Famine and overweight in China

There is an increasing body of literature that examines the association between restricted fetal growth and diseases in adulthood as proposed by Barker. One common way to test the hypothesis in humans is to make use of a natural disaster, such as famine, that happened during gestation and examine disease prevalence in later life. Most of the famine-based epidemiological studies use the 1944-5 Dutch Hunger Winter when a sharp decline in food intake occurred due to a German army blockade. Drawing on retrospective cohort analyses, these studies in general find that famine has a negative impact on various health outcomes. For example, prenatal exposure to famine is believed to be associated with antisocial personality disorder in early adulthood (Neugebauer, Hoek, and Susser), major affective disorders (Brown et al.), and schizophrenia (Hulshoff et al.) in adulthood, and higher BMI and waist circumference in fifty-year-old women (Ravelli et al.). However, studies (Stanner et al.) based on a small sample (less than 600 people) of survivors of the Leningrad siege of 1941-4 lead to opposite findings from those on the Dutch famine (Ravelli, van de Meulen, and Michels).1 In a word, the findings are inconclusive. Compared to the Dutch Famine, the Great Famine in China from the late 1950s to the early 1960s lasted much longer and affected more people. The estimated excess deaths numbered from 20 to 30 million (Johnson). The regional distribution of the famine was highly uneven. As shown in table 1, the percentage change of the highest mortality rate during 1959-62 relative to the average mortality rate prior to the famine in 1956-8 ranged from 14.9% in Tianjin to 474.9% in Anhui province (Yang). In addition, cities suffered much