The Correlation between Early Stages of Life Exposed to Chinese Famine and Cognitive Decline in Adulthood: Nutrition of Adulthood Plays an Important Role in the Link?

The Psychological, Cognitive, and Behavioural Effects of Starvation in Humans: A Scoping Review

BACKGROUND

Research has highlighted the physical complications of starvation, but there is less research examining the psychological effects of starvation in humans.

AIMS

This scoping review synthesises literature on the non-physical effects of starvation in humans.

METHOD

Following PRISMA-ScR guidelines, we searched MEDLINE, PsycINFO, and Global Health for studies published between 1946 and 2023 examining the non-physical effects of starvation in individuals aged 2-79 years, including those who were starved, malnourished, stunted, wasted, underweight, had a restrictive eating disorder, or were raised in famine conditions.

RESULTS

From 16,555 abstracts, 851 articles on the effects of malnutrition were reviewed, and 318 were included. Among these, 35% focused on children and adolescents, 25.5% on adults with comorbid illnesses, 17% on older adults, 13% on those with eating disorders, 6% on adults without comorbidities, and 3.5% on famine survivors. Cognitive impairments were the most frequently reported effects in children. In adults and older adults, depression and anxiety were common, along with reduced cognitive functioning, reduced quality of life, social withdrawal, impaired sleep and impaired sexual functioning. Individuals with eating disorders experienced depression, anxiety, obsessive-compulsive symptoms, emotion regulation difficulties, and cognitive impairment.

CONCLUSIONS

There is extensive evidence showing the detrimental non-physical consequences of starvation in children and adults. These findings should inform research, clinical interventions, and educational materials addressing the effects of insufficient nutrition, including in those with restrictive eating disorders.

Individual and combined effects of famine exposure and obesity parameters on type 2 diabetes in middle-aged and older adults: A population-based cross-sectional study

Malnutrition early in life may have adverse effects on health later in life. The relationship between malnutrition and obesity parameters (body mass index [BMI] and waist circumference [WC]) and type 2 diabetes is inconsistent. This study aimed to identify the effects of famine exposure and obesity parameters on type 2 diabetes individually or in combination among middle-aged and older adults in China. Data were extracted from the China Health and Retirement Longitudinal Study Wave1 in 2011. The sample involved 13,065 adults aged 45 to 90. The t- or F test was employed to compare age among groups. The chi-square test was utilized to compare baseline characteristics according to the categorical WC levels/BMI levels/famine exposure and examine between-group differences in type 2 diabetes (diabetes and non-diabetes). Odds ratio (OR) and 95% confidence interval (CI) were estimated by logistic regression models to estimate the individual and combined associations of BMI/WC levels and famine exposure with the prevalence of type 2 diabetes. In this study, 1559 (11.93%) individuals were exposed to Chinese famine during their fetal stage, 5132 (39.28%) and 4428 (33.89%) in childhood and adolescence/adulthood, respectively. Among BMI measurements, 3780 (28.93%) were overweight, and 1487 (11.38%) were obese, whereas WC measurements showed that 5408 (41.39%) were obesity. In addition, 831 (45.48%) males and 996 (54.52%) females reported type 2 diabetes. In multivariable-adjusted regression models, obesity parameters and famine exposure were independently associated with type 2 diabetes prevalence among all participants (P < .001). In the interaction analysis, there existed a trend of higher odds for prevalence of type 2 diabetes across all groups compared to the combination of no-exposed and normal BMI/WC level group (the most increase in odds, adolescence/adulthood-exposed group with central obesity in WC levels: OR 4.51 (95% CI = 3.42-5.95); adolescence/adulthood-exposed group with obesity in BMI levels: OR 5.84 (95% CI = 4.11-8.30; P for interaction <.001). The findings for females exhibited similar to the overall participants, when by gender stratification. Our results suggest famine exposure and obesity parameters have positive combined effects on type 2 diabetes in middle-aged and older adults in China.

The Interaction Effect of 27-Hydroxycholesterol Metabolism Disorder and CYP27A1 Single Nucleotide Polymorphisms in Mild Cognitive Impairment: Evidence from a Case-Control Study

SCOPE

The aim of the study is to investigate the relationship between 27-hydroxycholesterol (27-OHC), 27-hydroxylase (CYP27A1) polymorphisms, and Alzheimer's disease (AD).

