How hunger experienced in utero and childhood harms the body for decades

A humanitarian tragedy lived under Nazism, in one of the countries currently with one of the best indicators of human development in the world, has since brought lessons to the world about the impacts of extreme hunger on babies who were not yet born.

It was the winter of 1944 in Holland, which at the time was partially occupied by Nazi Germany.

For months, German troops blocked food supplies to large parts of Dutch territory, leaving 4.5 million people starving.

“People ate the dogs, cats and mice. It was just hopeless,” one survivor told the BBC in 2013. “The bakers didn’t have wheat, so they made watery loaves that stuck in your mouth.”

Some studies estimate that every Dutchman had food equivalent to 370 calories a day – noting that current health regulations suggest a daily intake of 2,000 calories a day for women and 2,500 for men.

It was one of the most serious episodes of famine that occurred during World War II, which left 20,000 dead and only ended with the defeat of Germany, in May 1945, and the liberation of Holland.

It is a disaster that remains in the collective memory of the Dutch to this day, explains researcher Tessa Roseboom, professor of Early Childhood Development and Health at the University of Amsterdam, to BBC News Brasil.

“The collective memory of the Dutch people about World War II is dramatic,” he says. “Of course the numbers of survivors are dwindling, but we all know stories of people who had to eat tulip bulbs, who had to walk hundreds of miles to find food.”

At the same time, the fact that extreme famine only occurred for a brief period of time (the shortage ended when the food supply was normalized, and the Netherlands moved towards being an extremely prosperous country) gave scientists an ideal setting to study what a lack of nutrients does to a person’s body—in particular, a person still in the making, inside the mother’s womb.

And research on the “winter of famine” (or “hongerwinter”, in the original) show that the consequences are still felt today by people in their 70s and 80s, and will likely be felt by their descendants.

More physical and mental health problems

Roseboom and her colleagues have collected detailed medical records from historical archives about women who were pregnant during the lean period and have since been analyzing the physical and mental health of these women’s now elderly children.

These people have a higher incidence of obesity, high cholesterol, type 2 diabetes and cardiovascular problems than the general Dutch population, “risks that contribute to less physical and mental well-being and more risk of mortality in this group”, he says. the researcher.

One likely reason is that these people have had their bodies “programmed” from the womb to survive on very little food. Over time, this became a health problem.

“We found clear differences in terms of body structure and size, and we think this is due to the lack of ‘building blocks’ – that is, poor nutrition – of their mothers when they were building their babies’ bodies,” he explains. Roseboom.

In addition, she says that MRI scans taken on these people indicate that their brains are smaller, which may explain why they appear to perform poorly on cognitive tasks.

And overall, these people’s brains seem to “age faster”, says the researcher.

Hunger in Brazil and in the world

The consequences observed in the Netherlands refer to a unique and extreme historical period, but they serve as a warning about the impacts that a lack of nutrients has on the long-term health of people, in particular fetuses and children – and how this can damage strength. of future work of a country, explains Roseboom.

This is true even for countries like Brazil, where 19 million people were, at the end of 2020, in a situation of food insecurity (when access and availability of food are scarce), according to calculations by the Research Network on Sovereignty and Food Security and Nutritional.

“First, the stress of the pandemic impacts children already in the womb, and we know this from past pandemics. The Spanish flu of 1918, for example, left lasting scars on unborn children. cardiovascular diseases and lower participation in the labor market,” says Roseboom.

“The restriction of access to food in Brazil at this time may very well have negative consequences, especially for children in the womb. We saw this in Dutch Famine, but similar effects were also observed at other times when there was food restriction”, such as in periods famines in China, Ireland or the African continent as a whole, she says.

“So how could this not have a similar effect on Brazilian children?”

In light of this scenario, Roseboom argues that when childhood is protected and pregnant women, babies and children are guaranteed healthy nutrition, it will benefit society as a whole, which will have more productive adults with fewer health problems. “It’s amazing to see how brains [de pessoas gestadas sob a fome] they are smaller, make fewer connections, have poorer brain profusion for cognitive tasks. Food shortages not only affect future physical health, but how these children will do in school, how they will be able to contribute to the labor market.”

“In that sense, there is an important economic effect to be considered. If children have poverty embedded in their brains, quite literally, they will never be able to contribute their [potencial] maximum. It is a problem that society as a whole will face if a generation is left unprotected. The legacy is longer, with a higher price to be paid.”

from generation to generation

Other researchers looking at the effects of the Dutch “winter of famine” have observed similar impacts to Roseboom’s on the children of pregnant women at that time, particularly those in early pregnancy.

Studies carried out by academics from universities in the United States and the Netherlands, for example, found that the death rate of those who were pregnant during the famine was 10% higher than those who were born before or after that winter.

Increased risks of overweight, high cholesterol and schizophrenia have also been identified by these researchers, and one theory behind this is that nutrient deprivation may have “silenced” some genes that participate in the body’s fat-burning process.

Roseboom also suspects that there are genetic impacts, which may even have already been passed on to the offspring of “winter of hunger” babies.

“The evidence is not as strong as what we’ve seen in babies themselves, but we do see evidence that the next generation also feels less healthy, is more obese, and is in worse health,” he explains.

impact on children

Although the studies of the “winter of famine” have focused mainly on pregnant women and their babies, considered the most vulnerable group at that time, Roseboom says that his other research indicates that children are also seriously harmed by periods of famine.

“In the Dutch famine, we know from the records that children were relatively more protected (than adults): those under the age of a year received servings of food of more than 1,000 calories a day. And you may ask: is this enough? And will eat [apenas] would tulip bulbs and potatoes be good for young children? I doubt. But the government has tried very hard to protect children as much as possible,” she reports. “But there are other studies that look at the impact on children, and I was involved in some of them. We also saw negative health effects.”

In Brazil, in 2019, according to a survey by the Abrinq Foundation for Children’s Rights, there were at least 9.1 million children aged up to 14 in a household situation of extreme poverty, which probably means that they were food insecure — a problem that worsened by the pandemic, unemployment and inflation.

A report by the US Psychological Association points out that food insufficiency is associated, in children, with more stomach and headache pain and more colds. “And severe hunger anticipates chronic diseases among preschool and school-age children,” the text says.

Furthermore, living with food insecurity can cause toxic stress, which in turn “affects children’s brain development, learning, information processing and academic results.”

Even so, it is in the babies in the womb that the harm is worst, says the Dutch researcher: “It is [durante a gravidez] that all the organs are being formed. If they are built with smaller, poorer blocks, it is not surprising that there are long-term consequences for resilience to the stresses of everyday life.”

The effects of this can be mitigated over a lifetime, but they are persistent, she adds.

“The heart will have fewer muscle cells, the kidneys will have fewer filtering units, the brain will have fewer neurons. (…) As you get older, you are more susceptible to problems. — a malnourished baby can get lots of healthy food, activities and stimulation and minimize the effects, but reversing completely is not possible because you can’t build your heart from scratch again.”