Early-life exposure to the Ukraine famine of 1933 and type 2 diabetes in adulthood

The Great Ukrainian famine of 1933 was a major famine in pre-WWII Europe. However, its long-term health consequences have not been studied in detail before. To examine a possible relation between exposure to famine in early life and health in adulthood, we compared the prevalence of type 2 diabetes (T2D) in the Ukrainian diabetes register of residents born before, during, and after the famine of 1933. The first sample includes 28,358 T2D patients in 2000 who were born in the period 1930-1938 and living in four Ukraine regions that suffered significant demographic losses due to famine: Chernihiv, Vinnitsa, Kharkiv and Kherson. There was an approximately 1.5-fold increase in the odds for T2D comparing men and women born in the first half of the 1934 to individuals who were born in comparable pre-famine or post-famine cohorts. Individuals born in the first half of the 1934 would have been conceived during the peak of the famine (April-July 1933). There was no change in the odds of T2D for men and women born in the second half of 1934 relative to comparable pre-famine or post-famine cohorts. The second sample includes 105,374 T2D patients in 2008 who were born between the 1920s and 1964 in Eastern and Western Ukraine regions with different famine histories. We first note a pronounced female preponderance among T2D patients overall, with a female/male odds ratio of 1:48 (95% CI: 1:46-1:50). The female-to-male predominance appears to be more pronounced among individuals residing in Eastern Ukraine regions (Chernihiv, Kherson and Crimea) who were exposed to the famine of 1933 compared to those residing in Western Ukraine regions (Volyn and Rivne), unexposed to the famine. One possible explanation for such female predominance may be due to the fact that women are more likely than men to be influenced by adverse early-life conditions. Future studies in different Ukrainian regions may provide additional information and clarify possible mechanisms linking early-life famine to later-life adverse health outcomes.