Chinese famine and the Type 2 diabetes epidemic: Challenges of connecting the dots

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March 25, 2019 — The Chinese Famine of 1959-61 has been widely interpreted as an important contributor to later epidemics of Type 2 Diabetes Mellitis (T2DM, but in re-examining 17 related Chinese studies researchers at Columbia University Mailman School of Public Health and Leiden University Medical Center, found little evidence for this association. The paper is published in Nature Reviews Endocrinology.

“Most Chinese studies were limited in using appropriate age-balanced controls,” said L. H. Lumey, MD, professor of Epidemiology at Columbia Mailman School. “Therefore, establishing a firm connection between prenatal famine and T2DM in future studies in China will require significant improvements in study design and execution.”

To demonstrate the limitation in the Chinese studies, the researchers re-analyzed published data using several control groups. With age-balanced controls, no increases were seen in T2DM.

Lumey and colleagues further determined that studying just pre-famine births as controls could suggest a ‘protective’ effect of famine on later health outcomes. Studies from both the Dutch Famine and the Chinese Famine show that increased body size in adulthood has important implications for T2DM after prenatal famine exposure. “However our studies of the Dutch famine have not yet examined if changes in DNA methylation in individuals exposed during gestation could lead to ‘intergenerational’ effects, on the grandchildren, large enough to explain the increased obesity and hyperglycemia in China today,” said Dr Bastiaan T. Heijmans of Leiden University Medical Center in the Netherlands.

Because of limitations in study design and the original analyses of the Chinese studies it is an open question if the famine has significantly contributed to the current epidemic in China. And accordingly, it is also not yet possible to make firm statements regarding the long-term impact of direct exposure or the intergenerational impact of indirect exposure.

“The current T2DM epidemic in China represents an enormous public health challenge,” noted Lumey. “Public health efforts for prevention and treatment should therefore focus now on well-established risk factors for overweight and obesity, especially the increased intake of energy dense foods and sedentary lifestyles that affect the entire population, regardless of early famine exposure.”

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Co-authors are Chihua Li, Columbia Mailman School and Zhengzhou Central Hospital/ Zhengzhou University, Henan, China; Elmar W. Tobi, Leiden University Medical Center, Netherlands

Columbia University Mailman School of Public Health

Founded in 1922, the Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Columbia Mailman School is the third largest recipient of NIH grants among schools of public health. Its over 450 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change & health, and public health preparedness. It is a leader in public health education with over 1,300 graduate students from more than 40 nations pursuing a variety of master’s and doctoral degree programs. The Columbia Mailman School is also home to numerous world-renowned research centers, including ICAP and the Center for Infection and Immunity. For more information, please visit http://www.mailman.columbia.edu.

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http://dx.doi.org/10.1038/s41574-019-0195-5

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