Famine Survivors Research Articles

Accelerated biological aging six decades after prenatal famine exposure

To test the hypothesis that early-life adversity accelerates the pace of biological aging, we analyzed data from the Dutch Hunger Winter Families Study (DHWFS, N = 951). DHWFS is a natural-experiment birth-cohort study of survivors of in-utero exposure to famine conditions caused by the German occupation of the Western Netherlands in Winter 1944 to 1945, matched controls, and their siblings. We conducted DNA methylation analysis of blood samples collected when the survivors were aged 58 to quantify biological aging using the DunedinPACE, GrimAge, and PhenoAge epigenetic clocks. Famine survivors had faster DunedinPACE, as compared with controls. This effect was strongest among women. Results were similar for GrimAge, although effect-sizes were smaller. We observed no differences in PhenoAge between survivors and controls. Famine effects were not accounted for by blood-cell composition and were similar for individuals exposed early and later in gestation. Findings suggest in-utero undernutrition may accelerate biological aging in later life.

IN UTERO EXPOSURE TO THE DUTCH HUNGER WINTER AND THE PACE OF BIOLOGICAL AGING

Abstract Adults with histories of early-life adversity experience younger age-of-onset for aging-related disease and shorter lifespan, suggesting an accelerated pace of biological aging. To test this hypothesis, we analyzed data from an established natural experiment: in-utero exposure to famine conditions induced by a Nazi blockade of the Southern Netherlands in Winter 1944-5. We analyzed data from the Dutch Hunger Winter Families Study (DHWFS, N=951). DHWFS enrolled survivors of in-utero famine exposure, matched controls born in the same hospitals as the survivors immediately prior to and following the famine period, and siblings of these individuals. Blood samples were collected when the famine survivors were aged 58. We analyzed blood DNA methylation data to measure the GrimAge and PhenoAge 2nd-generation epigenetic clocks and the DunedinPACE 3rd-generation clock. We tested if famine survivors were biologically older and aging faster as compared to controls. We found that famine survivors had faster DunedinPACE pace of aging, as compared with controls, but similar PhenoAge and GrimAge biological ages. In sex-stratified analyses, we found stronger effects of famine exposure in women as compared with men, including for the GrimAge and PhenoAge clocks; among women, famine exposure was associated with faster DunedinPACE and older GrimAge and PhenoAge, whereas in men effect-sizes were near zero. Famine effects were not accounted for by blood-cell composition and were similar for individuals exposed early and later in gestation. Sibling-difference analyses reproduced size and direction of effect estimates. Findings provide natural-experiment evidence for long-term effects of in-utero famine exposure on the pace biological aging.

Parents' early experience and children's years of schooling: The long-term impact of son preference

It is well documented that years of schooling are largely influenced by the family. However, few studies have examined the intergenerational effect of individuals' early experience on their offspring's educational attainment. Using China's 1959–1961 famine as an exogenous shock, we construct a difference-in-difference model based on different famine severities across provinces and cohorts. We find that daughters of rural famine fathers have lower educational attainment. Mechanism analysis shows that male famine survivors are more likely to be observed in families with a strong son preference, which is passed on to their daughters and damages their educational attainment. The effect is more pronounced especially when the daughter is not an only child, has a brother, or the second child in the family is a son. The above results are robust to different specifications and alternative measures, suggesting that individuals' early experience may negatively affect the offspring's educational attainment through an entrenched cultural concept.

The intergenerational legacy of the 1959–1961 Great Chinese Famine on children’s cognitive development

We investigate the effect of early exposure to malnutrition on the cognitive abilities of the offspring of survivors in the context of a natural experiment; i.e., the Great Chinese Famine (GCF) of 1959–61. We employ a novel dataset – the China Family Panel Studies (CFPS) – to do so. The paper finds that the cognitive abilities of children whose fathers were born in rural areas during the famine years (1959–1961) were impaired by exposure to the GCF and the negative effect was greater for girls than boys, whereas children whose mothers were born in rural areas during the famine years were not affected. The uncovered gender-specific effect is almost entirely attributable to son preference exhibited in families with male famine survivors.

