Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Childhood and Infant exposure to famine in the Biafran war is associated with hypertension in later life: the Abia NCDS study

Journal of Human Hypertension volume 37, pages 936–943 (2023)Cite this article

Subjects

Abstract

There are very few studies in Africans investigating the association between early life exposure to malnutrition and subsequent hypertension in adulthood. We set out to investigate this potential association within an adult cohort who were born around the time of the Biafran War (1968–1970) and subsequent famine in Nigeria. This was a retrospective analysis of Abia State Non-Communicable Diseases and Cardiovascular Risk Factors (AS-NCD-CRF) Survey, a community-based, cross-sectional study that profiled 386 adults (47.4% men) of Igbo ethnicity born in the decade between January 1965 and December 1974. Based on their date of birth and the timing of the famine, participants were grouped according to their exposure to famine as children (Child-Fam) or in-utero fetus/infant (Fet-Inf-Fam) or no exposure (No-Fam). Binomial logit regression models were fitted to determine the association between famine exposure and hypertension in adulthood. Overall, 130 participants had hypertension (33.7%). Compared to the No-Fam group (24.4%), the prevalence of hypertension was significantly elevated in both the Child-Fam (43% - adjusted OR 2.47, 95% CI 1.14–5.36) and Fet-Inf-Fam (44.6% - adjusted OR 2.54, 95% CI 1.33–4.86) groups. The risk of hypertension in adulthood was highest among females within the Child-Fam group. However, within the Fet-Inf-Fam group males had a equivalently higher risk than females. These data suggest that early life exposure to famine and malnutrition in Africa is associated with a markedly increased risk of hypertension in adulthood; with sex-based differences evident. Thus, the importance of avoiding armed conflicts and food in-security in the region cannot be overstated. The legacy effects of the Biafran War clearly show the wider need for ongoing programs that support the nutritional needs of African mothers, infants and children as well as proactive surveillance programs for the early signs of hypertension in young Africans.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Schematic presentation of Biafra famine.
Fig. 2: Forest plot of crude model of famine exposure and hypertension in adulthood individuals.
Fig. 3: Forest plot of crude model of famine exposure and hypertension in adulthood.
Fig. 4: Is a forest plot showing the average marginal effects of hypertension probability in adulthood.
Fig. 5: Plot of the predictive margins of the sex-specific hypertension risk in the 3 birth cohorts.
Fig. 6: Temporal trend of hypertension risk at follow up in 2010 according to year of birth and with 1974 as reference.
Fig. 7

Similar content being viewed by others

Data availability

Additional data collected in the research are available from the corresponding author upon request.

References

  1. Salter A, Tarling E, Langley-Evans S. Influence of maternal nutrition on the metabolic syndrome and cardiovascular risk in the offspring. Clin Lipido. 2009;4:145–58.

    Article  Google Scholar 

  2. Rasmussen KM. The “fetal origins” hypothesis: challenges and opportunities for maternal and child nutrition. Annu Rev Nutr. 2001;21:73–95.

    Article  CAS  PubMed  Google Scholar 

  3. Roseboom TJ, van der Meulen JH, Ravelli AC, van Montfrans GA, Osmond C, Barker DJ, et al. Blood pressure in adults after prenatal exposure to famine. J Hypertens. 1999;17:325–30.

    Article  CAS  PubMed  Google Scholar 

  4. Roseboom TJ, Van Der Meulen JHP, Van Montfrans GA, Ravelli ACJ, Osmond C, Barker DJP, et al. Maternal nutrition during gestation and blood pressure in later life. J Hypertens. 2001;19:29–34.

    Article  CAS  PubMed  Google Scholar 

  5. Roseboom TJ, Painter RC, Van Abeelen AFM, Veenendaal MVE, De Rooij SR. Hungry in the womb: What are the consequences? Lessons from the Dutch famine. Maturitas. 2011;70:141–5.

    Article  PubMed  Google Scholar 

  6. Stanner SA, Bulmer K, Andrès C, Lantseva OE, Borodina V, Poteen VV, et al. Does malnutrition in utero determine diabetes and coronary heart disease in adulthood? Results frm the Leningrad siege study, a cross sectional study. BMJ. 1997;315:1342–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Bleker LS, De Rooij SR, Painter RC, Ravelli ACJ, Roseboom TJ. Cohort profile: The Dutch famine birth cohort (DFBC) -a prospective birth cohort study in the Netherlands. BMJ Open 2021;11:e042078.

  8. Barker DJP, Eriksson JG, Forsén T, Osmond C. Fetal origins of adult disease: strength of effects and biological basis. Int J Epidemiol. 2002;31:1235–9.

    Article  CAS  PubMed  Google Scholar 

  9. Barker DJ, Gluckman PD, Godfrey KM, Harding JE, Owens JA, Robinson JS. Fetal nutrition and cardiovascular disease in adult life. Lancet 1993;341:938–41.