METHODS AND RESULTS

A case-control study based on EMCOA study includes 220 healthy cognition and mild cognitive impairment (MCI) subjects respectively, matched by sex, age, and education. The level of 27-OHC and its related metabolites are examined by high performance liquid chromatography-mass spectrometry (HPLC-MS). The results show that 27-OHC level is positively associated with risk of MCI (p < 0.001), negatively associated with specific domain of cognitive function. Serum 27-OHC is positively associated with 7a-hydroxy-3-oxo-4-cholestenoic acid (7-HOCA) in cognitive healthy subjects, while positively associated with 3β-hydroxy-5-cholestenoic acid (27-CA) in MCI subjects (p < 0.001). CYP27A1 and Apolipoprotein E (ApoE) single nucleotide polymorphisms (SNPs) genotyping are determined. The global cognitive function is significant higher in Del-carrier of rs10713583, compared with AA genotype (p = 0.007). Stroop Color-Word Test Interference Trial (SCWT-IT) is significant higher in G-carrier genotype (p = 0.042), compared with TT genotype in rs12614206.

CONCLUSIONS

The results show that 27-OHC metabolic disorder is associated with MCI and multi-domain cognitive function. CYP27A1 SNPs is correlated to cognitive function, while the interaction between 27-OHC and CYP27A1 SNPs need further study.

The Long-Term Effect of Famine Exposure on Cognitive Performance: Evidence from the 1959-1961 Chinese Famine

We examined the long-term impact of the 1959-1961 Chinese Famine on the survivors' cognitive performance in this study. Using data from the 2010 China Family Panel Study, our cohort comparison analysis showed that people who experienced the famine in early childhood (aged 1-3) had a lower score on a vocabulary test and that those who were exposed to the famine in utero did not differ from those born after the famine, probably due to positive selection for the in utero survivors. To deal with the problem of the lack of a comparable control group, we further applied a migrant-stayer comparison approach, with data from the 2016 China Family Panel Study and the 2017 Hong Kong Panel Study of Social Dynamics, to examine the effects of famine exposure at different life stages on adult cognition. We compared the people who stayed in Guangdong with the people who crossed the border to Hong Kong before the famine. The results showed that Guangdong stayers who experienced the famine when they were aged 1-18 had worse performance in immediate word recall. The findings suggested that exposure to malnutrition during childhood has long-term adverse effects on cognitive performance.

Association of Parental Famine Exposure With Offspring Depression and Cognition Function

BACKGROUND

The effect of early exposure to famine on depression and cognition in adulthood has been shown, but the intergenerational association of famine remain to be explored. This study focused on exploring the association of parental famine exposure with depression and cognition in the offspring.

METHODS

Based on the Chinese Family Panel Studies database, which is a longitudinal survey, we included 5,150 individuals born between 1959 and 1961 and divided them into fetal-exposed, infancy-exposed (birth year = 1957-1958), school-age-exposed (birth year = 1949-1956), adolescent-exposed (birth year = 1946-1948), and unexposed groups. We used one-way analysis of variance, multiple linear regression, and one follow-up measurement to analyze the association between parental famine exposure and offspring depression and cognitive function.

RESULTS

Compared with the unexposed group, the correlations between parental famine exposure during fetal period and their cognitive function (mother: β = -1.614, 95% CI: -2.535, -0.693; p = 0.001; father: β = -2.153, 95% CI: -3.104, -1.202, p < 0.001) were significant. For the offspring, there was a negative correlation between famine exposure of fathers during the fetal period and depression in their offspring (β = -0.477, 95% CI: -0.907, -0.047; p = 0.030). There was a negative correlation between maternal famine exposure during the infant and adolescent period and cognitive function in the offspring (math test: β = -0.730, 95% CI: -1.307, -0.153; p = 0.013; word test: β = -2.346, 95% CI: -4.067, -0.625; p = 0.008).

LIMITATIONS

Not all variables related to depression and cognition function were included in the CFPS database, and the other unknown or unmeasured confounders may explain our results.