Favorable pattern of arterial stiffness and vascular aging in a unique cohort of offspring of early life famine survivors

The impact of adverse factors in the early life can affect the rate of vascular aging in adulthood and be passed on to the next generations.Aim. To study the characteristics of arterial stiffness and vascular aging phenotypes in two generations of descendants (children and grandchildren) of the siege of Leningrad survivors, compared to a control group.Material and methods. Residents of the siege of Leningrad who experienced famine during early childhood in the Great Patriotic War (19411944) underwent examination between 2009 and 2014. In 2020-2021, 76 descendants of Leningrad siege survivors, aged 18 to 63 years (children — 54 (first generation) and grandchildren — 22 (second generation)), without diagnosed cardiovascular diseases, were examined. Questioning, measurement of blood pressure (BP) and biochemical blood tests were carried out. The cardio-ankle vascular index (CAVI) was determined using the VaSera VS-1500 system (Fukuda Denshi, Japan). Carotid-femoral pulse wave velocity (cfPWV) was assessed using applanation tonometry (SphygmoCor, AtCor, Australia). The phenomenon of supernormal vascular aging was diagnosed with cfPWV £10th percentile of the reference European population, normal vascular aging with cfPWV of 10th-90th percentiles, and early vascular aging with cfPWV ³90th percentile, taking into account age and BP (MattaceRaso F et al., 2010). Several control respondents from the ESSE-RF study (St. Petersburg residents aged 25-64 years) were selected for each descendant, considering generation, sex, age, and BMI. The statistical significance of results was adjusted for multiple comparisons.Results. The average age of descendants of Leningrad blockade survivors was 50 [36,7-55,0] years, which was comparable to the controls, who were 51 [37,5-55,0] years old (p=0,44). The proportion of men in the samples was also comparable — 43,4% vs 42,3% (p=0,88). The cfPWV values were similar in the study and control groups (p=0,4). Only CAVI values were lower in descendants compared to controls, with significant differences observed only in the first generation, regardless of sex (men — 7,6 [7,1;8,3] in the experimental group vs 8,6 [7,6;9,3] in the control group, p=0,02; women — 7,2 [6,7;7,8] in the experimental group vs 7,8 [7,3;8,2] in the control group, p=0,03). The phenotype of early vascular aging was found only in one participant from the experimental group, while the phenomenon of supernormal vascular aging was significantly more prevalent in the age group of 40-49 years in descendants of Leningrad blockade survivors compared to the control group — 25% vs 0% (p=0,01).Conclusion. Only in the first generation of descendants of Leningrad blockade survivors, a favorable pattern of arterial stiffness and a tendency towards a higher prevalence of supernormal vascular aging were observed compared to the control group.

Is it just a cure? Re-evaluating the effects of prenatal exposure to the Great Chinese Famine on the risk of infectious diseases in adulthood

BackgroundVery limited studies focused on the early-life adversities on infectious diseases. Taking the Great Chinese famine as a natural experiment, this study re-evaluated the long-term effect of prenatal famine exposure on infectious diseases by using nationally representative data. MethodsUsing difference-in-difference (DID) models, we analyzed 215,216 adults who participated in the Second National Sample Survey on Disability in 2006 across 734 counties of China to detect the effects of prenatal exposure to the Great Chinese Famine on the risk of infectious diseases in adulthood. Infectious diseases were ascertained by using the combination of self-reports or family members’ reports and on-site medical diagnosis by experienced specialists, and the severity of famine was measured by the cohort size shrinkage index (CSSI) at the county level. ResultsAll DID estimates of the effects of famine on the probability of infectious diseases were insignificant, with a coefficient of 0.0007 (−0.0024, 0.0026) for all participants and coefficients of 0.0001 (−0.0041, 0.0043) and −0.0002 (−0.0036, 0.0033) for males and females, respectively. That is, the famine cohort dwelling in regions with a greater intensity of famine had similar levels of infectious disease risks than the cohorts with post-famine prenatal exposure experience in less affected famine regions. Furthermore, there were no significant famine and post-famine cohort differences in the DID estimates by examining the variations in subgroups with different types of infectious diseases (trachoma, poliomyelitis, tuberculosis, maternal infections and other infectious diseases). ConclusionNo significant impact of prenatal exposure to the Chinese famine was observed on the risk of infectious diseases in adulthood. Famine survivors may be “cured” by the famine and were resilient to adverse environments in their life course because selective mortality may weaken the association between adverse prenatal exposure and later health.

