Time in the womb is a critical period for early childhood development. Now, a review by Monash University researchers suggests that pre-birth exposure to poor nutrition during famines and other natural disasters may put babies at risk of diabetes, contributing to today’s global type 2 diabetes mellitus (T2DM) epidemic.
The review, led by Monash University’s Department of Diabetes, examined data about the pre-birth (in utero) exposure to poor nutrition during the Chinese Famine (1959–1961), concluding it probably contributed to the modern-day epidemic. It was published today in the journal Nature Reviews Endocrinology.
Professor Paul Zimmet AO said early life events increased the risk of diabetes through what are called epigenetic changes – chemical modifications to genes caused by the environment. Epigenetic changes convey risk of diabetes and obesity in adulthood, and can become intergenerational, perpetuating risk through future generations.
"These gene-environment interactions resulting from famine and the subsequent increased intergenerational risk have contributed to the current epidemic of T2DM in China, which poses major social, health and economic challenges," Professor Zimmet said.
"More than 25% of all cases of diabetes globally are now in China. Yet, forty years ago, diabetes was uncommon. Today there are over 120 million people affected."
Genes and lifestyle change, the traditional ‘culprits’ held to be responsible for diabetes, do not alone explain this phenomenal increase, he said.
Recent global diabetes estimates suggest there were 449 million people with diabetes in 2017, with that figure expected to rise to more than 700 million by 2045.
Professor Zimmet said the paper’s conclusions suggest that the prevention of type 2 diabetes cannot be confined to lifestyle measures.
"The famine and diabetes scenario, a rise in diabetes seen many decades after catastrophic famines, provides an urgent public health warning. It has important implications for diabetes control in the developing world," he said. Professor Zimmet warned there was an urgent need for UN Food Agencies and others to review the way emergency food aid was given in populations for major catastrophes, including war and earthquakes. "The future welfare and life-course of millions of children depend on action on the urgent need for responsible and appropriate handling of the nutritional and social issues in terms of relief aid and food supplies," he said.
Rises in diabetes numbers also occurred many years after famines in the Netherlands (the Dutch Winter Famine), the Ukraine and elsewhere. The paper was co-written by Associate Professor Zumin Shi, who now works in the Human Nutrition Department Qatar University.
