Researchers find that the number of cases of type 2 diabetes more than doubled, seven decades after exposure to famine

Researchers from the Mailman School of Public Health at Columbia University, the University of North Carolina at Chapel Hill, and the National Academy of Sciences of Ukraine used the setting of the man-made Ukrainian Holodomor famine of 1932-1933 to examine the association between prenatal famine and type 2 diabetes mellitus (T2DM) in adults.

They studied 128,225 cases of type 2 diabetes diagnosed between 2000 and 2008 among 10,186,016 male and female Ukrainians born between 1930 and 1938.

People exposed to the famine in early pregnancy were more than twice as likely to develop type 2 diabetes compared to those not exposed to the famine, according to a study led by Columbia University Mailman School of Public Health. The results are published in the diary Science.

The famine resulted in an additional 4 million deaths in the short term, with losses concentrated in a six-month period. The Holodomor far exceeded other famines in terms of intensity. Life expectancy at birth in 1933 was only 7.2 years for women and 4.3 for men.

“The situation in Ukraine provided an unusual opportunity to examine the long-term consequences of the Holodomor (or starvation) on cases of type 2 diabetes diagnosed 70 years after prenatal exposure to famine,” said LH Lumey, MD, professor of epidemiology at Columbia Public Health.

“Since the famine was concentrated in a six-month period in early 1933, we can determine the timing of the famine, along with the extreme differences in intensity between provinces.”

This concentration was the result of Stalin’s use of famine as a weapon of terror against Ukrainian peasants. When Ukraine could not meet its grain purchase quotas to the Soviet central government, because they did not have enough for themselves, drastic measures were taken to meet the quotas, under the excuse that counterrevolutionary elements were sabotaging the grain purchases.

In late 1932, a nationwide campaign of raids on peasants’ homes in search of “hidden” or “stolen” grain was launched, and expanded in early 1933. All or most of the food was confiscated during many of these searches, leaving families without food for the rest of the winter. In addition, measures were taken to restrict the travel of Ukrainian peasants in search of food.

These measures caused a real storm. Many rural families were left without food; the possibilities of searching for food were cut off and the grain reserves 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 mortality between January and June 1933.

At the height of the famine in June 1933, an average of 28,000 people died each day from the famine. This amounted to 1,167 deaths per hour, or 19 per minute.

“Our research on the long-term health consequences of the Holodomor famine provides some important lessons for addressing the health risks posed by national disasters,” Lumey said.

“It underscores the need for a comprehensive health and policy framework that takes into account the lasting effects of early life adversity on public health and their potential long-term consequences for chronic diseases and mental health.”

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

“This awareness should encourage a proactive approach among policymakers and public health officials to anticipate increased health care 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 adversity,” Lumey noted.

“In addition to the need to develop policies to address long-term health problems after a national disaster, the results of our study highlight the importance of policies aimed at preventing a recurrence of events like the Holodomor. The Russian invasion of Ukraine in 2022 shows that history repeats itself,” emphasizes 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 submission 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 risk of starvation for millions of people in these countries.”