Songs of Famine and War: Irish Famine Memory in the Music of the US Civil War

This article illuminates ways in which memory of Ireland's Great Famine or ‘an Gorta Mór’ (1845–1852) shaped US music during the US Civil War (1861–1865). Among scholarship on Irish Americans in the Civil War, few sources substantively address lingering memories and trauma from the Great Famine. Yet, a significant amount of the estimated 1.6 million Irish immigrants living in the US in 1860, 170,000 of whom enlisted in the war, were famine survivors. Music's unique role in emotional life offers robust source material for understanding famine memory in this transnational context. Adopting a concept of ‘private, secret, insidious trauma’ from Laura Brown and Maria P.P. Root, as well as understanding Jeffrey Alexander's ideas about cultural trauma as a sociological process, the article highlights a some of the ways in which famine memories emerged in music-making during the war. Case studies include a survey of US sheet music, the transnational performance and reception history of the song ‘Kathleen Mavourneen’, and research on the life of the northern Union army's most successful bandleader, Patrick Gilmore, who left Athlone, in Ireland famine-ravaged West, as a teenager in the late 1840s. The approach is inherently transatlantic, accounting for histories that occurred in the United States, Ireland and the broader Atlantic world dominated by Britain. The essay illustrates how music can contribute to social history, ways in which the application of research on trauma can inform musicological work, and ways in which traumatic memories can emerge across time and distance, particularly in diasporic contexts.

Association of postnatal severe acute malnutrition with pancreatic exocrine and endocrine function in children and adults: a systematic review.

Severe acute malnutrition may lead both concurrently and subsequently to malabsorption and impaired glucose metabolism from pancreatic dysfunction. We conducted a systematic review to investigate the associations of current and prior postnatal wasting malnutrition with pancreatic endocrine and exocrine functions in humans. We searched PubMed, Google Scholar, Web of Science and reference lists of retrieved articles, limited to articles in English published before 1 February 2022. We included sixty-eight articles, mostly cross-sectional or cohort studies from twenty-nine countries including 592530 participants, of which 325998 were from a single study. Many were small clinical studies from decades ago and rated poor quality. Exocrine pancreas function, indicated by duodenal fluid or serum enzymes, or faecal elastase, was generally impaired in malnutrition. Insulin production was usually low in malnourished children and adults. Glucose disappearance during oral and intravenous glucose tolerance tests was variable. Upon treatment of malnutrition, most abnormalities improved but frequently not to control levels. Famine survivors studied decades later showed ongoing impaired glucose tolerance with some evidence of sex differences. The similar findings from anorexia nervosa, famine survivors and poverty- or infection-associated malnutrition in low- and middle-income countries (LMIC) lend credence to results being due to malnutrition itself. Research using large, well-documented cohorts and considering sexes separately, is needed to improve prevention and treatment of exocrine and endocrine pancreas abnormalities in LMIC with a high burden of malnutrition and diabetes.

