Hunger killed an estimated 4 million people in Ukraine between 1932 and 1933 due to the Holodomor, a man-made famine orchestrated by the Stalin-led Soviet regime. Recent research highlights that the detrimental effects of such famines extend beyond those who directly experience them, potentially impacting the health of individuals who were still in the womb during the crisis.
Published in Science, a new study strengthens the connection between fetal exposure to famine and an increased risk of developing type 2 diabetes later in life. Specifically, the study found that individuals exposed to the peak famine period during early gestation (the first three months of pregnancy) had double the risk of developing diabetes as adults compared to those not exposed. Furthermore, those born in regions most affected by the famine, such as Kyiv, Cherkasy, and Poltava, were at an even greater risk.
The study analyzed diabetes diagnoses recorded between 2000 and 2008 among more than 10 million people born in Soviet Ukraine between 1930 and 1938. According to L.H. Lumey, a professor of epidemiology at Columbia University and the lead author of the study, this research marks a significant step forward in understanding the long-term health consequences of malnutrition and starvation. The findings are especially compelling due to the comprehensive nature of the study, which builds on more limited research conducted in 2015.
“Because of the unusual combination of factors, the high-quality demographic data, the sudden onset of the famine, the limited duration of the famine, the huge numbers exposed — this makes it like a laboratory study from the point of view of medical science that is unlikely to be ever repeated,” Lumey explained.
Type 2 diabetes occurs when the pancreas fails to produce sufficient insulin, the hormone responsible for regulating blood sugar levels. Although the study did not pinpoint the exact mechanism linking prenatal famine exposure to adult-onset diabetes, experts like Simin Liu, a professor of epidemiology at Brown University, suggest that epigenetics may play a significant role. Epigenetics involves how environmental factors influence gene expression, and Liu has observed similar phenomena in studies of the Chinese famine of 1959, one of the deadliest famines in history.
“The short answer is epigenetic modifications may link prenatal exposure to famine to an increased risk of cardiometabolic diseases later in life,” Liu stated in an email. He emphasized the need for additional experimental studies involving animals to further explore this link.
The study supports the fetal programming hypothesis, which suggests that stimuli during critical periods of fetal development can have lasting effects on metabolism and other aspects of health. Peter Klimek, an associate professor at the Medical University of Vienna who studies the intersection of disease and socioeconomic factors, explained that fetuses exposed to famine in early gestation might develop a metabolism adapted to a nutritionally poor environment. If the famine ends by the time the baby is born, this adaptation may increase the risk of diabetes in a more nutritionally abundant environment.
However, Klimek cautioned that famine exposure does not always result in a higher risk of diabetes, noting that multiple factors contribute to the disease.
One challenge faced by the study’s authors was the falsification of the 1939 Soviet census, which inflated the population of Ukraine by nearly 3% to downplay the impact of the famine. Oleh Wolowyna, a study co-author and fellow at the Center for Slavic, Eurasian, and Eastern European Studies at the University of North Carolina, highlighted that births and deaths, particularly in 1933, were significantly under-registered. To obtain accurate yearly population estimates, the researchers used a demographic balancing equation that incorporated data from the 1926, 1937, and 1939 censuses, accounting for births, deaths, and net migration.
Today, hunger continues to be a pressing issue in Ukraine, exacerbated by the ongoing Russia-Ukraine war. According to a 2023 United Nations report, one in three Ukrainians is currently experiencing hunger. Prior to the conflict, Ukraine was a major supplier of agricultural products to Africa and Asia, and the war’s impact on food security extends far beyond Ukraine’s borders.
Liu emphasized the importance of this research and similar studies in highlighting the critical role of prenatal and early childhood nutrition in shaping long-term health outcomes. He advocated for public policies that prioritize nutritional support for at-risk populations during crucial developmental periods. Ensuring food security for pregnant women and young children, particularly in famine-prone regions, and providing support for managing metabolic disorders in those exposed to such conditions should be key policy goals.
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