Holodomor Famine Linked to Type II Diabetes in Later Life

Research drawing on a deadly famine that killed millions of Ukrainians in the early 1930s has uncovered the lasting effects that malnutrition can have on a fetus during development.

The Holodomor and famine across Ukraine

Ukrainians remember this devastating period as the Holodomor, a term meaning death by hunger. In 1932 and 1933, the Soviet Union deliberately restricted food supplies, causing differing levels of malnutrition among Ukraine’s provinces.

An examination of Ukraine’s national diabetes registry has now shown that people whose mothers were in early pregnancy at the height of the Holodomor in the hardest-hit provinces were more than twice as likely to have children who later developed type II diabetes, compared with those conceived outside the famine period.

Those diabetes diagnoses were made between four and seven decades after the famine.

"The findings … point to potential long-term public health consequences of the current Russia-Ukraine war," write Austrian physicists Peter Klimek and Stefan Thurner, who were not involved in the current study.

The United Nations World Food Program estimated that roughly 11 million Ukrainians faced a risk of hunger in 2023. During the same year, 187,000 children were born.

Klimek and Thurner calculate that, if the present-day famine affects developing fetuses across generations in the same way as the Holodomor, a further 19,000 people could be affected by diabetes in the decades ahead.

Earlier Holodomor research found that type II diabetes was 1.5 times more prevalent among men and women living in areas that had historically experienced severe famine.

Holodomor exposure and type II diabetes risk

The new study, however, explores nationwide how malnutrition during pregnancy and early childhood influences the long-term health of the following generation.

Researchers led by Columbia University epidemiologist LH Lumey compared birth records from 1930 to 1938 across every Ukrainian province except one with entries in the national diabetes registry covering 2000 to 2008.

The final study group contained more than 10 million births in Soviet Ukraine between 1930 and 1938.

Almost 15 percent of participants were born in areas experiencing extreme famine, while nearly 40 percent were born in regions where famine was categorised as ‘very severe’.

Ultimately, Lumey and colleagues reported a "more than twofold increase in the odds of developing [type II diabetes mellitus] in later life among individuals born in Ukrainian provinces exposed to famine in early 1934."

These individuals would have been conceived during the six-month stretch of 1933 when the Ukrainian famine was at its most severe, with an estimated 28,000 deaths each day. More than 80 percent of deaths linked to the Holodomor occurred during the first seven months of 1933.

Early pregnancy appears to be the critical period

Unlike findings from studies of historical famines in China, the recent analysis found a higher later-life risk of type II diabetes only among people who had been in the womb during the Ukrainian famine.

Babies exposed to the Ukraine famine during the middle or final stages of gestation, or during their earliest period of life, did not show the same elevated risk.

"Our analysis of famine studies from China showed that it was common for adverse health outcomes in middle age to be attributed to famine exposure in early life," write Lumey and colleagues.

However, those calculations grouped together children of every age. As the researchers note, malnutrition may raise the risk of metabolic disease only during the earliest phases of development.

"Although the likelihood of being diagnosed with [type II diabetes] depends on many factors, exposure to famine in this setting appears to be the dominant factor that overrides all others," conclude Lumey and his colleagues.

The study was published in Science.