Gray Markets in the Great Leap: Prosecuting “Profiteering” in Liangshan County, Shandong, 1958–1960

This article uses legal archives from Liangshan 梁山 county, Shandong, to explore the ambiguous position of rural markets in China during the Great Leap Forward campaign (1958–1962). These testimonies, though sparse, show that negotiations at a local, indeed personal, level underpinned the symbiosis between the “second economy” of illicit trade and the party-state’s putatively socialist political economy. Liangshan’s gray market bridged the gap between the party-state’s Sputnik promises and catastrophic realities, contributing twofold to the party-state’s political survival. First, illicit commerce helped famine survivors, including local cadres, obtain desperately needed sustenance; these cadres’ support of trading villagers despite top-down restrictions on such transactions likely helped them retain local moral authority after the Leap. Second, the intermittent formal prosecution of “profiteers” in the ritualized space of the county courtroom projected justice, stability, and coercive power, which also contributed to the party’s continuing hold on authority.

Long-term effects of malnutrition on early-life famine survivors and their offspring: New evidence from the Great Vietnam Famine 1944-45.

We investigate the long-term effects of the 1944-45 Great Vietnam Famine on early-life survivors and their offspring using census data, household survey data and historical administrative data. Unlike previous famine studies, we measure famine severity using a unique, more direct, and "plausibly exogenous" metric of food availability: province-level excess paddy (rice) production per capita in 1944. Our study makes two novel contributions. First, we overcome several selection problems associated with the estimation of true famine effects, given the short duration and spatial variation of the Vietnamese famine. Second, we investigate the intergenerational effects of famine, focusing specifically on the occupation of the survivors' parents and the school participation of the survivors' offspring. Our preferred specification estimates generalized triple differences that allow us to control for birth-year and birth-province fixed effects and nation-wide shocks. Our findings suggest that the Vietnamese famine reduced literacy by around 3 percent, BMI by 5.6%-8.4%, arm-length by 4.5%-6.7% (1.1-1.7cm), height by 2.2%-3.2% (3.4-5cm), and weight by 10%-14% (4.7-6.9kg) among the affected cohort. These detrimental famine effects also extended to economic welfare, in the form of lower household incomes and lower non-food household expenditures in adulthood. We also document a 4.9%-7.2% reduction in school participation among survivors' offspring, which has major implications for the exogenous origins of social mobility, inequality, and poverty.

‘If We Hadn’t Left … We Would Have All Died’: Escaping Famine on the Greek Island of Chios, 1941–44

AbstractThe decision-making processes of historical famine-induced migration movements have rarely been examined in detail. This article discusses such a movement from the Greek island of Chios and into Turkey in the early 1940s using first-hand accounts of famine survivors collected in the period 1999–2009. This article outlines the unfolding famine situation, describes the point at which individuals made the decision to leave or to stay and examines how that decision was implemented. The decision-making involved an elaborate process where pros and cons were assessed, where the wishes of individual family members were taken into consideration and where the long-term wellbeing of the family unit was the most important factor in any decision made. Difficult decisions, some of which may today appear irrational, were made. The article argues that individuals, even in crises situations, demonstrate agency and plan their actions and future, albeit within the constraints of a given situation.

Major famines as geopolitical strategies

This article offers a preliminary checklist for identifying the geopolitical motivations of decision makers responsible for major famines, events defined as economic and social crises causing one million or more excess deaths. Three geopolitical motivations are identified in three major famines in the twentieth century. The 1932–1933 Ukrainian famine illustrates the strategy of starving a geographically concentrated, politically distrusted minority into submission and repopulating areas with politically trustworthy settlers and indoctrinated or assimilated traumatized famine survivors. The 1943 Bengal famine illustrates the starvation of politically distrusted populations in areas likely to be lost to invasion to make consolidation of that conquest expensive and to impede further conquest. The 1994–1995 North Korean famine illustrates the starvation of population in areas that pose a lesser risk of catastrophic regime delegitimation. Given the near certain decrease in grain production and probable declines in livestock production and fish catch in the Global South anticipated with climate change, decision makers are likely to be tempted to execute major famines to realize these geopolitical objectives. The geopolitical advantage from major famine thus merits the attention of famine-studies scholars.

