Abstract
Following ethnic, economic, and religious tensions, the republic of Biafra unilaterally declared independence from the rest of Nigeria in 1967. This action triggered the Nigerian civil war in which the inflow of food and supplies to Biafra was blocked. The result was extensive famine, regarded as one of the great nutritional disasters of modern times. During the two-and-a-half years of armed conflict, an estimated one to three million people died, most of them from starvation.
Forty years later, adults in Enugu (the former capital of Biafra) who had been conceived or born during the famine and who survived the famine show health problems with two-to-three times higher prevalence of hypertension, glucose intolerance, and overweight than those born before or after the war. These findings support that undernutrition early in life have significant and adverse impact on human development and physiological design, eventually contributing to an increased risk for noncommunicable diseases in adulthood such as ischemic heart disease, stroke, and diabetes. The long-term effects of undernutrition during pregnancy and in infancy should be considered and receive high priority when setting goals for global health, education, and economic agendas.
Abbreviations
- BMI:
-
Body mass index
- OR:
-
Odds ratio
- SBP:
-
Systolic blood pressure
References
The Cebu Study Team (1991) Underlying and proximate determinants of child health: the Cebu Longitudinal Health and Nutrition Study. Am J Epidemiol 133:185–201
Aall C (1970) Relief, nutrition and health problems in the Nigerian-Biafran war. J Trop Pediatr (1967) 16:70–90
Adair LS, Cole TJ (2003) Rapid child growth raises blood pressure in adolescent boys who were thin at birth. Hypertension 41:451–456
Alberti KG, Zimmet P, Shaw J (2006) Metabolic syndrome – a new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med 23:469–480
Armitage JA, Khan IY, Taylor PD, Nathanielsz PW, Poston L (2004) Developmental programming of the metabolic syndrome by maternal nutritional imbalance: how strong is the evidence from experimental models in mammals? J Physiol 561:355–377
Barker DJP (1998) Mothers, babies and health in later life. Churchill Livingstone, Edinburgh
Barker DJ, Gluckman PD, Godfrey KM, Harding JE, Owens JA, Robinson JS (1993) Fetal nutrition and cardiovascular disease in adult life. Lancet 341:938–941
Bhargava SK, Sachdev HS, Fall CH, Osmond C, Lakshmy R, Barker DJ, Biswas SK, Ramji S, Prabhakaran D, Reddy KS (2004) Relation of serial changes in childhood body-mass index to impaired glucose tolerance in young adulthood. N Engl J Med 350:865–875
Black RE, Allen LH, Bhutta ZA, Caulfield LE, De Onis M, Ezzati M, Mathers C, Rivera J (2008) Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 371:243–260
Brenner BM, Mackenzie HS (1997) Nephron mass as a risk factor for progression of renal disease. Kidney Int Suppl 63:S124–S127
Brodszki J, Lanne T, Marsal K, Ley D (2005) Impaired vascular growth in late adolescence after intrauterine growth restriction. Circulation 111:2623–2628
Clough GF, Norman M (2011) The microcirculation: a target for developmental priming. Microcirculation 18:286–297
Ekblom-Bak E, Hellenius ML, Ekblom O, Engstrom LM, Ekblom B (2009) Fitness and abdominal obesity are independently associated with cardiovascular risk. J Intern Med 266:547–557
Eriksson J, Forsen T, Tuomilehto J, Osmond C, Barker D (2000) Fetal and childhood growth and hypertension in adult life. Hypertension 36:790–794
Fish EW, Shahrokh D, Bagot R, Caldji C, Bredy T, Szyf M, Meaney MJ (2004) Epigenetic programming of stress responses through variations in maternal care. Ann N Y Acad Sci 1036:167–180
Franks PW, Hanson RL, Knowler WC, Sievers ML, Bennett PH, Looker HC (2010) Childhood obesity, other cardiovascular risk factors, and premature death. N Engl J Med 362:485–493
Gale CR, Jiang B, Robinson SM, Godfrey KM, Law CM, Martyn CN (2006) Maternal diet during pregnancy and carotid intima-media thickness in children. Arterioscler Thromb Vasc Biol 26:1877–1882
Gluckman PD, Hanson MA (2004) Living with the past: evolution, development, and patterns of disease. Science 305:1733–1736
Gluckman PD, Hanson MA (eds) (2006) Developmental origins of health and disease. Cambrige University Press, Cambridge, UK, 519 pages
