Associations of famine exposure in early life with height in two consecutive generations in China

BACKGROUND: Poor nutrition early in life is associated with short stature, which is known to be associated with increased risk of cardiovascular disease and mortality in later life. Less evidence is available about whether early life nutrition affects height growth in the subsequent generation. OBJECTIVE: We aimed to investigate associations of famine exposure in utero and early-childhood with height across two generations. METHODS: We used the China Health and Nutrition Survey data and included 5,401 participants (F1) born in 1955-66 (the calendar year around the Chinese Great Famine in1959-61) and their 3,930 biological offspring (F2). We classified F1 participants into subgroups by famine exposure status (unexposed/exposed) and timing (fetal-/childhood-exposed) according to their birth year, and grouped F2 by their parents’ exposure. Linear regression models were conducted to evaluate the associations of famine exposure with adult height of F1 and F2. Linear mixed effect models with fractional polynomial functions were performed to estimate the difference in height between exposure groups of F2 during childhood. RESULTS: Participants (F1) exposed to famine in utero or childhood were shorter than those unexposed by 0.41 cm (95% CI: 0.03, 0.80) and 1.12 cm (0.75, 1.48), respectively. Offspring (F2) of exposed fathers were also shorter than those of unexposed parents by 1.07 cm (0.28, 1.86) during childhood (<18 years) and by 1.25 cm (0.07, 2.43) in adulthood (≥18 years), and those with exposed parents had a reduced height during childhood by 1.29 cm (0.68, 1.89). The associations were more pronounced among child offspring of highly-educated F1, particularly for paternal exposure and among female offspring (all p for interaction < 0.05). CONCLUSIONS: The findings support the intergenerational effect of famine exposure in early life on height in Chinese populations, and indicate public health significance to improve nutritional status of mothers and children in the long run. KEY MESSAGES: • Exposure to famine in uteri or early-childhood were associated with a shorter height during adulthood and in their offspring. • The adverse impact of famine exposure was more pronounced among child offspring of highly-educated F1, particularly for paternal exposure and among female offspring.