The Great Irish Famine (1845-52) and the Irish asylum system: remembering, forgetting, and remembering again.

The Great Irish Famine (1845-52) saw the Irish population fall by 20% as one million people died and another million emigrated. The Famine occurred at a time when the Irish asylums were growing rapidly anyway, so its precise effects on mental health are difficult although not impossible to study. Three groups merit consideration. First, for adults living through the Famine, starvation and poverty contributed to the continued rise in asylum presentations. Second, babies in utero during the Famine were reported to have accounted for an increase in first admissions when they reached the high-risk age for mental illness (1860-75). Third, the possibility of epigenetic effects (inherited changes in gene expression) as a result of Famine has been discussed as a possible mechanism whereby Famine survivors might have passed on experiences of physical and psychological trauma to their children and subsequent generations in a lasting, biological way. Intriguing as it is, this hypothesis requires further study, as does the distinctly uneven historiography of the Famine in relation to the Irish mental hospitals.

Leukocyte telomere length pattern in a Chuvash population that experienced mass famine in 1922–1923: a retrospective cohort study

To our knowledge, there are no experimental studies that have addressed the effects of starvation on the maintenance of telomere length. Two epidemiologic studies that have addressed this topic gave controversial results. We characterized leukocyte telomere length (LTL) in a Chuvash population that was comprised of survivors of the mass famine of 1922-1923 and in these survivors' descendants. The tested cohort consisted of native Chuvash men (n = 687) and women (n = 647) who were born between 1909 and 1980 and who resided in small villages in the Chuvash Republic of the Russian Federation. Data were gathered during 3 expeditions undertaken in 1994, 1999, and 2002. With the use of this method of gathering the study cohort, we were able to treat age and birth year as independent variables (i.e., after adjustment for age, we were able to analyze how LTL correlates with a birth year in the interval between 1909 and 1980). The DNA of peripheral blood leukocytes was used to measure the telomere length with a quantitative polymerase chain reaction technique. The main observations were as follows: 1) there were shorter leukocyte telomeres in men born after 1923 (i.e., after the mass famine) than in men born before 1922 (i.e., before the mass famine); 2) there was a stable inheritance of shorter telomeres by men of ensuing generations; and 3) there was an absence of a correlation between LTL and birth year in women. Our study does not provide direct evidence for leukocyte telomere shortening in famine survivors. However, the comparative analysis of LTL in the survivors and their descendants suggests that such an effect did take place. The study also implies that mass famine may be associated with telomere shortening in male descendants of famine survivors. This observation is in agreement with the "thrifty telomere hypothesis" predicting that longer telomeres are disadvantageous in nutritionally marginal environments.

