{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T13:43:41Z","timestamp":1785851021828,"version":"3.56.0"},"reference-count":55,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Three-Year Public Health Action Plan of Shanghai","award":["GWVI-11.1-22"],"award-info":[{"award-number":["GWVI-11.1-22"]}]},{"name":"Three-Year Public Health Action Plan of Shanghai","award":["GWVI-11.1-23"],"award-info":[{"award-number":["GWVI-11.1-23"]}]},{"name":"Three-Year Public Health Action Plan of Shanghai","award":["GWVI-11.2-XD10"],"award-info":[{"award-number":["GWVI-11.2-XD10"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Early-life undernutrition may exert lifelong and intergenerational effects on height and weight, but its impact on body shape remains unclear. Using the Great Chinese Famine (1959\u20131961) as a natural experiment, this study explored the associations between early-life undernutrition and body shape indices across two generations. Methods: We analyzed nine waves of longitudinal data from the China Health and Nutrition Survey (1991\u20132015), including 5156 participants (F1) born in 1955\u20131966 and their 2383 biological offspring (F2). F1 famine exposure was classified by birth year; F2 exposure was defined by parental status. Anthropometric indices including body adiposity index (BAI), body roundness index (BRI), waist-to-height ratio (WHtR), conicity index (COI), and a body shape index (ABSI) were derived from repeated measurements. Age-specific fitted curves of these indices were compared across exposure groups using mixed-effects models with fractional polynomials of age. Results: Fetal famine exposure was modestly associated with lower COI and ABSI in adulthood, particularly among men. Childhood famine exposure was significantly linked to lower BAI (\u22120.40), BRI (\u22120.26), WHtR (\u22120.0140), COI (\u22120.0188), and ABSI (\u22120.0008), with stronger associations in men (all P for sex interaction &lt;0.05). Intergenerationally, maternal childhood exposure was associated with higher offspring BAI, whereas paternal childhood exposure was associated with lower BAI, BRI, WHtR, COI, and ABSI. Conclusions: Famine exposure showed more pronounced associations with body shape in men, and maternal and paternal exposures displayed different intergenerational patterns. These exploratory findings suggest the possibility that early-life undernutrition may relate to long-term phenotypes in a sex-specific manner, though this requires independent replication.<\/jats:p>","DOI":"10.3390\/nu18152544","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T12:32:43Z","timestamp":1785846763000},"page":"2544","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sex-Specific Associations of Famine Exposure in Early Life with Body Shape Indices Across Two Generations in China"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2786-6819","authenticated-orcid":false,"given":"Weiyuan","family":"Yao","sequence":"first","affiliation":[{"name":"Department of Chronic Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China"},{"name":"Department of Epidemiology, NHC Key Laboratory for Health Technology Assessment, Fudan University School of Public Health, 138 Yi Xue Yuan Road, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3603-6457","authenticated-orcid":false,"given":"Leah","family":"Li","sequence":"additional","affiliation":[{"name":"Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London WC1N 1EH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4208-9480","authenticated-orcid":false,"given":"Yongfu","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, NHC Key Laboratory for Health Technology Assessment, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2045-2218","authenticated-orcid":false,"given":"Wanghong","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, NHC Key Laboratory for Health Technology Assessment, Fudan University School of Public Health, 138 Yi Xue Yuan Road, Shanghai 200032, China"},{"name":"Yiwu Research Institute of Fudan University, Building V of Zhongfu Square, Yiwu 322000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1111\/j.1365-2796.2007.01809.x","article-title":"The origins of the developmental origins theory","volume":"261","author":"Barker","year":"2007","journal-title":"J. Intern. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1056\/NEJMra0708473","article-title":"Effect of in utero and early-life conditions on adult health and disease","volume":"359","author":"Gluckman","year":"2008","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/S0140-6736(19)32472-9","article-title":"The double burden of malnutrition: Aetiological pathways and consequences for health","volume":"395","author":"Wells","year":"2020","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1255903","DOI":"10.1126\/science.1255903","article-title":"In utero effects. In utero undernourishment perturbs the adult sperm methylome and intergenerational metabolism","volume":"345","author":"Radford","year":"2014","journal-title":"Science"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1016\/j.cmet.2017.02.016","article-title":"Epigenetic Mechanisms of Transmission of Metabolic Disease across Generations","volume":"25","author":"Sales","year":"2017","journal-title":"Cell Metab."