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Early-life undernutrition increases the risk of death from chronic diseases in adulthood: a population-based cohort

Mengqiu Wu¹, Hongrui Tian¹, Chuanhai Guo¹

¹Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genetics, Peking University Cancer Hospital and Institute, #52 Fucheng Rd, Beijing, 100142, China.

Global Health Research and Policy

|July 9, 2025

Abstract

Background:

Early-life undernutrition, particularly during critical developmental periods, may have lasting impacts on non-communicable diseases (NCDs) in adulthood. The Chinese Great Famine (1959-1961) provides a unique opportunity to evaluate these effects in a large-scale population study. To investigate the impact of early-life undernutrition on adult mortality due to NCDs in individuals exposed to the Chinese Great Famine.

Methods:

We analyzed data from a medical insurance database in Hua County, China, including 15,088 individuals born during the famine (1959-1961) and 49,924 individuals deemed unexposed because they were born after the famine (1962-1964), with follow-up from 2012 to 2023. Multivariable Cox regression and competing risks regression were used to assess the association between early-life undernutrition and mortality.

Results:

Early-life undernutrition was associated with increased risks of all-cause mortality (HR_adjusted = 1.49, 95% CI 1.37-1.62), cancer mortality (HR_adjusted = 1.41, 95% CI 1.22-1.64), cardiovascular and cerebrovascular diseases mortality (HR_adjusted = 1.51, 95% CI 1.34-1.71), and chronic obstructive pulmonary disease mortality (HR_adjusted = 4.37, 95% CI 2.51-7.61). Subgroup analysis revealed that the exposed group had a higher risk of death from lung, esophageal, gastric, hepato-biliary, and pancreatic cancers, cerebrovascular disease and cardiovascular disease.

Conclusions:

This study demonstrates the long-term adverse effects of early-life undernutrition on NCD mortality in adulthood, underscoring the importance of nutritional interventions during critical developmental periods to reduce the burden of NCDs.

Clinical Trial Registration:

Endoscopic Screening for Esophageal Cancer in China (ESECC) randomized controlled trial (Clinical trial: NCT01688908).

Keywords:

Chinese great famine Chronic non-communicable diseases Early-life undernutrition Mortality

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