Early life undernutrition and chronic diseases at older ages: the effects of the Dutch famine on cardiovascular diseases and diabetes.

Nutritional conditions in early life may causally affect health at older ages. This paper examines the effects of early life exposure to the Dutch famine (Winter 1944-45) on the prevalence of heart diseases, peripheral arterial diseases (PAD) and diabetes mellitus (DM) at ages 60-76. Analyses are performed using data from the fifth cycle of the Longitudinal Aging Study Amsterdam. Exposure to the famine is determined by reported place of residence during the Dutch famine, with those living in the cities in the West of the Netherlands defined as exposed (n = 278) and those living in the rural areas in the West or living in the North or East defined as non-exposed (n = 521). We successively compare the prevalence of heart diseases, PAD and DM at ages 60-76 of 370 males and 429 females exposed and non-exposed to the famine in early life. We distinguish four age classes of exposure in early life: gestation and infancy (ages 0-1), childhood (age 1-5), pre-adolescence (ages 6-10) and adolescence (ages 11-14). The analysis shows that exposure to severe undernutrition at ages 11-14 is significantly associated with a higher probability of developing DM and/or PAD at ages 60-76. The associations are found only in women, but not in men. If suggests that adolescence may be a critical period with respect to exposure to adverse (nutritional) conditions and that research should take this into account. These findings are relevant for children in developing countries who are exposed to severe nutritional deprivation.