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"460","DOI":"10.2337\/db08-0490","article-title":"Intergenerational transmission of glucose intolerance and obesity by in utero undernutrition in mice","volume":"58","author":"Isganaitis","year":"2009","journal-title":"Diabetes"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1111\/1471-0528.12136","article-title":"Transgenerational effects of prenatal exposure to the 1944\u201345 Dutch famine","volume":"120","author":"Veenendaal","year":"2013","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1023\/A:1010241825519","article-title":"Longevity determined by paternal ancestors\u2019 nutrition during their slow growth period","volume":"49","author":"Bygren","year":"2001","journal-title":"Acta Biotheor."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/j.ajcnut.2023.10.021","article-title":"Exposure to Chinese famine in early life and height across 2 generations: A longitudinal study based on the China Health and Nutrition Survey","volume":"119","author":"Yao","year":"2024","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1016\/j.clnu.2023.02.013","article-title":"Parental exposure to famine in early life and child overweight in offspring in Chinese populations","volume":"42","author":"Yao","year":"2023","journal-title":"Clin. Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1002\/oby.23593","article-title":"Transgenerational associations of parental famine exposure in early life with offspring risk of adult obesity in China","volume":"31","author":"Yao","year":"2023","journal-title":"Obesity"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1038\/ijo.2010.5","article-title":"Diagnostic performance of body mass index to identify obesity as defined by body adiposity: A systematic review and meta-analysis","volume":"34","author":"Okorodudu","year":"2010","journal-title":"Int. J. Obes."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1093\/advances\/nmy101","article-title":"Perspective: What Does Stunting Really Mean? A Critical Review of the Evidence","volume":"10","author":"Leroy","year":"2019","journal-title":"Adv. Nutr."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Krakauer, N.Y., and Krakauer, J.C. (2012). A new body shape index predicts mortality hazard independently of body mass index. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0039504"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1016\/0895-4356(91)90059-I","article-title":"A simple model-based index of abdominal adiposity","volume":"44","author":"Valdez","year":"1991","journal-title":"J. Clin. Epidemiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2264","DOI":"10.1002\/oby.20408","article-title":"Relationships between body roundness with body fat and visceral adipose tissue emerging from a new geometrical model","volume":"21","author":"Thomas","year":"2013","journal-title":"Obesity"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1038\/oby.2011.38","article-title":"A better index of body adiposity","volume":"19","author":"Bergman","year":"2011","journal-title":"Obesity"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"m3324","DOI":"10.1136\/bmj.m3324","article-title":"Central fatness and risk of all cause mortality: Systematic review and dose-response meta-analysis of 72 prospective cohort studies","volume":"370","author":"Jayedi","year":"2020","journal-title":"BMJ"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e13023","DOI":"10.1111\/obr.13023","article-title":"Effectiveness of body roundness index in predicting metabolic syndrome: A systematic review and meta-analysis","volume":"21","year":"2020","journal-title":"Obes. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"8370304","DOI":"10.1155\/2018\/8370304","article-title":"Anthropometric Indicators of Adiposity Related to Body Weight and Body Shape as Cardiometabolic Risk Predictors in British Young Adults: Superiority of Waist-to-Height Ratio","volume":"2018","author":"Amirabdollahian","year":"2018","journal-title":"J. Obes."