Gluckman PD, Hanson MA, Bateson P, Beedle AS, Law CM, Bhutta ZA, Anokhin KV, Bougneres P, Chandak GR, Dasgupta P, Smith GD, Ellison PT, Forrester TE, Gilbert SF, Jablonka E, Kaplan H, Prentice AM, Simpson SJ, Uauy R, West-Eberhard MJ (2009) Towards a new developmental synthesis: adaptive developmental plasticity and human disease. Lancet 373:1654–1657
Godfrey KM, Sheppard A, Gluckman PD, Lillycrop KA, Burdge GC, Mclean C, Rodford J, Slater-Jefferies JL, Garratt E, Crozier SR, Emerald BS, Gale CR, Inskip HM, Cooper C, Hanson MA (2011) Epigenetic gene promoter methylation at birth is associated with child’s later adiposity. Diabetes 60:1528–1534
Grajeda R, Behrman JR, Flores R, Maluccio JA, Martorell R, Stein AD (2005) The human capital study 2002–04: tracking, data collection, coverage, and attrition. Food Nutr Bull 26:S15–S24
Hult M, Tornhammar P, Ueda P, Chima C, Bonamy AK, Ozumba B, Norman M (2010) Hypertension, diabetes and overweight: looming legacies of the Biafran famine. PLoS One 5:e13582
Ike SO (2009) Prevalence of hypertension and its complications among medical admissions at the University of Nigeria Teaching Hospital, Enugu (Study 2). Niger J Med 18:68–72
Jirtle RL, Skinner MK (2007) Environmental epigenomics and disease susceptibility. Nat Rev Genet 8:253–262
Johansson S, Norman M, Legnevall L, Dalmaz Y, Lagercrantz H, Vanpee M (2007) Increased catecholamines and heart rate in children with low birth weight: perinatal contributions to sympathoadrenal overactivity. J Intern Med 261:480–487
Joshi R, Jan S, Wu Y, MacMahon S (2008) Global inequalities in access to cardiovascular health care: our greatest challenge. J Am Coll Cardiol 52:1817–1825
Law CM, Gordon GS, Shiell AW, Barker DJ, Hales CN (1995) Thinness at birth and glucose tolerance in seven-year-old children. Diabet Med 12:24–29
Leeson CP, Whincup PH, Cook DG, Donald AE, Papacosta O, Lucas A, Deanfield JE (1997) Flow-mediated dilation in 9- to 11-year-old children: the influence of intrauterine and childhood factors. Circulation 96:2233–2238
Manson JE, Skerrett PJ, Greenland P, Vanitallie TB (2004) The escalating pandemics of obesity and sedentary lifestyle. A call to action for clinicians. Arch Intern Med 164:249–258
Martin H, Gazelius B, Norman M (2000a) Impaired acetylcholine-induced vascular relaxation in low birth weight infants: implications for adult hypertension? Pediatr Res 47:457–462
Martin H, Hu J, Gennser G, Norman M (2000b) Impaired endothelial function and increased carotid stiffness in 9-year-old children with low birthweight. Circulation 102:2739–2744
Martyn CN, Greenwald SE (1997) Impaired synthesis of elastin in walls of aorta and large conduit arteries during early development as an initiating event in pathogenesis of systemic hypertension. Lancet 350:953–955
Miller JP (1970) Medical relief in the Nigerian civil war. Lancet 760:1330–1334
Mitchell P, Liew G, Rochtchina E, Wang JJ, Robaei D, Cheung N, Wong TY (2008) Evidence of arteriolar narrowing in low-birth-weight children. Circulation 118:518–524
Murphy SK, Jirtle RL (2003) Imprinting evolution and the price of silence. Bioessays 25:577–588
Murray R, Bryant J, Titcombe P, Barton SJ, Inskip H, Harvey NC, Cooper C, Lillycrop K, Hanson M, Godfrey KM (2016) DNA methylation at birth within the promoter of ANRIL predicts markers of cardiovascular risk at 9 years. Clin Epigenetics 8:90
Painter RC, Roseboom TJ, Bleker OP (2005) Prenatal exposure to the Dutch famine and disease in later life: an overview. Reprod Toxicol 20:345–352
Phillips DI, Barker DJ, Hales CN, Hirst S, Osmond C (1994a) Thinness at birth and insulin resistance in adult life. Diabetologia 37:150–154
Phillips DI, Hirst S, Clark PM, Hales CN, Osmond C (1994b) Fetal growth and insulin secretion in adult life. Diabetologia 37:592–596
Rapsomaniki E, Timmis A, George J, Pujades-Rodriguez M, Shah AD, Denaxas S, White IR, Caulfield MJ, Deanfield JE, Smeeth L, Williams B, Hingorani A, Hemingway H (2014) Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1.25 million people. Lancet 383:1899–1911
Ravelli AC, van der Meulen JH, Michels RP, Osmond C, Barker DJ, Hales CN, Bleker OP (1998) Glucose tolerance in adults after prenatal exposure to famine. Lancet 351:173–177
Ravelli AC, van der Meulen JH, Osmond C, Barker DJ, Bleker OP (1999) Obesity at the age of 50 y in men and women exposed to famine prenatally. Am J Clin Nutr 70:811–816
