Nature Medicine | Spoonful of Medicine

Even if Somalia’s turmoil subsides, famine might increase long-term disease risk for survivors

somalia-july11.jpgDrought and war have come together in Somalia, culminating in the worst famine to hit the region in decades. An estimated 800,000 children in the Horn of Africa are acutely malnourished, and over 80% of them are cut off from relief by warlords in the area. Today the UN World Food Programme intended to drop food supplies to the Somali capital to feed the 40,000 refugees gathered there, the first airlift in the two weeks since the UN declared the crisis an official famine.

Aid workers are rightfully focused on the immediate needs of the starving Somalis. But their plight may not be over once the famine ends, whenever that may be. Studies of past famines hint that children who endure severe malnutrition at a young age or while in the womb might be at a higher risk for certain diseases.

Scientists from the Chinese Center for Disease Control and Prevention in Beijing have used data from their country’s National Health and Nutrition Survey, taken by the government every ten years, to follow up on those citizens affected by the Great Chinese Famine that lasted from 1958 to 1961. The widespread famine officially resulted in 15 million deaths, but scholars estimate that the actual number is closer to 40 million.

One paper published last month from the Chinese analysis found that those born during the famine were more likely to suffer from high systolic blood pressure — a risk factor for cardiovascular disease. Additionally, those under the most severe famine conditions were more susceptible to hypertension later on. Famine survivors who ate a western diet high in fat, refined carbohydrates, and low in fruits in vegetables later in life had a more pronounced risk of blood pressure woes than their counterparts who ate the same foods but had never been exposed to famine. A study from the same group published in February came to similar conclusions regarding famine and metabolic syndrome.

Of note, the risks to those in utero during the famine were higher than those who were born just before. “This suggests that gestation is the most vulnerable period,” says author Frank Hu, an epidemiologist at Harvard’s School of Public Health in Cambridge, Massachusetts who worked with the Chinese team. “The individuals that were conceived during that period, if they do survive, will carry long-term risk of chronic disease up to several decades.”

Researchers found similar long-term risks studying 1944’s “Hunger Winter”, a 6-month famine which hit the eastern cities of the Netherlands during World War II. Its short stint allowed the researchers to even distinguish the effects of famine on early versus late gestation, and found that women, but not men, born to mothers who faced malnourishment early in pregnancy had body mass indexes over 7% higher than controls. Neither sex showed any significant difference in BMI as a result of late-term exposure to malnutrition. “Short famine is the only time where you can tease apart these timings,” says Lambert Lumey, an epidemiologist at Columbia University’s Mailman School of Public Health in New York City, an expert on the Dutch cohort.

Not all findings are consistent, though. A 2005 study on the Chinese famine found increased risk of schizophrenia in babies born malnourished, but no cognitive effects were seen in a study on the Dutch famine published this April. “These are single isolated things and not necessarily replicated,” says Aryeh Stein, a researcher at Emory University’s Rollins School of Public Health in Atlanta, Georgia who co-authored the April study with Lumey.

“It’s very hard to evaluate the possible long term effects because of the circumstances of famine,” says Lumey. “Events are so chaotic” with migration, infection, war and supply access that “it would be very difficult for someone to do some systematic study of the long term effects.”

Image: Oxfam East Africa via flickr, under Creative Commons


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