In an ambitious new study poised to reshape our understanding of developmental origins of health and disease, researchers have delved into the long-term effects of early-life nutritional deprivation on adult obesity markers, bringing hormonal regulation into sharper focus than ever before. The Chinese famine, which unfolded between 1959 and 1961 and is recognized as one of the most devastating famines of the twentieth century, provides a tragic natural experiment to probe these deep biological questions. This research, recently published in the International Journal of Obesity, harnesses data from this period to reveal surprising insights into how famine exposure during critical developmental windows may predispose individuals to obesity decades later—and implicates testosterone as a key intermediary in this process.
The global obesity epidemic has prompted researchers to investigate not only lifestyle factors but also prenatal and early postnatal influences on metabolic health. While existing literature on famine exposure and adult obesity presents conflicting results, this new study attempts to clarify the picture by examining multiple obesity-related phenotypes and integrating hormonal analyses into the framework. By doing so, the researchers have ventured beyond simple weight measurements to consider deeper endocrine underpinnings, offering a more nuanced understanding of how early adversity shapes adult physiology.
The study encompasses a cohort of individuals born around the time of the Chinese famine, allowing a longitudinal perspective. Researchers categorized participants based on the timing and duration of famine exposure, such as prenatal, infancy, and early childhood periods. By employing sophisticated statistical models, they compared these exposed groups with non-exposed cohorts to detect significant differences in obesity indicators including body mass index (BMI) and waist circumference, accepted proxies for general and central obesity respectively. The large sample size and robust design contribute to the study’s impact, mitigating prior limitations that hampered conclusiveness in similar research.
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One of the most compelling aspects of this investigation is the exploration of testosterone’s mediating role. Testosterone, a principal androgen hormone, has long been implicated in the regulation of fat distribution, muscle mass, and energy metabolism. Nevertheless, its involvement in the pathway linking early-life famine exposure and adult obesity phenotypes remains underexplored. This study measured serum testosterone levels to evaluate whether disruptions in androgen status could explain alterations in obesity risk observed in famine-exposed individuals.
Statistical mediation analysis revealed testosterone as a partial mediator of the relationship between early famine exposure and adult obesity measures. Specifically, diminished testosterone levels were observed among males exposed to famine in utero or during infancy, corresponding with increased BMI and central adiposity metrics later in life. This finding is significant because it highlights a potential hormonal mechanism through which environmental stress during critical periods can imprint lasting metabolic vulnerabilities, beyond direct nutritional deficits.
Furthermore, the study highlights sex differences in the effects of famine exposure and subsequent hormonal regulation. While male participants exhibited more pronounced associations between early deprivation, testosterone reduction, and obesity markers, females displayed different or less marked patterns. These sex-specific responses underscore the complexity of developmental programming and suggest hormonal milieu as a pivotal factor in mediating lifelong health trajectories differentially by sex.
Delving into biological mechanisms, the authors propose that famine-induced stress might disrupt hypothalamic-pituitary-gonadal (HPG) axis development during sensitive periods. This disruption can lead to long-term decrements in testosterone synthesis and secretion, with downstream impacts on adipose tissue behavior and energy homeostasis. Reduced androgen levels could impair lipid metabolism and favor visceral fat accumulation, thereby elevating obesity risk—a hypothesis consistent with experimental endocrinology models.
These findings position testosterone as a promising biomarker for identifying individuals at heightened risk of obesity following early-life nutritional adversity. Clinical interventions aimed at restoring androgen balance or mitigating its downstream metabolic effects might one day help break the link between developmental insults and adult metabolic disease, although such applications require cautious further research given the complex hormonal interplay and potential side effects.
The study also resonates with the broader concept of “developmental origins of health and disease” (DOHaD), emphasizing that health trajectories stem not merely from adult lifestyle choices but are significantly programmed by early environmental exposures. Famines, often viewed solely as humanitarian crises, may therefore also serve as inadvertent natural experiments revealing the intricate interplay between environment, development, and long-term physiology.
However, while the study robustly associates famine exposure with adult obesity indicators and hormonal disruption, causality cannot be definitively established due to potential confounding variables including genetic background, socioeconomic factors, and lifestyle differences in adulthood. The researchers acknowledge these limitations and call for complementary longitudinal and mechanistic studies to fully elucidate causal pathways and identify critical intervention windows.
Beyond academic interest, the implications of this research are striking in a public health context. As hundreds of millions worldwide suffer from obesity and its comorbidities, understanding the roots of obesity susceptibility is paramount. Historical famines, and even more subtle nutritional insufficiencies during pregnancy and early childhood, may silently sow seeds of metabolic dysfunction that only fully emerge decades later, suggesting that preventive efforts must begin much earlier than previously considered.
Moreover, the identification of testosterone as a mediating factor opens avenues for integrating endocrinology with epidemiology to devise novel screening and therapeutic strategies. For example, testosterone modulation could be explored cautiously as a preventive or therapeutic tool in populations known to have experienced early-life nutritional adversity. Nonetheless, such ideas must be rigorously tested to avoid unintended consequences given the hormone’s multifaceted roles in human physiology.
This study also enriches the dialogue around precision medicine and personalized health, championing a life course perspective. Not everyone exposed to famine will develop obesity, indicating that genetic predispositions, environmental modifiers, and hormonal regulators interact in complex, individualized ways. Understanding these interactions could lead to tailored interventions optimized for people’s unique developmental and biological histories.
Future research directions include expanding the biological scope to encompass other hormonal axes such as insulin, leptin, and cortisol, which also regulate energy balance and may interact with androgen pathways. Multi-omics approaches integrating genomic, epigenetic, metabolomic, and proteomic data could reveal additional mediators and mechanisms, helping decode the comprehensive biological imprint of early-life famine.
In sum, this groundbreaking study sheds new light on the hidden legacy of the Chinese famine and its enduring imprint on adult obesity risk, mediated in part by hormonal disruption. It underscores the importance of viewing obesity through a developmental and endocrine lens rather than solely behavior and nutrition. As the world continues grappling with obesity’s epidemic, such integrative insights bring hope for more effective prevention and treatment strategies grounded in biology from the very start of life.
Subject of Research: Early-life exposure to famine and its impact on adult obesity indicators, with a focus on testosterone as a potential mediator.
Article Title: Association of exposure to famine early in life with indicators of obesity in adulthood: testosterone as a potential mediator?
Article References:
Cao, Q., Jia, Z., Huan, C. et al. Association of exposure to famine early in life with indicators of obesity in adulthood: testosterone as a potential mediator?. Int J Obes (2025). https://doi.org/10.1038/s41366-025-01876-5
Image Credits: AI Generated
DOI: https://doi.org/10.1038/s41366-025-01876-5
Tags: Chinese famine 1959-1961critical developmental windowsdevelopmental origins of health and diseaseearly-life nutritional deprivationendocrine underpinnings of obesityglobal obesity epidemic researchhormonal regulation and obesitylong-term effects of famine exposureobesity markers in adultsobesity-related phenotypes analysisprenatal influences on metabolic healthtestosterone and obesity connection