Combined Effect of Famine Exposure and Obesity Parameters on Hypertension in the Midaged and Older Adult: A Population-Based Cross-Sectional Study

OBJECTIVES

Undernutrition early in life may increase the incidence of adverse effects on adult health. The relations between undernutrition and obesity parameters (body mass index (BMI) and WC (waist circle)) and hypertension were often contradictory. Our study is aimed at identifying the combined effects of famine exposure and obesity parameters on hypertension in middle-aged and older Chinese.

DESIGN

A population-based cross-sectional study. Setting. Data were selected from the China Health and Retirement Longitudinal Study Wave2011 (CHARLS Wave2011). Participants. The sample included 12945 individuals aged 45 to 96. Main Outcome Measurements. The study analyzed data from 12945 middle-aged and older Chinese selected from CHARLS Wave2011. Differences between baseline characteristics and famine exposure/BMI levels/WC levels were evaluated using the t-, Chi-square- (χ 2-), and F-test. Then, the difference in the prevalence of hypertension between baseline characteristics was estimated by the t- and χ 2-test. Finally, multivariable-adjusted logistic regression models were used to explore the associations of famine exposure and obesity parameters with odds of prevalence of hypertension.

RESULTS

Among the 12945 participants, 1548 (11.96%) participants had been exposed to the Chinese famine during the fetal group, whereas 5101 (39.41%) participants and 4362 (33.70%) participants had been exposed to the famine during childhood and adolescence/adult group, respectively. Regarding the participants with BMI levels, 3746 (28.94%) were overweight, and 1465 (11.32%) were obese, whereas 5345 (41.29%) of the participants with WC levels were obese, respectively. Furthermore, 1920 (31.17%) had hypertension in males and 2233 (32.91%) in females. In multivariable-adjusted models, famine exposure and obesity parameters were related with prevalence of hypertension independently in total populations ((1) model threec, famine exposure with prevalence of hypertension: the fatal-exposed vs. no-exposed group (OR1.27; 95% CI 1.08, 1.49); childhood-exposed vs. no-exposed group (OR1.64; 95% CI 1.44, 1.87); the adolescence/adult-exposed vs. no-exposed group (OR3.06; 95% CI 2.68, 3.50); P for trend < 0.001; (2) model threee, famine exposure with prevalence of hypertension: the fatal-exposed vs. no-exposed group (OR1.25; 95% CI 1.06, 1.47); childhood-exposed vs. no-exposed group (OR1.52; 95% CI 1.34, 1.73); the adolescence/adult-exposed vs. no-exposed group (OR2.66; 95% CI 2.33, 3.03); P for trend < 0.001; (3) model threeg, BMI levels with prevalence of hypertension: overweight vs. normal (OR1.75; 95% CI 1.60, 1.91); obesity vs. normal (OR2.79; 95% CI 2.48, 3.15); P for trend < 0.001; (4) WC levels with prevalence of hypertension: overweight vs. normal (OR1.42; 95% CI 1.36, 1.48)). When stratified by sex, results in both males and females were mostly similar to those in the total population. In general, interaction analysis in the multivariable-adjusted model, compared with the combination of normal BMI/WC levels and no-exposed famine group, all groups trended towards higher odds of prevalence of hypertension (the greatest increase in odds, adolescence/adult-exposed group with obesity in BMI levels: (OR8.13; 95% CI 6.18, 10.71); adolescence/adult-exposed group with obesity in WC levels: (OR6.36; 95% CI 5.22, 7.75); P for interaction < 0.001). When stratified by sex, the results in both males and females were also similar to those in the total population.

CONCLUSION

Our data support a strongly positive combined effect of famine exposure and obesity parameters on hypertension in middle-aged and elderly Chinese.

The Effect and Mechanism of Cholesterol and Vitamin B12 on Multi-Domain Cognitive Function: A Prospective Study on Chinese Middle-Aged and Older Adults

Background: Nutrients are associated with cognitive function, but limited research studies have systematically evaluated on multi-domain cognitive function. The aim of this study was to investigate the effect and mechanism of specific nutrient on multi-domain cognitive function, and provide nutrition guidance for improving cognitive function.

