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Enteral and parenteral nutrition

Chinese famine exposure in infancy and metabolic syndrome in adulthood: results from the China health and retirement longitudinal study



To explore the association between famine exposure in early life and the risk of metabolic syndrome in the Chinese adults.


A total of 2148 participants aged 50s were selected from a large national epidemiological survey in the China. The logistic regression models were used to analyze the association between famine exposure in early life and risk of metabolic syndrome in adulthood.


The prevalence of metabolic syndrome among individuals in the preschool exposed group, infant exposed group, fetal exposed group, and the non-exposed group was 37.9, 43.5, 37.5, and 34.0%, respectively. The prevalence of metabolic syndrome in the infant exposed group was significantly higher than the non-exposed group (43.5 vs. 34.0%, P = 0.006). Compared with the non-exposed group, individuals who exposed to the famine in infancy significantly increased the risk of metabolic syndrome (OR = 1.83; 95% CI: 1.24, 2.70) after adjusting for gender, smoking status, drinking status, physical activity, and the educational levels of participants and their parents. However, similar results were not observed in the fetal (OR = 1.25; 95% CI: 0.89, 1.74) or the preschool (OR = 1.30; 95% CI: 0.97, 1.75) exposed groups.


The Great China famine exposure during infancy was linked with the elevated risk of metabolic syndrome in adults aged 50s, which provided further evidence for the developmental origins hypothesis.

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Fig. 1
Fig. 2


  1. 1.

    Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120:1640–5.

    CAS  Article  Google Scholar 

  2. 2.

    Meigs JB. Invited commentary: insulin resistance syndrome? Syndrome X? Multiple metabolic syndrome? A syndrome at all? Factor analysis reveals patterns in the fabric of correlated metabolic risk factors. Am J Epidemiol. 2000;152:908–11. discussion 912

    CAS  Article  Google Scholar 

  3. 3.

    Alberti KG, Zimmet P, Shaw J, Group IDFETFC. The metabolic syndrome--a new worldwide definition. Lancet. 2005;366:1059–62.

    Article  Google Scholar 

  4. 4.

    Lorenzo C, Okoloise M, Williams K, Stern MP, Haffner SM, San Antonio Heart S. The metabolic syndrome as predictor of type 2 diabetes: the San Antonio heart study. Diabetes Care. 2003;26:3153–9.

    Article  Google Scholar 

  5. 5.

    Rutter MK, Meigs JB, Wilson PW. Cardiovascular risk and the metabolic syndrome. Metab Syndr Relat Disord. 2006;4:252–60.

    Article  Google Scholar 

  6. 6.

    Gu D, Reynolds K, Wu X, Chen J, Duan X, Reynolds RF, et al. Prevalence of the metabolic syndrome and overweight among adults in China. Lancet. 2005;365:1398–405.

    Article  Google Scholar 

  7. 7.

    Xi B, He D, Hu Y, Zhou D. Prevalence of metabolic syndrome and its influencing factors among the Chinese adults: the China Health and Nutrition Survey in 2009. Prev Med. 2013;57:867–71.

    Article  Google Scholar 

  8. 8.

    Moore BF, Clark ML, Bachand A, Reynolds SJ, Nelson TL, Peel JL. Interactions between diet and exposure to secondhand smoke on metabolic syndrome among children: NHANES 2007-10. J Clin Endocrinol Metab. 2016;101:52–58.

    CAS  Article  Google Scholar 

  9. 9.

    Huang JH, Li RH, Huang SL, Sia HK, Chen YL, Tang FC. Lifestyle factors and metabolic syndrome among workers: the role of interactions between smoking and alcohol to nutrition and exercise. Int J Environ Res Public Health. 2015;12:15967–78.

    CAS  Article  Google Scholar 

  10. 10.

    Barker DJ, Bagby SP, Hanson MA. Mechanisms of disease: in utero programming in the pathogenesis of hypertension. Nat Clin Pract Nephrol. 2006;2:700–7.