History Reformatted: Vietnam's Great Famine (1944-45) in Archival Form

We primarily see the archive as storehouse of memory and fact, as the place from whence history issues forth. However, the archive is much more than this; it is . . . a place of trauma and pain. It is a place of sorrow and loss for many, where unpacified ghosts with unfinished business await, yielding stories and letters different from expectation, a site where loss is localized and realized. (Murphy 2011, 481)Many Vietnamese present ritual offerings to wandering spirits during T?t Trung Nguyen, a popular festival that occurs on the 15th day of the seventh lunar month. Participants recite prayers and then light seven sticks of incense to appease these spirits, who cannot become benevolent ancestors due to the unjust and often violent nature of their deaths. People pour small portions of boiled sweet potato, cassava, roasted corn, hard rice pancakes, and porridge-foods commonly eaten during periods of scarcity-into cones made of leaves from banyan trees. They then place the offerings outside in bushes, small shrines, and other hidden spaces for these ontological refugees (Kwon 2008, 16), who are neither fully dead nor alive, to dine upon. The festival's primary purpose, several Vietnamese explained to me, is to absolve the hungry ghosts of any harm they may have caused the living, such as misfortune or serious illness, over the past year. Several of them told me that the offerings also function as insurance against future problems because the offerings are meant to keep the hungry ghosts satiated for the next 12 months. The explanations are not mutually exclusive, and since the early 1990s growing numbers of people have used the festival to commemorate the victims of the Great Famine of 1944- 45 (N?n ðoi ?t D?u).Official Vietnamese estimates, first put forward in a famous speech by H? Chi Minh and then reiterated with little empirical support until recently, place the number of people who died within the space of six months at approximately two million (Nguyen Kh?c Ð?m 1988; Van T?o and Nguyen Kh?c Ð?m 1988; Ð?ng C?ng s?n Vi?t Nam 2008, 921; Gunn 2014, 259n1). Given the vast number of hungry ghosts this famine reportedly produced, the gradual inclusion of its victims, as part of this festival, is not surprising.1) The Great Famine affected 32 provinces across colonial Tonkin and Annam, reducing the population of what is now northern and central Vietnam by an estimated 15 percent (Duong Trung Quoc 2005). Yet, despite the size and scale of loss, no national monument exists to collectively memorialize the deaths. Instead, commemorative practices remain decidedly local in nature and revolve around the mass that can still be found across the countryside, usually in close proximity to villages where death rates were particularly high. Ghost graves (c?n ma) and hunger tombs (m? ðoi), as they are colloquially known, typically consist of a small mound of earth or a pile of carefully arranged bricks. These sites become visible to nonresidents only when famine survivors and their descendants visit them during the festival to appease the hungry ghosts.A three-meter-high concrete memorial, once part of a charity cemetery (nghia trang h?p thi?n) in Hanoi, is an exception to these informal practices. The remains of thousands of people who fled the countryside to seek refuge in the city but perished shortly after their arrival are interred beneath it. Residents of Hanoi raised funds to construct the memorial, which was completed in April 1951. Photographs, displayed in a small room adjacent to the memorial, indicate that people visited the site year-round for the next several years. But the memorial fell into disrepair by the time the Second Indochina War (1954-75) began. In September 2001, the People's Committee of Hanoi announced that it would rectify this situation by providing funds to renovate the longneglected memorial. The announcement, which appeared as a small sidebar in local newspapers, stated that the renovations would be completed by 2005, in time to mark the 60th anniversary of the Great Famine. …

Is natural experiment a cure? Re-examining the long-term health effects of China's 1959–1961 famine

The fetal origins hypothesis posits that adverse prenatal exposures, particularly malnutrition, increase the risk of poor adult health. Studies using famine as a natural experiment to test the fetal origins hypothesis present conflicting findings, partly because of data limitations and modeling flaws. Capitalizing on the biomarker data and prefecture-level geographic information from the 2011 China Health and Retirement Longitudinal Study, this study estimates the effects of prenatal exposure to China's 1959–61 famine on later-life risks of cardiovascular and metabolic diseases. Our analysis addresses the problems of measurement error and intrinsic cohort differences that challenge prior studies. We use provincial and prefecture-level geographic variations in famine severity, a proxy for prenatal malnutrition, for model identification. We construct instrumental variables from geocoded newspaper archive data to adjust for measurement error in famine exposure. We find that estimates of the famine effects are highly sensitive to the choices of health indicators, measures of famine severity, and regression model specifications. Overall, we find little evidence supporting the fetal origins hypothesis. In fact, it appears that prenatal exposure to famine reduces later-life disease risks in certain cases. We interpret this finding as evidence of mortality selection among the famine survivors at work. We conclude that using famine as a natural experiment in itself does not guarantee correct statistical inference about the long-term health impacts of prenatal malnutrition when other analytical challenges remain unresolved.