Methods: Participants were selected based on a multicenter prospective study on middle-aged and older adults in China. Global cognitive function was evaluated by the Mini-Mental State Examination (MMSE). Nutrients intake was assessed according to food frequency questionnaire and China Food Composition Database, and principal component analysis was performed to extract nutrient patterns. Associations between specific nutrients and cognitive function were assessed using log-binomial regression. Restricted cubic spline was used to illustrate the dose-response relationship of nutrients with multi-domain cognitive function. Mediation analysis was used to determine the mechanism of nutrients in cognitive function.

Results: Four nutrient patterns were identified (vitamin-mineral, protein-carbohydrate, fatty acid-vitamin E, and cholesterol-vitamin B₁₂), and only a nutrient pattern rich in cholesterol and vitamin B₁₂ was found associated with cognitive function (RR = 0.891, 95%CI = 0.794–0.999). In multi-domain cognitive function, dietary cholesterol and vitamin B₁₂ were related to better performance of visual memory function (P = 0.034, P = 0.02). In dose-response relationship, it suggested a U-shaped association between vitamin B₁₂ and MMSE (P = 0.02) within a certain range.

Conclusions: Dietary intake rich in cholesterol and vitamin B₁₂ was associated with better cognitive function, and vitamin B₁₂ had a U-shaped dose-response relation with MMSE. Thus, ensuring moderate cholesterol and vitamin B₁₂intake may be an advisable strategy to improve cognitive function in middle-aged and older adults.

Clinical Trial Registration: EMCOA, ChiCTR-OOC-17011882, Registered 5th, July 2017-Retrospectively registered, http://www.medresman.org/uc/project/projectedit.aspx?proj=2610

Early Life Nutrition and Mental Health: The Role of DNA Methylation

Does the quality of our diet during early life impact our long-term mental health? Accumulating evidence suggests that nutrition interacts with our genes and that there is a strong association between the quality of diet and mental health throughout life. Environmental influences such as maternal diet during pregnancy or offspring diet have been shown to cause epigenetic changes during critical periods of development, such as chemical modifications of DNA or histones by methylation for the regulation of gene expression. One-carbon metabolism, which consists of the folate and methionine cycles, is influenced by the diet and generates S-Adenosylmethinoine (SAM), the main methyl donor for methylation reactions such as DNA and histone methylation. This review provides current knowledge on how the levels of one-carbon metabolism associated micronutrients such as choline, betaine, folate, methionine and B vitamins that play a role in brain function can impact our well-being and mental health across the lifespan. Micronutrients that act as methyl donors for SAM formation could affect global or gene methylation, altering gene expression and phenotype. Strategies should then be adopted to better understand how these nutrients work and their impact at different stages of development to provide individualized dietary recommendations for better mental health outcomes.

Consequences of early life exposure to the 1983-1985 Ethiopian Great Famine on cognitive function in adults: a historical cohort study

OBJECTIVES

To investigate the association between early life famine exposure and cognitive function in adults.

DESIGN

Historical cohort study SETTING: North Wollo Zone, Northeast Ethiopia.

PARTICIPANTS

We recruited 1047 adult men and women aged 30-38 years who had history of early life exposure to Ethiopian great famine. Based on self-reported age and birth date, participants were categorised into famine exposed in early life (prenatal/postnatal) and non-exposed groups.

OUTCOME MEASURES

The primary outcome measure of this study was cognitive function in adults after early life exposure to famine. Cognitive function was measured using Montreal Cognitive Assessment-basic. Associations between exposure and outcome variables were examined by linear regression analysis models.

RESULTS

Adjusted for covariates, early life exposure to famine showed 1.29 (β=-1.29; 95% CI -2.16 to -0.52) points lower cognitive function score compared with non-exposed. Based on subanalysis for timing of famine exposure, postnatal exposure to famine resulted in 2.26 (β=-2.26; 95% CI -3.12 to -1.36) points lower cognitive function score compared with non-exposed groups. Prenatal famine exposure had 1.26 (β=-1.26; 95% CI -2.35 to 0.94) points lower cognitive function score although not statistically significant.

