Early exposure to famine tied to risk of rheumatoid arthritis in adulthood

Severe malnutrition or childhood famine, particularly wasting, threatens the survival of an estimated 47 million children under 5 in low/middle-income countries. At present, efforts to address severe childhood malnutrition are focused on community-based management with ready-to-use therapeutic foods along with inpatient treatment of complicated cases to prevent short-term mortality. As these efforts reduce case-fatality rates and global child mortality declines, considering the long-term health consequences of severe malnutrition and effects of therapeutic foods is increasingly important.

Therefore, Hannah VanEvery and colleagues from the Pennsylvania State University, State College, USA carried out the present study to investigate whether early life exposure to the Great Chinese Famine of 1959−1961 is associated with the risk of RA development in adulthood.

This study included 101,510 participants who were enrolled. RA cases were confirmed by medical record review. Logistic regression was used to calculate the odds ratio (OR) and 95% confidence interval (95% CI) for RA according to famine exposure status (exposed in utero or between ages 0 and 3 years, between ages 3 and 6 years, or at age 6 years or older), in comparison to participants born after 1961 who were not exposed to famine.

The following results were observed-

1. During 12 years of follow‐up, the authors identified 187 RA cases.
2. Individuals exposed to famine in utero or between ages 0 and 3 years had a higher prevalence of RA relative to other groups (0.2−0.35% versus 0.08−0.20%).
3. After adjustment for potential confounders, the OR for RA was 2.95 (95% CI 1.55−5.59) for individuals exposed in utero, 4.53 (95% CI 2.72−7.54) for those exposed between ages 0 and 3 years, 2.55 (95% CI 1.43−4.57) for those exposed between ages 3 and 6 years, and 2.72 (95% CI 1.70−4.36) for those exposed at age 6 years or older versus individuals born after 1961.
4. Similar associations with the risk of RA were observed for men and women when subjects were stratified by sex (P for interaction = 0.89).

Hence, the authors concluded that "individuals exposed to famine in utero or in early childhood (between ages 0 and 3 years) were more likely to develop RA in adulthood, highlighting the importance of early life as a vulnerable developmental period."