Holodomor Famine Linked to Type II Diabetes Risk in Later Life

The Holodomor and fetal malnourishment

Research into the devastating famine that killed millions of Ukrainians in the early 1930s has highlighted the lasting effects that undernutrition can have on a fetus during development.

Ukrainians remember this catastrophe as the Holodomor, a term meaning death by hunger. During 1932 and 1933, the Soviet Union deliberately restricted food supplies, causing differing levels of malnutrition throughout Ukraine’s provinces.

A review of Ukraine’s national diabetes registry has now shown that people who were in the earliest stage of gestation at the height of the Holodomor, in the provinces hit hardest, were more than twice as likely to have type II diabetes later in life than those whose pregnancies occurred outside the famine.

The diabetes cases were recorded between four and seven decades after the famine.

"The findings … point to potential long-term public health consequences of the current Russia-Ukraine war," write Austrian physicists Peter Klimek and Stefan Thurner, who did not take part in the study.

The United Nations World Food Program estimated that roughly 11 million Ukrainians faced a risk of hunger in 2023. In that year, 187,000 children were born.

Klimek and Thurner estimate that, if the present famine affects developing fetuses across generations in the same way as the Holodomor, a further 19,000 people could be affected by diabetes in the decades ahead.

Earlier Holodomor research has indicated that type II diabetes is 1.5 times more prevalent among men and women living in places historically exposed to severe famine.

Type II diabetes risk after famine exposure

However, the latest assessment examines, on a nationwide basis, how malnutrition in pregnancy and early childhood shapes long-term health in the following generation.

Researchers led by Columbia University epidemiologist LH Lumey matched birth records from 1930 to 1938 across every Ukrainian province except one with entries in the national diabetes registry covering 2000 to 2008.

The completed study population comprised more than 10 million births in Soviet Ukraine between 1930 and 1938.

Almost 15 percent of those individuals were born in areas of extreme famine, while nearly 40 percent were born in regions where the famine was classified as ‘very severe’.

Ultimately, Lumey and colleagues reported a "more than twofold increase in the odds of developing [type II diabetes mellitus] in later life among individuals born in Ukrainian provinces exposed to famine in early 1934."

Early pregnancy was the critical period

Those born at that time would have been conceived during the six months of 1933 in which the Ukrainian famine was most severe, with an estimated 28,000 deaths each day. Indeed, the first seven months of 1933 accounted for more than 80 percent of all deaths ascribed to the Holodomor.

Unlike findings from studies of historic famines in China, the new research found elevated later-life type II diabetes risk only among people who were in the womb during the Ukrainian famine.

Babies exposed to the famine in Ukraine during the middle or final stages of gestation, or immediately after birth, were not subject to the same heightened risk.

"Our analysis of famine studies from China showed that it was common for adverse health outcomes in middle age to be attributed to famine exposure in early life," write Lumey and colleagues.

Yet those assessments grouped children of every age together. As the researchers note, malnutrition may pose a metabolic-disease risk only during the earliest developmental stages.

"Although the likelihood of being diagnosed with [type II diabetes] depends on many factors, exposure to famine in this setting appears to be the dominant factor that overrides all others," conclude Lumey and his colleagues.

The study was published in Science.