Cardiovascular consequences of famine in the young

Aims The developmental origins hypothesis proposes that undernutrition during foetal life, infancy, or childhood is associated with an increased risk of cardiovascular disease in adulthood. As data on postnatal developmental programming are scarce, we investigated whether exposure to undernutrition during childhood, adolescence, or young adulthood is related to coronary heart disease (CHD) and stroke in adult life. Methods and results We studied 7845 women from the Prospect-EPIC cohort who had been exposed at various degrees to the 1944-45 Dutch famine when they were aged between 0 and 21 years. We used Cox proportional hazard regression models to explore the effect of famine on the risk of CHD and stroke, overall and within exposure age categories (0-9, 10-17, ≥18 years). We adjusted for potential confounders, including age at famine exposure, smoking, and level of education as a proxy for socio-economic status. Overall, stronger famine exposure was associated with higher CHD risk. Among those who experienced the famine between ages 10 and 17 years, CHD risk was significantly higher among severely exposed women compared with unexposed women (HR 1.38; 95% CI 1.03-1.84), which only slightly attenuated after adjustment for confounding (HR 1.27; 95% CI 0.94-1.71). We observed a lower stroke risk among famine exposed women (HR 0.79; 95% CI 0.61-1.02). Adjustment for potential confounders produced similar results (HR 0.77; 95% CI 0.59-0.99). Conclusion Exposure to undernutrition during postnatal periods of development, including adolescence, may affect cardiovascular health in adult life.