    Article  CAS  PubMed  Google Scholar 

  10. Barker DJP, Bull AR, Osmond C, Simmonds SJ. Fetal and placental size and risk of hypertension in adult life. Br Med J. 1990;301:259–62.

    Article  CAS  Google Scholar 

  11. Calkins K, Devaskar SU. Fetal origins of adult disease. Curr Probl Pediatr Adolesc Heal Care. 2011;41:158–76.

    Google Scholar 

  12. Adekanmbi A, Obadina O, Fetuga M, Adejumo A. Prevalence of malnutrition and high blood pressure amongst adolescents in semi-urban area of Ogun State south- western Nigeria. Niger Med Pract 2016;69:83–8.

    Google Scholar 

  13. Sesso R, Barreto GP, Neves J, Sawaya AL. Malnutrition is associated with increased blood pressure in childhood. Nephron Clin Pr. 2004;97:c61–6.

    Article  Google Scholar 

  14. Adeloye D, Basquill C, Aderemi AV, Thompson JY, Obi FA. An estimate of the prevalence of hypertension in Nigeria: a systematic review and meta-analysis. J Hypertens. 2015;33:230–42.

    Article  CAS  PubMed  Google Scholar 

  15. Hult M, Tornhammar P, Ueda P, Chima C, Bonamy AE, Ozumba B, et al. Hypertension, diabetes and overweight: looming legacies of the Biafran famine. PLoS One. 2010;5:1–8.

    Article  Google Scholar 

  16. Rubin LP. Historical Perspective of Developmental Origins of Health and Disease ... Origins of Health and Disease. Oxford: Academic Press; 2016. pp. 17–32.

  17. Okpechi IG, Chukwuonye II, Tiffin N, Madukwe OO, Onyeonoro UU, Umeizudike TI, et al. Blood pressure gradients and cardiovascular risk factors in urban and rural populations in Abia State South Eastern Nigeria using the WHO STEPwise approach. PLoS One. 2013;8:4–6.

    Article  Google Scholar 

  18. Ogah OS, Madukwe OO, Onyeonoro UU, Chukwuonye II, Ukegbu AU, Okpechi IG. Cardiovascular risk factors and non-communicable diseases in Abia state, Nigeria: report of a community- based survey. Int J Med Biomed Res. 2013;2:57–68.

    Article  Google Scholar 

  19. World Medical Association (WMA). WMA declaration of Helsinki - ethical principles for medical research involving human subjects. WMA Gen Assem; 2008. p. 1–8. https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/.

  20. Forsyth F. The making of an African legend: the Biafra story. South Yorkshire: Pen and Sword Military; 2007. p. 291.

  21. Desgrandchamps M. ‘Organising the unpredictable’: the Nigeria – Biafra war and its impact on the ICRC. Internatrional Rev Red Cross. 2012;94:1409–32.

    Article  Google Scholar 

  22. Akresh R, Bhalotra S, Leone M, Osili U. First and second generation impacts of the Biafran war. Colchester: IZA Institute of Labour Economics; 2017.

  23. World Health Organization. A framework for surveillance: the WHO STEPwise approach to surveillance of noncommunicable diseases (STEPS). Geneva: World Health Organization; 2003.

  24. WHO. Waist circumference and waist-hip ratio: report of a WHO expert consultation. Geneva: World Heal Organisation; 2008. p. 8–11.

  25. Mink J, Boutron-Ruault M-C, Charles M, Allais O, Fagherazzi G. Associations between early-life food deprivation during World War II and risk of hypertension and type 2 diabetes at adulthood. Sci Rep. 2020;10:1–9.

    Article  Google Scholar 

  26. Jyoti DF, Frongillo EA, Jones SJ. Food insecurity affects school children’s academic performance, weight gain, and social skills. J Nutr. 2005;135:2831–9.

    Article  CAS  PubMed  Google Scholar 

  27. Lawlor DA, Ebrahim S, Smith GD. Is there a sex difference in the association between birth weight and systolic blood pressure in later life? Findings from a meta-regression analysis. Am J Epidemiol. 2002;156:1100–4.

    Article  PubMed  Google Scholar 

  28. Kuopil I, Shestov D, Plavinskaja S, Parfenova N, Vagero D. Blood pressure, hypertension and mortality from circulatory disease in men and women who survived the siege of Leningrad. Eur J Epidemiol. 2007;22:223–34.

    Article  Google Scholar 

  29. Hoet JJ, Hanson MA. Intrauterine nutrition: its importance during critical periods for cardiovascular and endocrine development. J Physiol. 1999;514:617–27.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Fall CHD. Fetal malnutrition and long-term outcomes. Nestle Nutr Inst Work Ser. 2013;74:11–25.

    Article  Google Scholar 

  31. Eriksson J, Forse T, Tuomilehto J, Osmond C, Barker D. Fetal and childhood growth and hypertension in adult life. Hypertension. 2000;36:790–4.

    Article  CAS  PubMed  Google Scholar 

  32. Deodati A, Inzaghi E, Cianfarani S. Epigenetics and in utero acquired predisposition to metabolic disease. Front Genet. 2020;10:1–11.

