The Dutch famine and its long-term consequences for adult health
Section snippets
Fetal origins of adult disease
Coronary heart disease remains a major burden on public health in the western world, and is taking on epidemic proportions in the developing countries [1]. Small babies go on to develop more coronary heart disease in adult life [2]. Restricted intrauterine growth has been identified as an important contributor to later coronary heart disease and its biological risk factors. Developing organ systems adapt in response to the reduced availability of nutrients, particularly during periods of rapid
Dutch famine as an experimental study design
While famine is sadly not uncommon in many parts of the world, studying effects of undernutrition during specific periods of pregnancy is hampered by the fact that undernutrition is usually not restricted to pregnancy alone, and the effects of chronic undernutrition and accompanying problems of infection complicate the situation. What is unusual about the Dutch famine is; first, that the famine was imposed on a previously well-nourished population; second, that there was a sudden onset and
The Dutch famine
After weeks of heavy fighting following the invasion on the 6th of June 1944, the Allied forces finally broke through German lines. With lightning speed the Allied troops took possession of much of France, Luxembourg and Belgium. By the 4th of September 1944 the Allies had the strategic city of Antwerp in their hands, and on the 14th they entered the Netherlands. Everyone in the Netherlands expected that the German occupation would soon be over. The advance went so quickly that also the
Famine studies
The period of starvation ceased early in May 1945 immediately after the final surrender of the Germans. In addition to the immediate provision of food after the war, medical aid was a top priority for the Netherlands. Doctors from the UK and US were sent to survey medical needs. Clement Smith from Harvard Medical School was among the first to witness the effects of the famine on the health of the Dutch population. He immediately saw the opportunity to obtain information that would help resolve
The Dutch famine birth cohort study
We traced a group of 2414 term singletons born alive between November 1943 and February 1947 in the Wilhelmina Gasthuis in Amsterdam for whom we had detailed birth records. At ages 50 and 58, we invited the cohort to come to the clinic for detailed investigations. We defined exposure according to the daily official food rations for the general population older than 21 years in Amsterdam. A person was considered to be exposed if the average daily ration during any thirteen week period of
Glucose tolerance
We found that undernutrition during gestation was associated with reduced glucose tolerance and raised insulin concentrations at age 50 and 58. We found that both 120-min glucose and insulin concentrations were higher in people exposed to famine at any stage of fetal development than in unexposed people. Importantly, this effect was larger than could be explained by the lower birth weights of babies born during the famine and by the low weight gain of their mothers [14], [15]. To determine
Limitations
In interpreting our findings, a number of matters need to be considered. Women were less fertile during the famine. The women who did conceive during the famine, whose offspring was exposed to famine in early gestation, may have been of a different constitution. However, correcting for markers of maternal constitution or fertility, such as maternal weight, age and parity and socio economic status did not affect the outcome.
The high rates of infant mortality during the famine affected groups
Interpretation
The findings of the Dutch famine birth cohort study broadly support the fetal origins hypothesis. Chronic diseases originate in the womb through adaptations made by the fetus in response to undernutrition. The effects on undernutrition, however, depend upon its timing during gestation and the organs and systems developing during that critical time window. Furthermore, our findings suggest that maternal malnutrition during gestation may permanently affect adult health without affecting the size
Relevance
The Dutch famine study has established the importance of maternal nutrition during early pregnancy for the offspring's cardiovascular risk. The nutritional experience of babies who were exposed to famine in early gestation may resemble that of babies in developing countries whose mothers are undernourished in early pregnancy and receive supplementation later on, but also of babies in developed countries whose mothers suffer from severe morning sickness. Morning sickness is common in the first
References (45)
- et al.
Global mortality, disability, and the contribution of risk factors: global burden of disease study
Lancet
(1997) The effects of wartime starvation in Holland on pregnancy and its product
Am J Obstet Gynecol
(1947)- et al.
Timing of prenatal starvation in women and birth weight in their first and second born offspring: the Dutch famine birth cohort study
Eur J Obstet Gynecol
(1995) - et al.
Glucose tolerance in adults after in utero exposure to the Dutch famine
Lancet
(1998) - et al.
Plasma lipid profile in adults after prenatal exposure to the Dutch famine
Am J Clin Nutr
(2000) - et al.
Early growth determines longevity in male rats and may be related to telomere shortening in the kidney
FEBS Lett
(1999) Fetal programming of the growth hormone-insulin-like growth factor axis
Trends Endocrinol Metab
(2002)- et al.
Circulating concentrations of insulin-like growth factor-I and risk of breast cancer
Lancet
(1998) Fetal origins of coronary heart disease
BMJ
(1995)- et al.
Intrauterine nutrition: its importance during critical periods for cardiovascular and endocrine development
J Physiol
(1999)
The nutritional basis of the fetal origins of adult disease
Int J Epidemiol
Food shortage and public health, first half of 1945
Am Acad Polit Soc Sci
Nutrition and mental performance
Science
Obesity in young men after famine exposure in utero and early pregnancy
NEJM
Schizoid personality disorder after prenatal exposure to famine
Am J Psych
Prenatal exposure to wartime famine and development of antisocial personality disorder in early adulthood
JAMA
Decreased birth weight in infants after maternal in utero exposure to the Dutch famine of 1944–1945
Paediatr Perinat Epidemiol
Glucose tolerance at age 58 and the decline of glucose tolerance in comparison with age 50 in people prenatally exposed to the Dutch famine
Diabetologia
Blood pressure in adults after prenatal exposure to famine
J Hypertens
Maternal nutrition during gestation and blood pressure in later life
J Hypertens
Cited by (798)
The importance of developmental programming in the dairy industry
2024, Animal Reproduction ScienceChildhood circumstances, social mobility and the obesity transition: Evidence from South Africa
2024, Economics and Human Biology