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1093\/ije\/dyp322","article-title":"Cohort Profile: The China Health and Nutrition Survey--monitoring and understanding socio-economic and health change in China, 1989\u20132011","volume":"39","author":"Popkin","year":"2010","journal-title":"Int. J. Epidemiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"690","DOI":"10.2105\/AJPH.85.5.690","article-title":"Body weight patterns among the Chinese: Results from the 1989 and 1991 China Health and Nutrition Surveys","volume":"85","author":"Popkin","year":"1995","journal-title":"Am. J. Public Health"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1093\/ije\/dyx013","article-title":"Exposure to the Chinese famine of 1959-61 in early life and long-term health conditions: A systematic review and meta-analysis","volume":"46","author":"Li","year":"2017","journal-title":"Int. J. Epidemiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1136\/bmj.319.7225.1619","article-title":"China\u2019s great famine: 40 years later","volume":"319","author":"Smil","year":"1999","journal-title":"BMJ"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.ehb.2015.03.003","article-title":"Intergenerational health consequences of the 1959-1961 Great Famine on children in rural China","volume":"18","author":"Li","year":"2015","journal-title":"Econ. Hum. Biol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1111\/j.1467-789X.2012.01016.x","article-title":"The expanding burden of cardiometabolic risk in China: The China Health and Nutrition Survey","volume":"13","author":"Yan","year":"2012","journal-title":"Obes. Rev. Off. J. Int. Assoc. Study Obes."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1136\/bmj.312.7027.377","article-title":"Ratio of waist circumference to height may be better indicator of need for weight management","volume":"312","author":"Ashwell","year":"1996","journal-title":"BMJ"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"70","DOI":"10.3109\/03014460.2014.903998","article-title":"Body shape indices and cardiometabolic risk in adolescents","volume":"42","author":"Xu","year":"2015","journal-title":"Ann. Hum. Biol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"8170","DOI":"10.3390\/nu7095386","article-title":"Dietary Pattern Is Associated with Obesity in Older People in China: Data from China Health and Nutrition Survey (CHNS)","volume":"7","author":"Xu","year":"2015","journal-title":"Nutrients"},{"key":"ref_30","unstructured":"Li, C. (2022). Prenatal Famine Exposure and Later-Life Risk of Type 2 Diabetes: Examining the Relationship in a National Longitudinal Study in China. [Ph.D. Thesis, Columbia University]."},{"key":"ref_31","first-page":"100399","article-title":"Socio-economic disparities in child-to-adolescent growth trajectories in China: Findings from the China Health and Nutrition Survey 1991\u20132015","volume":"21","author":"Gao","year":"2022","journal-title":"Lancet Reg. Health West Pac."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Royston, P., and Sauerbrei, W. (2008). Multivariable Model-Building: A Pragmatic Approach to Regression Analysis Based on Fractional Polynomials for Modelling Continuous Variables, John Wiley & Sons Ltd.","DOI":"10.1002\/9780470770771"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1161\/HYPERTENSIONAHA.121.18022","article-title":"Famine and Trajectories of Body Mass Index, Waist Circumference, and Blood Pressure in Two Generations: Results from the CHNS From 1993\u20132015","volume":"79","author":"Li","year":"2022","journal-title":"Hypertension"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1038\/sj.ejhg.5200859","article-title":"Cardiovascular and diabetes mortality determined by nutrition during parents\u2019 and grandparents\u2019 slow growth period","volume":"10","author":"Kaati","year":"2002","journal-title":"Eur. J. Hum. Genet."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"7954856","DOI":"10.1155\/2019\/7954856","article-title":"Famine Exposure in Early Life and Risk of Metabolic Syndrome in Adulthood: Comparisons of Different Metabolic Syndrome Definitions","volume":"2019","author":"Ning","year":"2019","journal-title":"J. Diabetes Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1007\/s12603-018-1144-z","article-title":"The Risks of Overweight, Obesity and Abdominal Obesity in Middle Age after Exposure to Famine in Early Life: Evidence from the China\u2019s 1959\u20131961 Famine","volume":"22","author":"Chang","year":"2018","journal-title":"J. Nutr. Health Aging"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Schellong, K., Schulz, S., Harder, T., and Plagemann, A. (2012). Birth weight and long-term overweight risk: Systematic review and a meta-analysis including 643,902 persons from 66 studies and 26 countries globally. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0047776"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1056\/NEJM197608122950701","article-title":"Obesity in young men after famine exposure in utero and early infancy","volume":"295","author":"Ravelli","year":"1976","journal-title":"N. Engl. J. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1210\/edrv.18.5.0313","article-title":"Catch-up growth","volume":"18","author":"Boersma","year":"1997","journal-title":"Endocr. Rev."