Abstract
BACKGROUND: As the threat of child malnutrition increases, the focus remains mostly on short-term consequences. Long-term sequelae are increasingly recognised but lack strong evidence, and many studies face methodological limitations. METHOD: A retrospective cohort of survivors of the 1984-1985 Great-Ethiopian Famine was compared with two novel control groups: born post-famine; and age category- and sex-matched controls. Exposure to famine at different age categories was explored (fetal, 0-2, 2-5, 5-10 and 10-18 years). Follow-up was 40 years later. Outcomes included anthropometry, body composition, arterial stiffness, mental health, and risk of cardiometabolic and non-communicable diseases (NCDs). Adjusted differences and 95% CI between exposed and controls were calculated. RESULTS: Compared with matched and post-famine controls, adjusted differences (95% CI) for exposed group were: height, -1.4 cm (-2.4 to -0.3) and -2.4 cm (-3.7 to -1.1); weight, -1.4 kg (-2.7 to -0.1) and -1.7 kg (-3.3 to -0.1); diastolic blood pressure (DBP), -2.8 mm Hg (-4.4 to -1.1) and 2.8 mmHg (0.9 to 4.7); handgrip strength, -1.7 kg (-2.7 to -0.6) and -4.1 kg (-5.5 to -2.7); brachial augmentation index, 5.4% (0.3% to 10.5%) and 16.1% (10.1% to 22.1%); aortic augmentation index, 6.0% (1.5% to 10.4%) and 11.7% (6.1% to 17.3%); subscapular skinfold thickness, 1.1 mm (0.2 to 1.9) and 1.2 mm (0.1 to 2.3); triceps skinfold thickness, 1.8 mm (0.8 to 2.7) and 2.1 mm (1.0 to 3.3) and waist-to-height ratio, 0.01 (0.003 to 0.02) and 0.01 (0.001 to 0.02), respectively. When comparing risk by timing of exposure, individuals exposed during early childhood (0-2 years), preschool age (2-5 years), and late childhood (5-10 years) had reduced adult stature of -2.8 cm (-4.8 to -0.9), -2.8 cm (-4.7 to -0.9) and -2.1 cm (-4.0 to -0.2), respectively, and increased triceps skinfold of 1.7 mm (-0.5 to 3.8), 3.2 mm (0.8 to 5.6) and 3.8 mm (1.6 to 6.02), respectively. CONCLUSIONS: Early-life famine exposure is associated with smaller adult size and several, but not all NCD risks. Lower DBP in survivors compared with matched controls is surprising and might reflect differential susceptibility to specific later-life health risks. Greater arterial stiffness underscores the need to identify both preclinical and clinical risk. In contrast to exposure in utero, risk was higher among those exposed during early childhood (0-2 years), preschool (2-5 years) and late childhood (5-10 years). The study underscores the need for a dual approach in low- and middle-income settings: tackling the immediate undernutrition while also anticipating and mitigating long-term NCD risk in populations exposed to early-life severe malnutrition or famine.