Richter LM, Norris SA, De Wet T (2004) Transition from birth to ten to birth to twenty: the South African cohort reaches 13 years of age. Paediatr Perinat Epidemiol 18:290–301
Roseboom TJ, van der Meulen JH, Ravelli AC, van Montfrans GA, Osmond C, Barker DJ, Bleker OP (1999) Blood pressure in adults after prenatal exposure to famine. J Hypertens 17:325–330
Roseboom TJ, van der Meulen JH, van Montfrans GA, Ravelli AC, Osmond C, Barker DJ, Bleker OP (2001) Maternal nutrition during gestation and blood pressure in later life. J Hypertens 19:29–34
Roseboom TJ, Painter RC, van Abeelen AF, Veenendaal MV, De Rooij SR (2011) Hungry in the womb: what are the consequences? Lessons from the Dutch famine. Maturitas 70:141–145
Sachdev HS, Fall CH, Osmond C, Lakshmy R, Dey Biswas SK, Leary SD, Reddy KS, Barker DJ, Bhargava SK (2005) Anthropometric indicators of body composition in young adults: relation to size at birth and serial measurements of body mass index in childhood in the New Delhi birth cohort. Am J Clin Nutr 82:456–466
Sandovici I, Smith NH, Nitert MD, Ackers-Johnson M, Uribe-Lewis S, Ito Y, Jones RH, Marquez VE, Cairns W, Tadayyon M, O’Neill LP, Murrell A, Ling C, Constancia M, Ozanne SE (2011) Maternal diet and aging alter the epigenetic control of a promoter-enhancer interaction at the Hnf4a gene in rat pancreatic islets. Proc Natl Acad Sci U S A 108:5449–5454
Singhal A, Lucas A (2004) Early origins of cardiovascular disease: is there a unifying hypothesis? Lancet 363:1642–1645
Smith NAOS (2006) The developmental environment and insulin resistance. In: Gluckman P, Hanson M (eds) Developmental origins of health and disease. Cambridge, UK: Cambrige University Press, pp 244–254
Topouchian JA, El Assaad MA, Orobinskaia LV, El Feghali RN, Asmar RG (2006) Validation of two automatic devices for self-measurement of blood pressure according to the International Protocol of the European Society of Hypertension: the Omron M6 (HEM-7001-E) and the Omron R7 (HEM 637-IT). Blood Press Monit 11:165–171
Unwin N (2001) Non-communicable disease and priorities for health policy in sub-Saharan Africa. Health Policy Plan 16:351–352
van Abeelen AF, Elias SG, Bossuyt PM, Grobbee DE, van der Schouw YT, Roseboom TJ, Uiterwaal CS (2012a) Cardiovascular consequences of famine in the young. Eur Heart J 33:538–545
van Abeelen AF, Elias SG, Bossuyt PM, Grobbee DE, van der Schouw YT, Roseboom TJ, Uiterwaal CS (2012b) Famine exposure in the young and the risk of type 2 diabetes in adulthood. Diabetes 61:2255–2260
van Abeelen AF, Elias SG, Roseboom TJ, Bossuyt PM, van der Schouw YT, Grobbee DE, Uiterwaal CS (2012c) Postnatal acute famine and risk of overweight: the dutch hungerwinter study. Int J Pediatr 2012:936509
van Abeelen AF, Veenendaal MV, Painter RC, De Rooij SR, Dijkgraaf MG, Bossuyt PM, Elias SG, Grobbee DE, Uiterwaal CS, Roseboom TJ (2012d) Survival effects of prenatal famine exposure. Am J Clin Nutr 95:179–183
Vickers MH, Breier BH, Cutfield WS, Hofman PL, Gluckman PD (2000) Fetal origins of hyperphagia, obesity, and hypertension and postnatal amplification by hypercaloric nutrition. Am J Physiol Endocrinol Metab 279:E83–E87
Vickers MH, Breier BH, Mccarthy D, Gluckman PD (2003) Sedentary behavior during postnatal life is determined by the prenatal environment and exacerbated by postnatal hypercaloric nutrition. Am J Physiol Regul Integr Comp Physiol 285:R271–R273
Victora CG, Barros FC, Lima RC, Behague DP, Gon Alves H, Horta BL, Gigante DP, Vaughan JP (2003) The Pelotas birth cohort study, Rio Grande do Sul, Brazil, 1982–2001. Cad Saude Publica 19:1241–1256
Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, Sachdev HS (2008) Maternal and child undernutrition: consequences for adult health and human capital. Lancet 371:340–357
Welberg LA, Seckl JR (2001) Prenatal stress, glucocorticoids and the programming of the brain. J Neuroendocrinol 13:113–128
Yach D, Hawkes C, Gould CL, Hofman KJ (2004) The global burden of chronic diseases: overcoming impediments to prevention and control. JAMA 291:2616–2622
Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G (2000) Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 342:145–153
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Norman, M., Ueda, P. (2017). Biafran Famine. In: Preedy, V., Patel, V. (eds) Handbook of Famine, Starvation, and Nutrient Deprivation. Springer, Cham. https://doi.org/10.1007/978-3-319-40007-5_8-1
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