    Article  Google Scholar 

  11. 11.

    Gluckman PD, Hanson MA, Cooper C, Thornburg KL. Effect of in utero and early-life conditions on adult health and disease. N Engl J Med. 2008;359:61–73.

    CAS  Article  Google Scholar 

  12. 12.

    Li Y, Jaddoe VW, Qi L, He Y, Wang D, Lai J, et al. Exposure to the chinese famine in early life and the risk of metabolic syndrome in adulthood. Diabetes Care. 2011;34:1014–8.

    Article  Google Scholar 

  13. 13.

    Ruster M, Sommer M, Stein G, Bauer K, Walter B, Wolf G, et al. Renal angiotensin receptor type 1 and 2 upregulation in intrauterine growth restriction of newborn piglets. Cells Tissues Organs. 2006;182:106–14.

    Article  Google Scholar 

  14. 14.

    Sahajpal V, Ashton N. Renal function and angiotensin AT1 receptor expression in young rats following intrauterine exposure to a maternal low-protein diet. Clin Sci. 2003;104:607–14.

    CAS  Article  Google Scholar 

  15. 15.

    Woods LL, Ingelfinger JR, Nyengaard JR, Rasch R. Maternal protein restriction suppresses the newborn renin-angiotensin system and programs adult hypertension in rats. Pediatr Res. 2001;49:460–7.

    CAS  Article  Google Scholar 

  16. 16.

    Manning J, Vehaskari VM. Low birth weight-associated adult hypertension in the rat. Pediatr Nephrol. 2001;16:417–22.

    CAS  Article  Google Scholar 

  17. 17.

    de Rooij SR, Painter RC, Holleman F, Bossuyt PM, Roseboom TJ. The metabolic syndrome in adults prenatally exposed to the Dutch famine. Am J Clin Nutr. 2007;86:1219–24.

    Article  Google Scholar 

  18. 18.

    Rabusic L. The demographic crisis in China, 1959-61. Demografie. 1990;32:132–42.

    CAS  PubMed  Google Scholar 

  19. 19.

    Cai Y, Feng W. Famine, social disruption, and involuntary fetal loss: evidence from Chinese survey data. Demography. 2005;42:301–22.

    Article  Google Scholar 

  20. 20.

    Wang N, Wang X, Li Q, Han B, Chen Y, Zhu C, et al. The famine exposure in early life and metabolic syndrome in adulthood. Clin Nutr. 2015;36:253–59.

    CAS  Article  Google Scholar 

  21. 21.

    Zheng X, Wang Y, Ren W, Luo R, Zhang S, Zhang JH, et al. Risk of metabolic syndrome in adults exposed to the great Chinese famine during the fetal life and early childhood. Eur J Clin Nutr. 2012;66:231–6.

    CAS  Article  Google Scholar 

  22. 22.

    Zhao Y, Hu Y, Smith JP, Strauss J, Yang G. Cohort profile: the China health and retirement longitudinal study (CHARLS). Int J Epidemiol. 2014;43:61–68.

    Article  Google Scholar 

  23. 23.

    Wang Z, Li C, Yang Z, Zou Z, Ma J. Infant exposure to Chinese famine increased the risk of hypertension in adulthood: Results from the China Health and Retirement Longitudinal Study. BMC Public Health. 2016;16:435.

    Article  Google Scholar 

  24. 24.

    Luo ZC, Xiao L, Nuyt AM. Mechanisms of developmental programming of the metabolic syndrome and related disorders. World J Diabetes. 2010;1:89–98.

    Article  Google Scholar 

  25. 25.

    Association CDSoM. Guideline to the prevention and treatment of type 2 diabetes in China (2013 Edition). Chin J Endocrinol Metab. 2013;10:893–942.

