Early-life undernutrition increases the risk of death from chronic diseases in adulthood: a population-based cohort study

Background Early-life undernutrition, particularly during critical developmental periods, may have lasting impacts on non-communicable diseases (NCDs) in adulthood. The Chinese Great Famine (1959–1961) provides a unique opportunity to evaluate these effects in a large-scale population study. To investigate the impact of early-life undernutrition on adult mortality due to NCDs in individuals exposed to the Chinese Great Famine. Methods We analyzed data from a medical insurance database in Hua County, China, including 15,088 individuals born during the famine (1959–1961) and 49,924 individuals deemed unexposed because they were born after the famine (1962–1964), with follow-up from 2012 to 2023. Multivariable Cox regression and competing risks regression were used to assess the association between early-life undernutrition and mortality. Results Early-life undernutrition was associated with increased risks of all-cause mortality (HR adjusted = 1.49, 95% CI 1.37–1.62), cancer mortality (HR adjusted = 1.41, 95% CI 1.22–1.64), cardiovascular and cerebrovascular diseases mortality (HR adjusted = 1.51, 95% CI 1.34–1.71), and chronic obstructive pulmonary disease mortality (HR adjusted = 4.37, 95% CI 2.51–7.61). Subgroup analysis revealed that the exposed group had a higher risk of death from lung, esophageal, gastric, hepato-biliary, and pancreatic cancers, cerebrovascular disease and cardiovascular disease. Conclusions This study demonstrates the long-term adverse effects of early-life undernutrition on NCD mortality in adulthood, underscoring the importance of nutritional interventions during critical developmental periods to reduce the burden of NCDs. Clinical trial registration Endoscopic Screening for Esophageal Cancer in China (ESECC) randomized controlled trial (Clinical trial: NCT01688908).