Type 2 diabetes cases more than doubled seven decades after exposure to famine

Researchers at Columbia University Mailman School of Public Health, the University of North Carolina at Chapel Hill and at the National Academy of Sciences of Ukraine used the setting of the man-made Ukrainian Holodomor famine of 1932-1933 to examine the relation between prenatal famine and adult Type 2 diabetes mellitus (T2DM). They studied 128,225 Type 2 diabetes cases diagnosed between 2000-2008 among 10,186,016 male and female Ukrainians born between 1930 and 1938.

Individuals who were exposed in early gestation to the famine had a more than two-fold likelihood of developing Type 2 diabetes compared to those unexposed to the famine, according to a study led by Columbia University Mailman School of Public Health. The results are published in the journal Science.

The famine led to 4 million excess deaths in the short-term and losses were concentrated in a 6 month period. The Holodomor far exceeded other famines in terms of its intensity. Life expectancies at birth in 1933 were only 7.2 years for females and 4.3 for males.

“The Ukraine setting provided an unusual opportunity to investigate the long-term impact of the Holodomor -- or death by hunger --on Type 2 Diabetes Mellitus (T2DM) cases diagnosed seven decades after prenatal famine exposure,” said L.H. Lumey, MD, professor of Epidemiology at Columbia Public Health. “With the famine concentrated in a six-month period in early 1933, we are able to pinpoint the timing of famine together with extreme variations in intensity across provinces.”

This concentration was the result of Stalin’s use of famine as a weapon of terror against Ukrainian farmers. When Ukraine could not fulfill its grain procurement quotas to the Soviet Central Government,  having not enough for themselves, drastic measures were implemented to fulfill the quotas, under the excuse that counter-revolutionary elements sabotaged grain procurement. A countrywide campaign of searches of peasant's homes looking for "hidden" or "stolen" grain was launched in late 1932 and expanded in early 1933. All or most of the food was confiscated during many of these searches, leaving families without any food for the rest of the winter. In addition, measures were implemented that curtailed Ukrainian peasants' travel in search of food. 

These measures created a perfect storm. Many rural families were left without any food; avenues to search for food were closed and grain reserve funds were depleted. Thousands of rural families were condemned to a slow death by starvation in their villages. The result was an extraordinary increase in Holodomor excess deaths between January and June 1933. At the peak of the famine in June 1933, there were, on the average, 28,000 famine-related deaths per day caused by the famine, equivalent to 1,167 deaths per hour or 19 per minute.   

“Our study into the long-term health impact of the Holodomor famine offers several critical lessons for addressing health challenges posed by national disasters,” observes Lumey. “It underscores the necessity for a comprehensive health care and policy framework that takes into account the lasting effects of early-life adversities on population health and their potential long-term repercussions on chronic diseases and mental health.”

While individuals diagnosed with T2DM in 2000-2008 may also be overweight or obese and have other risk factors for the disease, the relation between adult T2DM risk and the place and date of birth at the time of the famine is so specific that famine exposure in early gestation appears to be the dominant factor that overrides all others, according to the research team.

“This awareness should prompt a proactive approach among policymakers and public health officials to anticipate the increased healthcare needs among populations affected by national disasters. It also highlights the importance of raising awareness about the potential long-term health effects of early-life adversities,” observed Lumey.

“Besides the need to develop policies for addressing long-term health challenges after a national disaster, the results of our study underscore the importance of policies aimed at preventing events like the Holodomor from happening again. Russia’s invasion of Ukraine in 2022 shows that history repeats itself” points out Dr. Wolowyna of the University of North Carolina at Chapel Hill. “The three-month siege in 2022 of the city of Mariupol during the current war in Ukraine to starve the population into surrender serves as a reminder of a current and real danger. The blockade of Ukrainian ports to prevent the export of Ukrainian grain to developing countries in Africa and Asia, has increased the danger of starvation for millions of persons in these countries.”

Co-authors are Chihua Li, University of Michigan, Johns Hopkins University, and University of Macau; Mykola Khalangot, Komisarenko Institute of Endocrinology and Metabolism, Kyiv and Shupyk National Healthcare University, Kyiv; Nataliia Levchuk, ⁷Ptoukha Institute of Demography and Social Sciences, Kyiv and⁸Max Planck Institute for Demographic Research, Germany.

The study was supported by Ukraine State complex program Diabetes Mellitus, 0106U000844; the Holodomor Research and Education Consortium in Canada; NIDI-NIAS Fellowship of the Royal Netherlands Academy of Sciences; National Institute of Aging, R01 AG028593 and R01 AG06687, R01 AG070953 and R01AG075719.

The authors declare they have no competing interests.

Columbia University Mailman School of Public Health

Founded in 1922, the Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Columbia Mailman School is the fourth largest recipient of NIH grants among schools of public health. Its nearly 300 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change and health, and public health preparedness. It is a leader in public health education with more than 1,300 graduate students from 55 nations pursuing a variety of master’s and doctoral degree programs. The Columbia Mailman School is also home to numerous world-renowned research centers, including ICAP and the Center for Infection and Immunity. For more information, please visit www.mailman.columbia.edu.