Seven decades after the effects of the famine, cases of type 2 diabetes have more than doubled.

Women who experienced hunger during early pregnancy were more than twice as likely to develop type 2 diabetes compared to those who didn't experience hunger, according to a study led by Columbia University's Mailman School of Public Health, published in the journal Nature. Science.

The famine killed 4 million people in a short time, with losses concentrated in a six-month period. The Holodomor far surpassed other famines in its intensity. Life expectancy at birth in 1933 was only 7.2 years for women and 4.3 years for men.

“The situation in Ukraine provided a rare opportunity to examine the long-term effects of the Holodomor on cases of type 2 diabetes mellitus (T2DM) diagnosed 70 years after the prenatal experience of starvation,” said LH Rumai, MD, professor of epidemiology at Columbia University School of Public Health. “Because the famine was concentrated in a six-month period early in 1933, we can pinpoint the extreme differences in the timing of the famine and its intensity across states.”

This concentration was the result of Stalin's use of starvation as a weapon of terror against the Ukrainian peasantry. As Ukraine was unable to meet its grain procurement quotas to the Soviet central government and did not have enough of its own, drastic measures were implemented to meet the quotas on the pretext that counter-revolutionary elements were sabotaging grain procurement. A nationwide search campaign was launched in late 1932 and expanded in early 1933 to search peasant homes for “hidden” or “stolen” grain. Many of these searches resulted in the seizure of all or most of the food supplies, leaving families without food through the winter. Furthermore, measures were implemented to restrict the movement of Ukrainian peasants in search of food.

These measures created a terrible situation: many rural families ran out of food, their options for finding food were cut off, and grain reserves were depleted. Thousands of rural families were doomed to slowly starve to death in their villages. As a result, the number of excess deaths from the Holodomor increased abnormally between January and June 1933. At the peak of the famine in June 1933, the number of deaths from famine reached an average of 28,000 per day, which equates to 1,167 deaths per hour and 19 deaths per minute.

“Our study of the long-term health effects of the Holodomor famine offers several important lessons for addressing health challenges caused by national disasters,” LeMay said. “It highlights the need for comprehensive health care and policy frameworks that consider the lasting effects of early life adversity on population health and the potential long-term effects on chronic diseases and mental health.”

Although people diagnosed with type 2 diabetes between 2000 and 2008 may have been overweight or obese and had other risk factors for the disease, the association between adult type 2 diabetes risk and place and date of birth at the time of the famine was so specific that exposure to famine during early pregnancy appears to be the dominant factor that overrides all other factors, the researchers say.

“This recognition should spur proactive efforts among policymakers and public health officials to anticipate increased medical needs among victims of national disasters. It also highlights the importance of raising awareness of the potential long-term effects of early life adversity on health,” LeMay said.

“In addition to the need to develop policies to address long-term health issues after national disasters, our findings highlight the importance of policies to prevent events like the Holodomor from happening again. Russia's invasion of Ukraine in 2022 shows that history repeats itself,” notes Dr. Worowina of the University of North Carolina at Chapel Hill. “The three-month siege of the city of Mariupol in 2022 during the current war in Ukraine to starve its residents into surrender is a reminder of the real danger we face today. The blockade of Ukrainian ports and the blocking of Ukrainian grain exports to developing countries in Africa and Asia have increased the risk of starvation for millions of people in these countries.”

Co-authors are Chihua Li of the University of Michigan, Johns Hopkins University and University of Macau, Mykola Khalangot of the Komisarenko Institute of Endocrinology and Metabolism in Kyiv and Shpik National Medical University in Kyiv, and Nataliia Levchuk of Kyiv. ⁷Putka Institute of Population and Social Sciences, Kyiv,⁸Max Planck Institute for Demographic Research, Germany.

This study was supported by the National Diabetes Complex Program of Ukraine 0106U000844, the Holodomor Research and Education Consortium of Canada, a NIDI-NIAS fellowship from the Royal Netherlands Academy of Sciences, and National Institute on Aging Grants R01 AG028593 and R01 AG06687, R01 AG070953 and R01AG075719.