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"R25","DOI":"10.1152\/ajpregu.00418.2004","article-title":"Gestational programming: Population survival effects of drought and famine during pregnancy","volume":"288","author":"Ross","year":"2005","journal-title":"Am. J. Physiol. Regul. Integr. Comp. Physiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1404","DOI":"10.1038\/s41418-023-01159-4","article-title":"The hunger strikes back: An epigenetic memory for autophagy","volume":"30","author":"Joseph","year":"2023","journal-title":"Cell Death Differ."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"4046","DOI":"10.1093\/hmg\/ddp353","article-title":"DNA methylation differences after exposure to prenatal famine are common and timing- and sex-specific","volume":"18","author":"Tobi","year":"2009","journal-title":"Hum. Mol. Genet."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1111\/j.1469-185X.2006.00007.x","article-title":"The thrifty phenotype as an adaptive maternal effect","volume":"82","author":"Wells","year":"2007","journal-title":"Biol. Rev. Camb. Philos. Soc."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.tem.2009.11.006","article-title":"Intergenerational transmission of programmed effects: Public health consequences","volume":"21","author":"Drake","year":"2010","journal-title":"Trends Endocrinol. Metab."},{"key":"ref_45","first-page":"20140074","article-title":"The role and interaction of imprinted genes in human fetal growth","volume":"370","author":"Moore","year":"2015","journal-title":"Philos. Trans. R. Soc. Lond. Ser. B Biol. Sci."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e22708","DOI":"10.1016\/j.heliyon.2023.e22708","article-title":"How does early-life famine experience influence household energy transition?","volume":"9","author":"Wang","year":"2023","journal-title":"Heliyon"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.ssresearch.2014.07.007","article-title":"Long-term health and socioeconomic consequences of early-life exposure to the 1959-1961 Chinese Famine","volume":"49","author":"Fan","year":"2015","journal-title":"Soc. Sci. Res."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.ehb.2016.07.001","article-title":"Transgenerational effects of childhood conditions on third generation health and education outcomes","volume":"23","author":"Pinger","year":"2016","journal-title":"Econ. Hum. Biol."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Fransen, H.P., Peeters, P.H., Beulens, J.W., Boer, J.M., de Wit, G.A., Onland-Moret, N.C., van der Schouw, Y.T., Bueno-de-Mesquita, H.B., Hoekstra, J., and Elias, S.G. (2016). Exposure to Famine at a Young Age and Unhealthy Lifestyle Behavior Later in Life. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0156609"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e13405","DOI":"10.1111\/obr.13405","article-title":"Multigenerational transmission of obesity: A systematic review and meta-analysis","volume":"23","author":"Kanmiki","year":"2022","journal-title":"Obes. Rev. Off. J. Int. Assoc. Study Obes."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Zhang, X., Ye, R., Sun, L., Liu, X., Wang, S., Meng, Q., and Chen, X. (2023). Relationship between novel anthropometric indices and the incidence of hypertension in Chinese individuals: A prospective cohort study based on the CHNS from 1993 to 2015. BMC Public Health, 23.","DOI":"10.1186\/s12889-023-15208-7"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e067516","DOI":"10.1136\/bmj-2021-067516","article-title":"Anthropometric and adiposity indicators and risk of type 2 diabetes: Systematic review and dose-response meta-analysis of cohort studies","volume":"376","author":"Jayedi","year":"2022","journal-title":"BMJ"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Zhang, A., Li, Y., Ma, S., Bao, Q., Sun, J., Cai, S., Li, M., Su, Y., Cheng, B., and Dong, J. (2022). Conicity-index predicts all-cause mortality in Chinese older people: A 10-year community follow-up. BMC Geriatr., 22.","DOI":"10.1186\/s12877-022-03664-6"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1959","DOI":"10.1093\/aje\/kwae376","article-title":"Genetic analysis of selection bias in a natural experiment: Investigating in-utero famine effects on elevated body mass index in the Dutch Hunger Winter Families Study","volume":"194","author":"Zhou","year":"2024","journal-title":"Am. J. Epidemiol."},{"key":"ref_55","unstructured":"UNICEF (2026, May 10). 1 in 4 Children Globally Live in Severe Child Food Poverty Due to Inequity, Conflict, and Climate Crises. Available online: https:\/\/www.unicef.org\/press-releases\/1-4-children-globally-live-severe-child-food-poverty-due-inequity-conflict-and."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/15\/2544\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T12:43:58Z","timestamp":1785847438000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/15\/2544"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,4]]},"references-count":55,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["nu18152544"],"URL":"https:\/\/doi.org\/10.3390\/nu18152544","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,4]]}}}