Historical Traumas and the Roots of Political Distrust: Political Inference from the Great Chinese Famine

What shapes a citizen’s trust and attitudes towards the government, and what makes them persist over time? We study the causal effect of the Great Chinese Famine (1959-1962) on the level of political trust and attitudes among its survivors. Using a novel nationally representative survey, we employ a difference-in-differences framework to compare citizens who experienced the Famine versus those who did not, across regions with differential levels of drought during the Famine. Famine survivors inferred the government’s liability from personal hunger experiences, and they were more likely to blame the government for their starvation in regions with usual rainfall during the Famine. As a result, these citizens trusted the local government significantly less, and held less favorable attitudes toward the government’s performances on key issues in contemporary China. These effects on political trust and attitudes persist even half a century after the Famine, and we provide suggestive evidence on the mechanisms that foster such persistence.

The Long-Term Health Effects of Fetal Malnutrition: Evidence from the 1959-1961 China Great Leap Forward Famine

We report evidence of long-term adverse health impacts of in utero exposure to malnutrition based on survivors in their 50s who were born during the China Famine that occurred in the years 1959-1961. We take advantage of recently available data provided by the China Health and Retirement Longitudinal Study (CHARLS) to corroborate evidence supporting the Fetal Origin Hypothesis.We find that fetal exposure to malnutrition has large and long-lasting impacts on both physical health and cognitive abilities, including the risks of suffering a stroke, physical disabilities in speech, walking and vision, and measures of mental acuity. Our findings on the health impacts of fetal malnutrition on middle-age survivors suggest that it would be desirable to trace the changes of health status of the famine survivors as they age into later life stages. We suspect that such further study would support the lifetime benefits of in utero and early infancy health interventions that extend through the life cycle in the form of avoiding both physical and mental impairment.

The case for establishing a Holocaust survivors cohort in Israel.

In this issue, Keinan-Boker summarises the main studies that have followed up offspring of women exposed to famine during pregnancy and calls for the establishment of a national cohort of Holocaust survivors and their offspring to study inter-generational effects. She suggests that the study would consolidate the fetal origins theory and lead to translational applications to deal with the inter-generational effects of the Holocaust. Barker suggested that alterations in the nutritional supply during critical stages of intra-uterine development permanently alter the structure and metabolism of fetal organs which he termed ‘fetal programming’ (now known as developmental origins of health and disease). The famine studies have played an important role in refining the hypothesis by allowing a ‘quasi-experimental’ setting that would otherwise have been impossible to recreate. The developmental origins hypothesis provides a framework to link genetic, environmental and social factors across the lifecourse and offers a primordial preventive strategy to prevent non-communicable disease. Although the famine studies have provided valuable information, the results from various studies are inconsistent. It is perhaps unsurprising given the problems with collecting and interpreting data from famine studies. Survival bias and information bias are key issues. With mortality rates being high, survivors may differ significantly from non-survivors in factors which influence disease development. Most of the data is at ecological level; a lack of individual-level data and poor records make it difficult to identify those affected and assess the severity of effect. Confounding is also possible due to the varying periods and degrees of food deprivation, physical punishment and mental stress undergone by famine survivors. Nonetheless, there would be value in setting up a cohort of Holocaust survivors and their offspring and Keinan-Boker correctly argues that they deserve special attention. National support is essential as the study may re-open old wounds. The study will need to be appropriately planned and resourced. If properly designed, it may provide further insight into the developmental origins hypothesis and suggest translational applications. It may also influence provision of support to women and children affected by man-made wars and famines that continue to happen across the world.

Sins of the Father: The Intergenerational Legacy of the 1959-61 Great Chinese Famine on Children's Cognitive Development

The effect of early exposure to malnutrition on the next generation’s cognitive abilities has rarely been studied in human beings in large part due to lack of data. A natural experiment, the Great Chinese Famine, and a novel dataset are employed to study this effect. The paper finds that the cognitive abilities of children born to rural famine fathers were affected and that the impact is more pronounced in girls than in boys, whereas children born to female survivors are not affected. The uncovered gender-specific effect is almost entirely attributable to son preference exhibited in families with male famine survivors.