Peer-reviewed article
Forty years later: adult health and non-communicable disease following the 1984-1985 Great Ethiopian Famine - a retrospective cohort study.
Mubarek Abera, Gemechu Ameya, Melkamu Berhane, Carlos Salvador Grijalva-Eternod, Natasha Lelijveld et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study followed survivors of the 1984-1985 Great Ethiopian Famine into adulthood, 40 years later, to understand the long-term health effects of childhood malnutrition. Compared with controls, famine survivors were shorter and lighter as adults, had reduced muscle strength, and showed signs of increased arterial stiffness. The effects were strongest among those exposed to famine between ages 0 and 10 years. The findings highlight that severe malnutrition in childhood carries lasting health risks into adulthood, including increased risk of non-communicable diseases.
Key points
- Famine-exposed adults were 1.4-2.4 cm shorter and 1.4-1.7 kg lighter than controls
- Exposed individuals showed reduced handgrip strength of 1.7-4.1 kg compared with controls
- Arterial stiffness markers (augmentation indices) were substantially higher in exposed survivors, indicating vascular changes
- Exposure during early childhood (0-2 years), preschool (2-5 years), and late childhood (5-10 years) carried higher risk than fetal exposure
- The study recommends dual approaches in low- and middle-income countries: addressing immediate undernutrition while mitigating long-term non-communicable disease risk
Limitations
The study is retrospective and relies on recall of exposure during childhood famine, which may introduce misclassification. The findings are specific to one famine event in Ethiopia and may not generalise to other populations or types of malnutrition.
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.