | 0–1 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 al27 | Netherlands, women 49–70 years | 0–9 years (n=n/r) 10–17 years (n=n/r) |
T2D | ↑ T2D (0–9 years) | · / · |
| van Abeelen et al28 | Netherlands, women 49–70 years | 0–9 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 al33 | Russia, adults 40–70 years | 1–5 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 al34 | Russia, adults 64–81 years | 0–1 years (n=50) 1–10 years (n=210) |
Cardiovascular health, telomere length | ↔ CVD, organ damage ↓ Telomere length |
· / – |
| Sparen et al32 | Russia, men 64 – 83 years | 6–8 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 al22 | England, adults~70 years | 8–22 years (n=225) | CVD | ↑ CVD | – / – |
| Head et al54 | England, adults~70 years | 8–22 years (n=87) | Cholesterol levels | ↔ Cholesterol levels | – / – |
| Holodomor famine (1932–1933) | |||||
| Khalangot et al26 | Ukraine, adults>44 years | Age in childhood n/s (n=62) | Glucose tolerance | ↓ T2D | · / · |
| Vaiserman et al18 | Ukraine, adults~70 years | 0–3 years (n=n/r) | T2D | ↔ T2D | · / · |
| Post-monsoon famine in Bangladesh (1974–1975) | |||||
| Finer et al21 | Bangladesh, adults~30 years | 1–2 years (n=81) | Glucose tolerance, epigenetics | ↔ Glucose tolerance ↕ Epigenetics |
· / · |
| Biafran civil war (1967–1970) | |||||
| Hult et al17 | Nigeria, adults~40 years | 0–3 years (n=246) | Hypertension, glucose tolerance, BMI | ↑ Blood pressure ↔ Glucose tolerance, BMI |
· / – |
Acceptable IV and EV 
Poor IV or EV 
Poor IV and EV 
.
*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.