    Google Scholar 

  26. 26.

    van Abeelen AF, Elias SG, Bossuyt PM, Grobbee DE, van der Schouw YT, Roseboom TJ, et al. Famine exposure in the young and the risk of type 2 diabetes in adulthood. Diabetes. 2012;61:2255–60.

    Article  Google Scholar 

  27. 27.

    Liu L, Wang W, Sun J, Pang Z. Association of famine exposure during early life with the risk of type 2 diabetes in adulthood: a meta-analysis. Eur J Nutr. 2016;57:741–9.

    Article  Google Scholar 

  28. 28.

    Wang N, Cheng J, Han B, Li Q, Chen Y, Xia F, et al. Exposure to severe famine in the prenatal or postnatal period and the development of diabetes in adulthood: an observational study. Diabetologia. 2017;60:262–9.

    Article  Google Scholar 

  29. 29.

    Li Y, He Y, Qi L, Jaddoe VW, Feskens EJ, Yang X, et al. Exposure to the Chinese famine in early life and the risk of hyperglycemia and type 2 diabetes in adulthood. Diabetes. 2010;59:2400–6.

    CAS  Article  Google Scholar 

  30. 30.

    Barker DJ, Osmond C, Forsen TJ, Kajantie E, Eriksson JG. Trajectories of growth among children who have coronary events as adults. N Engl J Med. 2005;353:1802–9.

    CAS  Article  Google Scholar 

  31. 31.

    Hoet JJ, The role of fetal and infant growth and nutrition in the causality of diabetes and cardiovascular disease in later life. SCN News. 1997;14:10–13.

    Google Scholar 

  32. 32.

    Bai SY, Briggs DI, Vickers MH. Increased systolic blood pressure in rat offspring following a maternal low-protein diet is normalized by maternal dietary choline supplementation. J Dev Orig Health Dis. 2012;3:342–9.

    CAS  Article  Google Scholar 

  33. 33.

    Bol V,Desjardins F,Reusens B,Balligand JL,Remacle C, Does early mismatched nutrition predispose to hypertension and atherosclerosis, in male mice?. PLoS ONE. 2010;5:e12656

    Article  Google Scholar 

  34. 34.

    Li Y, Jaddoe VW, Qi L, He Y, Lai J, Wang J, et al. Exposure to the Chinese famine in early life and the risk of hypertension in adulthood. J Hypertens. 2011;29:1085–92.

    CAS  Article  Google Scholar 

  35. 35.

    Roseboom T, de Rooij S, Painter R. The Dutch famine and its long-term consequences for adult health. Early Hum Dev. 2006;82:485–91.

    Article  Google Scholar 

  36. 36.

    Lumey LH, Stein AD, Kahn HS, Romijn JA. Lipid profiles in middle-aged men and women after famine exposure during gestation: the Dutch hunger winter families study. Am J Clin Nutr. 2009;89:1737–43.

    CAS  Article  Google Scholar 

  37. 37.

    Aagaard-Tillery KM, Grove K, Bishop J, Ke X, Fu Q, McKnight R, et al. Developmental origins of disease and determinants of chromatin structure: maternal diet modifies the primate fetal epigenome. J Mol Endocrinol. 2008;41:91–102.

    CAS  Article  Google Scholar 

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The authors thank the CHARLS program team for help in data available and training for using their data. Authors also thank all the students and staff of the China CDC who participated in this program.


This work was supported by the National Science Foundation of China (grant number NEFC 81673192).

Author contributions

Z.W. and Z.Z. participated in the design of this study, Z.W. and S.W. performed the statistical analysis, and J.M. supervised data analysis. All authors participated in writing the paper. All authors read and approved the final manuscript.

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Corresponding author

Correspondence to Jun Ma.

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The authors declare that they have no conflict of interest.

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Wang, Z., Zou, Z., Wang, S. et al. Chinese famine exposure in infancy and metabolic syndrome in adulthood: results from the China health and retirement longitudinal study. Eur J Clin Nutr 73, 724–732 (2019).

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