GLUCOSE-TOLERANCE IN ADULTS AFTER PRENATAL EXPOSURE TO FAMINE

Background Reduced growth in utero is associated with type 2 (non-insu lin-dependent) diabetes and impaired glucose tolerance in adult life. There is no direct evidence in human beings that maternal nutrition du ring gestation affects insulin-glucose metabolism. We investigated glu cose tolerance in people born around the time of famine in the Netherl ands during 1944-45. Methods We included 702 people born between Nov 1 , 1943, and Feb 28, 1947, in Amsterdam, for whom we had detailed prena tal and birth records. We compared glucose and insulin responses to a standard oral glucose load in participants exposed to famine at any st age during gestation (exposed participants) with those who were born i n the year before or conceived in the year after the famine (non-ex po sed participants). Findings Glucose concentrations were increased 2 h after a standard glucose load among exposed participants (p=0.006), an d were highest in men and women exposed during mid and late gestation. Mean 2 h glucose concentration among non-exposed participants was 5.8 mmol/L; concentrations were 0.5 mmol/L (95% Cl 0.1-0.9) higher among participants exposed during late gestation, 0.4 mmol/L (0-0.8) higher among those exposed during mid gestation, and 0.1 mmol/L (-0.4 to 0.6) among those exposed during early gestation. Participants born as thin babies to mothers with low bodyweights had the highest concentrations and concentrations were especially high among people exposed to famin e who became obese as adults, Prenatal exposure to famine was related to increased fasting proinsulin (p=0.05) and 2 h insulin concentration s (p=0.04), which suggests an association with insulin resistance. Int erpretation Prenatal exposure to famine, especially during late gestat ion, is linked to decreased glucose tolerance in adults. Poor nutritio n in utero may lead to permanent changes in insulin-glucose metabolism , even if the effect on fetal growth is small. This effect of famine o n glucose tolerance is especially important in people who become obese .