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Early under-nutrition may increase heart disease risk in later life

By Nathan Gray , 25-Aug-2011

Early under-nutrition may increase heart disease risk in later life

Exposure to famine or under-nutrition during childhood and adolescence may affect cardiovascular health in adult life, according to a new study.

The research, published in the European Heart Journal, claims to provide the first direct evidence that acute under-nutrition during childhood development has an important impact on future health.

Researchers from the University Medical Centre Utrecht and the University of Amsterdam investigated the medical history of 7845 women who were children, teenagers or young adults during the Dutch famine in 1944. The authors found that under-nutrition, particularly in the adolescent years, was associated with an increased risk of coronary heart disease in later life.

“The Dutch famine of 1944-45 is a ‘natural experiment’ in history, which gave us the unique possibility to study the long-term effects of acute under-nutrition during childhood, adolescence, and young adulthood in otherwise well-nourished girls and women,” write the authors of the study, led by Annet van Abeelen from Utrecht.

“Our findings suggest that a relatively short period of severe under-nutrition is associated with an increased coronary heart disease risk in adult life, in a dose-dependent manner,” they added.

Study details

The researchers recruited the women to the study between 1993 and 1997, and followed them up until the end of 2007. They divided the women into three groups: 1) unexposed – women who reported being “hardly” exposed to hunger and weight loss during the famine; 2) severely exposed – women who reported being “very much” exposed to hunger and weight loss; and 3) moderately exposed – the remaining women whose famine experience was somewhere between these two experiences.

van Abeelen and her colleagues found that, compared with unexposed women, the risk of coronary heart disease was slightly higher overall for women who had been moderately exposed to the famine, and significantly higher among those who had been severely exposed.

Women who aged between 10 and 17 at the start of the famine, and who had been severely exposed to it, were found to have a 38% higher of coronary heart disease in later life, compared to those who had been moderately exposed or unexposed – who had no increased risk.

After adjusting for factors that could confound the results, such as age at start of the famine, smoking, and education (as a measure of socio-economic status), the researchers reported a 27% higher risk of coronary heart disease for the severely exposed women compared to unexposed women.

“Our findings support the notion that disturbed postnatal development, particularly in adolescence, can have important implications for adult health,” said the researchers.

“The contemporary relevance of our findings is that famine and under-nutrition are still a major problem worldwide; the first millennium developmental goal is to eradicate extreme hunger. Since the incidence of CVD [cardiovascular disease] is the number one cause of death globally, and rising in many parts of the world, further research into the impact of under-nutrition during sensitive periods of growth and maturation is warranted,” they added.

van Abeelen said that more research was needed to confirm the findings and to explore the possible mechanisms underlying the effects of famine on the risk of future heart disease.

“Our study indicates that growth that has been hampered by under-nutrition in later childhood, followed by a subsequent recovery, may have metabolic consequences that contribute to an increased risk of diseases later in adulthood,” she added.

Source: European Heart Journal
Published online ahead of print, doi:10.1093/eurheartj/ehr228
“Cardiovascular consequences of famine in the young”
Authors: A.F.M. van Abeelen, S.G. Elias, P.M.M. Bossuyt, D.E. Grobbee, et al

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