    Article  Google Scholar 

  33. Peñagaricano F, Wang X, Rosa GJM, Radunz AE, Khatib H. Maternal nutrition induces gene expression changes in fetal muscle and adipose tissues in sheep. BMC Genomics. 2014;15:1–13.

    Article  Google Scholar 

  34. Lan X, Cretney EC, Kropp J, Khateeb K, Berg MA, Peñagaricano F, et al. Maternal diet during pregnancy induces gene expression and DNA methylation changes in fetal tissues in sheep. Front Genet. 2013;4:1–12.

    Article  CAS  Google Scholar 

  35. Rosenfeld CS. Sex-specific placental responses in fetal development. Endocrinology. 2015;156:3422–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Johansson S, Norman M, Legnevall L, Dalmaz Y, Lagercrantz H, Vanpee M. Increased catecholamines and heart rate in children with low birth weight: perinatal contributions to sympathoadrenal overactivity. J Intern Med. 2007;261:480–7.

    Article  CAS  PubMed  Google Scholar 

  37. Alves JL, de B, Costa-Silva JH. Maternal protein malnutrition induced-hypertension: New evidence about the autonomic and respiratory dysfunctions and epigenetic mechanisms. Clin Exp Pharm Physiol. 2018;45:422–9.

    Article  Google Scholar 

  38. Sawaya AL, Sesso R, Florêncio TMMT, Fernandes MT, Martins PA. Association between chronic undernutrition and hypertension. Matern Child Nutr. 2005;1:155–63.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Wu L, Feng X, He A, Ding Y, Zhou X, Xu Z. Prenatal exposure to the Great Chinese Famine and mid-age hypertension. PLoS One. 2017;12:1–12.

    Google Scholar 

  40. Dunn G. The impact of the Boko Haram insurgency in Northeast Nigeria on childhood wasting: a double-difference study. Confl Health. 2018;12:1–12.

    Article  Google Scholar 

Download references

Acknowledgements

The authors thank all the research assistants who participated in the survey.

Author information

Authors and Affiliations

  1. Cardiology Unit, Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria

    Okechukwu S. Ogah

  2. Cardiology Unit, Department of Medicine, University College Hospital, Ibadan, Nigeria

    Okechukwu S. Ogah, Ayodipupo Sikiru Oguntade & Olanike Allison Orimolade

  3. Institute of Advanced Medical Research and Training, College of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria

    Okechukwu S. Ogah

  4. Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK

    Innocent Ijezie Chukwuonye

  5. Department of Internal Medicine, Federal Medical Centre, Umuahia, Nigeria

    Ugochukwu Uchenna Onyeonoro

  6. Department of Public Health, Abia State Ministry of Health, Umuahia, Nigeria

    Okechukwu Ojoemelam Madukwe

  7. Nephrology Unit, Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria

    Adanze Asinobi

  8. Department of Chemical Pathology, University College Hospital Ibadan, Ibadan, Nigeria

    Fisayo Ogah

  9. Alexander Brown Hall, College of Medicine, University of Ibadan, Ibadan, Nigeria

    Abdulhammed Opeyemi Babatunde, Mesoma Frances Okeke, Ojoma Peace Attah & Ikponmwosa Gabriel Ebengho

  10. Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa

    Karen Sliwa

  11. Soweto Cardiovascular Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Karen Sliwa

  12. Institute of Health Research, University of Notre Dame Australia, Fremantle, WA, Australia

    Simon Stewart

Authors
  1. Okechukwu S. Ogah
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ayodipupo Sikiru Oguntade
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Innocent Ijezie Chukwuonye
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ugochukwu Uchenna Onyeonoro
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Okechukwu Ojoemelam Madukwe
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Adanze Asinobi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fisayo Ogah
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Olanike Allison Orimolade
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Abdulhammed Opeyemi Babatunde
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Mesoma Frances Okeke
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Ojoma Peace Attah
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Ikponmwosa Gabriel Ebengho
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Karen Sliwa
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Simon Stewart
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

OSO, ASO, AA, FO, IIC, UUO and OOM conceptualized the study; OSO, ASO, FO, UUO, IIC and OOM designed the study and coordinated the data collection; ASO and OSO wrote the first draft of the manuscript; ASO, OSO, KS, SS, AOB, MFO, OPA, OAO, FO, AA and  IGE wrote the final manuscript and figures. All authors approved the manuscript for submission.

Corresponding author

Correspondence to Okechukwu S. Ogah.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval

The ethical approval was obtained at the Abia State Ministry of Health, Nigeria with reference number: AB/MH/E&HR/1/004/15.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ogah, O.S., Oguntade, A.S., Chukwuonye, I.I. et al. Childhood and Infant exposure to famine in the Biafran war is associated with hypertension in later life: the Abia NCDS study. J Hum Hypertens 37, 936–943 (2023). https://doi.org/10.1038/s41371-022-00782-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41371-022-00782-x

Search

Advanced search

Quick links