Researchers conducted a study using the backdrop of the man-made famine known as the Ukrainian Holodomor of 1932-1933 to explore how prenatal famine influences the development of adult Type 2 diabetes mellitus.
A collaborative effort involving scholars from Columbia University’s Mailman School of Public Health, the University of North Carolina at Chapel Hill, and the National Academy of Sciences of Ukraine focused on the Holodomor, examining its link to Type 2 diabetes (T2DM). They analyzed data from 128,225 diagnosed cases of T2DM between 2000 and 2008 among more than 10 million Ukrainians born from 1930 to 1938.
According to findings from Columbia University Mailman School of Public Health, individuals exposed to famine during early pregnancy were more than twice as likely to develop Type 2 diabetes compared to those who were not exposed. These findings were published in the journal Science.
The famine resulted in approximately 4 million additional deaths over a short period, with the majority occurring within just six months. The Holodomor was particularly severe compared to other famines. In 1933, life expectancy at birth plummeted to 7.2 years for females and 4.3 years for males.
“The Ukrainian context provided a rare chance to study the long-term effects of the Holodomor — a situation of death by hunger — on T2DM cases identified nearly seventy years later following prenatal famine exposure,” stated L.H. Lumey, MD, an Epidemiology professor at Columbia Public Health. “The famine’s concentration in early 1933 allows us to precisely link the timing and varying intensities of the famine across different provinces.”
This concentration of famine was a result of Stalin’s strategy to use it as a means of oppression against Ukrainian farmers. When Ukraine failed to meet grain procurement quotas for the Soviet government because they had insufficient supplies for themselves, extreme measures were instituted to enforce compliance, under the pretense that there were counter-revolutionary groups sabotaging grain production. A nationwide campaign to search farmers’ homes for “hidden” or “stolen” grain began in late 1932 and escalated in early 1933. Most of the food discovered during these searches was confiscated, leaving families without food for the remaining winter. Furthermore, restrictions were placed on Ukrainian peasants’ ability to travel in search of food.
These circumstances created a dire situation. Many rural households found themselves with no food, their options for seeking food were restricted, and grain reserves were exhausted. Thousands of families in the countryside faced a tragic and slow death from starvation. This led to a remarkable surge in famine-related deaths between January and June 1933. At the peak in June 1933, there were, on average, 28,000 famine-related deaths per day, accounting for approximately 1,167 deaths per hour or 19 deaths every minute.
“Our research into the long-term health repercussions of the Holodomor famine provides essential insights for tackling health issues spawned by national disasters,” Lumey notes. “It highlights the urgent need for comprehensive health care and policy strategies that recognize the lasting impact of early-life hardships on the health of populations and the potential long-term implications for chronic illnesses and mental health.”
While individuals diagnosed with T2DM during 2000-2008 may also be overweight or face other risk factors for the disease, the study indicates that the correlation between adult T2DM risk and the time and place of birth amid the famine is so notable that early gestational exposure to famine seems to be the dominant factor, overshadowing others, as observed by the research team.
“This knowledge should encourage policymakers and public health officials to proactively address the increased healthcare demands experienced by populations affected by national calamities. It also accentuates the need to raise awareness regarding the potential long-lasting health consequences of early-life hardships,” Lumey emphasized.
“In addition to the necessity of creating policies that tackle long-term health challenges following national disasters, our findings emphasize the importance of implementing measures to prevent tragedies similar to the Holodomor from occurring in the future. Russia’s invasion of Ukraine in 2022 exemplifies a troubling recurrence of history,” states Dr. Wolowyna from the University of North Carolina at Chapel Hill. “The recent three-month siege of the city of Mariupol aimed at starving its inhabitants into submission serves as a stark reminder of ongoing threats. The blockade of Ukrainian ports, which restricts the export of grain to developing countries in Africa and Asia, further intensifies the risk of famine for millions in these regions.”
The co-authors include Chihua Li from the University of Michigan, Johns Hopkins University, and the University of Macau; Mykola Khalangot from the Komisarenko Institute of Endocrinology and Metabolism in Kyiv and Shupyk National Healthcare University in Kyiv; and Nataliia Levchuk from the Ptoukha Institute of Demography and Social Sciences in Kyiv and the Max Planck Institute for Demographic Research in Germany.
This study received support from several sources, including the Ukraine State complex program Diabetes Mellitus, 0106U000844; the Holodomor Research and Education Consortium in Canada; the NIDI-NIAS Fellowship of the Royal Netherlands Academy of Sciences; and the National Institute of Aging, with multiple associated grants.