CONCLUSIONS

Famine exposure in early life was associated with cognitive functions in adults. While the overall findings highlight the importance of optimal nutrition in early life for brain growth and development, the association observed between postnatal famine exposure and adult cognitive function may indicate the relative importance of learning and experience during early childhood for optimal brain development after birth. Further studies are needed to elucidate the potential mechanism behind this association.

Exposure to Chinese famine in early life and the risk of sensory impairment in adulthood

BACKGROUND

Studies have shown that malnutrition in early life has a negative effect on midlife cognitive functions. Little is known, however, about the relationship between early-life malnutrition and visual, hearing or dual sensory impairments in adulthood. This study aims to investigate the association between exposure to the 1959-1961 Chinese famine in early life and sensory impairments in adulthood.

METHODS

A total of 6347 adults born between 1952 and 1964 surveyed in the 2015 China Health and Retirement Longitudinal Study were included in this study. The presence of sensory impairments was identified by self-reported assessment of visual and hearing functions. The associations between multi-stage early-life famine exposure and sensory functions were estimated using the multiple generalised linear model.

RESULTS

Compared with the unexposed group, respondents exposed to famine in the fetal period and late childhood had a significantly higher risk of hearing impairment (OR 1.54, 95% CI 1.06 to 2.24; OR 1.75, 95% CI 1.23 to 2.50) and dual sensory impairments (OR 1.45, 95% CI 1.00 to 2.11; OR 1.55, 95% CI 1.09 to 2.21), respectively. Furthermore, in severely famine-affected areas, the early, mid and late childhood-exposed groups were more likely to have hearing and dual sensory impairments than the unexposed group. Those associations were not observed in less famine-affected areas. However, no significant association was found between famine exposure and visual impairment in early-life famine-exposed group.

CONCLUSION

Exposure to Chinese famine in the fetal period and late childhood was linked to hearing and dual sensory impairments in adulthood.

The environment as a determinant of successful aging or frailty

The number of elderly persons is rising rapidly, and healthspan is a key factor in determining the well-being of individuals and the sustainability of national health systems. Environmental health is crucial for a "successful aging". Complex relationships between environmental factors and non-communicable diseases play a major role, causing or accelerating disabilities. Besides genetic factors, aging results from the concurrence of several environmental factors starting from early (i.e. in utero) life, able to increase susceptibility to diseases in adulthood, and to promote frailty in the elderly. In aged people, an unhealthy environment contributes to a fast and early decline and increases vulnerability. Exposure to pollutants facilitates the onset and progression of cardiovascular, respiratory, metabolic and neurologic diseases through direct effects and epigenetic mechanisms negatively affecting biological age. Healthy diet, healthy environment and constant physical activity could counteract, at least in part, the negative effects of environmental stressors. Almost all environmental factors generating detrimental effects on aging are modifiable, with relevant implications in terms of primary prevention measures potentially leading to decreased frailty, to an increase in the number of years lived without diseases or disability, and to a significant reduction in health expenditure.

Dietary Intake of Riboflavin and Unsaturated Fatty Acid Can Improve the Multi-Domain Cognitive Function in Middle-Aged and Elderly Populations: A 2-Year Prospective Cohort Study

Objective

This study was aimed to explore the effects of dietary nutrients on cognitive function among the middle-aged and elderly populations.

Methods

A prospective cohort study of 1,385 middle-aged and elderly people was conducted from January 2014 to December 2017. Dietary nutrients were assessed according to the food frequency questionnaire (FFQ) and China Food Composition Database (CFCD). Montreal cognitive assessment (MoCA) was used to evaluate the participants’ global cognitive function. Six other neuropsychological measures [auditory verbal learning test-immediate recall (AVLT-IR), auditory verbal learning test-short recall (AVLT-SR), auditory verbal learning test-long recall (AVLT-LR), logical memory test (LMT), digit span forward (DST-F), and digit span backward (DST-B)] were used to assess the verbal memory domain and the attention domain by principal component analysis (PCA). Multiple linear regressions were conducted to explore associations between nutrients and cognition. Sensitivity analyses were performed to confirm the results.

