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Cited by 1,606Birth, Development, and HealthGestational Diabetes Research and ManagementPancreatic function and diabetes

Glucose tolerance in adults after prenatal exposure to famine

Ravelli, ACJ, van der Meulen, JHP, Michels, RPJ, Osmond, C, Barker, DJP, Hales, CN, Bleker, OP·1998·The Lancet
DOI 10.1016/s0140-6736(97)07244-9
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Abstract

Background Reduced growth in utero is associated with type 2 (non-insulin-dependent) diabetes and impaired glucose tolerance in adult life. There is no direct evidence in human beings that maternal nutrition during gestation affects insulin-glucose metabolism. We investigated glucose tolerance in people born around the time of famine in the Netherlands during 1944-45.Methods We included 702 people born between Nov 1, 1943, and Feb 28, 1947, in Amsterdam, for whom we had detailed prenatal and birth records. We compared glucose and insulin responses to a standard oral glucose load in participants exposed to famine at any stage during gestation (exposed participants) with those who were born in the year before or conceived in the year after the famine (non-exposed participants).Findings Glucose concentrations were increased 2 h after a standard glucose load among exposed participants (p = 0.006), and were highest in men and women exposed during mid and late gestation. Mean 2 h glucose concentration among non-exposed participants was 5.8 mmol/L; concentrations were 0.5 mmol/L (95% CI 0.1-0.9) higher among participants exposed during late gestation, 0.4 mmol/L (0-0.8) higher among those exposed during mid gestation, and 0.1 mmol/L (-0.4 to 0.6) among those exposed during early gestation. Participants born as thin babies to mothers with low bodyweights had the highest concentrations and concentrations were especially high among people exposed to famine who became obese as adults. Prenatal exposure to famine was related to increased fasting proinsulin (p = 0.05) and 2 h insulin concentrations (p = 0.04), which suggests an association with insulin resistance.Interpretation Prenatal exposure to famine, especially during late gestation, is linked to decreased glucose tolerance in adults. Poor nutrition in utero may lead to permanent changes in insulin-glucose metabolism, even if the effect on fetal growth is small. This effect of famine on glucose tolerance is especially important in people who become obese.

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  • Adults exposed to famine conditions during World War II in the Dutch Famine Study had increased insulin resistance than those who had not been exposed.

    “Results from the Dutch Famine Study show that adults exposed to famine conditions during World War II had increased insulin resistance than those who had not been exposed (54).”

    From Globalization of Diabetes (2011) · cites this paper as [54]

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Authors
Ravelli, A., van der Meulen, J., Michels, R., Osmond, C., Barker, D., Hales, C., & Bleker, O.
Affiliations
  • Southampton General Hospital (GB)
  • University of Cambridge (GB)
ORCID
Osmond, C
Venue
The Lancet
Publisher
Elsevier BV
Published
1998-01
Volume
351
Issue
9097
Pages
173-177
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(97)07244-9
OpenAlex
W2166194564
Cited by
1,606
References
45
Citations by year
2026: 17 · 2025: 23 · 2024: 36 · 2023: 30 · 2022: 40 · 2021: 50 · 2020: 65 · 2019: 78 · 2018: 64 · 2017: 79 · 2016: 65 · 2015: 64 · 2014: 79 · 2013: 82 · 2012: 92
FWCI
45.56
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Funders
Medical Research Council
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
  • Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
Keywords
prenatal famine exposure, glucose tolerance, impaired glucose tolerance, type 2 diabetes, insulin resistance, prenatal nutrition, fetal growth restriction, adult obesity, proinsulin
MeSH terms
Birth Weight, Diabetes Mellitus, Type 2, Female, Fetal Growth Retardation, Glucose Tolerance Test, Humans, Insulin, Male, Middle Aged, Netherlands, Pregnancy, Prenatal Exposure Delayed Effects, Starvation, Cohort Studies, Body Mass Index, Glucose Intolerance

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