Results

Dietary riboflavin was protective for global cognitive function (β = 1.31, 95% CI: 0.26, 2.35) and the verbal memory domain (β = 0.37, 95% CI: 0.02, 0.71). Unsaturated fatty acid (USFA) played a protective role in global cognitive function (β = 1.15, 95% CI: 0.16, 2.14). The protective effects of riboflavin and USFA on cognitive function were consistent and reliable when different confounders were adjusted during sensitivity analyses. During the follow-up, neuropsychological measure scores revealed a reduced decline in the high-riboflavin group (d-MoCA, P = 0.025; d-AVLT-IR, P = 0.001; d-DST-B, P = 0.004; and d-composite score, P = 0.004) and the high-USFA group (d-AVLT-IR, P = 0.007; d-LMT, P = 0.032; d-DST-B, P = 0.002; and d-composite score, P = 0.008).

Conclusion

Higher intake of riboflavin and USFA can improve multi-dimensional cognitive functioning in middle-aged and elderly people. These findings were consistent in different models of sensitivity analyses.

Early-Life Exposure to the Chinese Famine and Risk of Cognitive Decline

Previous studies on the Chinese famine suggested long-term effects of early-life famine exposure on health conditions. This study aims to investigate the association between exposure to the Chinese famine of 1959-1961 at different early-life stages and the risk of cognitive decline in adulthood. A total of 6417 adults born between 1952 and 1964 in the 2015 survey data of China Health and Retirement Longitudinal Study were included in this study. Cognitive performance was estimated through a series of comprehensive neuropsychological tests, including the Telephone Interview of Cognitive Status (TICS-10), word recall, and pentagon drawing. Multiple generalized linear model (GLM) was employed to detect the association between multi-stage early-life famine exposure and late-life cognitive performance. Compared with the unexposed group, respondents exposed to famine in the fetal period performed worse in the TICS (difference -0.52, 95% confidence interval (CI): -0.93 to -0.10), word recall (difference -0.46, 95% CI: -0.74 to -0.19), and general cognition (difference -1.05, 95% CI: -1.64 to -0.47). Furthermore, we also found negative effects of famine exposure on performance of word recall and pentagon drawing in the early (word recall difference -0.56, 95% CI: -1.00 to -0.11; pentagon drawing difference -0.76, 95% CI: -1.40 to -0.12), mid (word recall difference -0.46, 95% CI: -0.81 to -0.11; pentagon drawing difference -0.66, 95% CI: -1.16 to -0.16), and late (word recall difference -0.30, 95% CI: -0.55 to -0.04; pentagon drawing difference -0.75, 95% CI: -1.13 to -0.37) childhood-exposed groups. Early-life famine exposure in different stages is positively associated with late-life cognitive decline. Fetal famine exposure might affect the overall cognitive status in adulthood, and childhood famine exposure has potential adverse effects on visuospatial episodic memory.

The Interplay Between Nutrition and Stress in Pregnancy: Implications for Fetal Programming of Brain Development

Growing evidence supports an important role for the intrauterine environment in shaping fetal development and subsequent child health and disease risk. The fetal brain is particularly plastic, whereby even subtle changes in structure and function produced by in utero conditions can have long-term implications. Based on the consideration that conditions related to energy substrate and likelihood of survival to reproductive age are particularly salient drivers of fetal programming, maternal nutrition and stress represent the most commonly, but independently, studied factors in this context. However, the effects of maternal nutrition and stress are context dependent and may be moderated by one another. Studies examining the effects of the bidirectional nutrition-stress interplay in pregnancy on fetal programming of brain development are beginning to emerge in the literature. This review incorporates all currently available animal and human studies of this interplay and provides a synthesis and critical discussion of findings. Nine of the 10 studies included here assessed nutrition-stress interactions and offspring neurodevelopmental or brain development outcomes. Despite significant heterogeneity in study design and methodology, two broad patterns of results emerge to suggest that the effects of prenatal stress on various aspects of brain development may be mitigated by 1) higher fat diets or increased intake and/or status of specific dietary fats and 2) higher dietary intake or supplementation of targeted nutrients. The limitations of these studies are discussed, and recommendations are provided for future research to expand on this important area of fetal programming of brain development.