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Early life exposure to famine raises risk of RA in adulthood

Publish date:: December 18, 2020

Key clinical point: Individuals who experienced famine in utero or early childhood were significantly more likely than those not exposed to famine to develop rheumatoid arthritis as adults.

Major finding: Over a 12-year follow-up period, individuals exposed to famine in utero or in early childhood were significantly more likely to develop RA compared to those not exposed, with odds ratios of 2.95, 4.53, and 2.55 for those who experienced famine in utero, at ages 0-3 years, and ages 3-6 years, respectively.

Study details: The data come from a population-based study of 101,510 individuals in China, and included 187 rheumatoid arthritis cases.

Disclosures: The study was funded by the College of Health and Human Development and the Department of Nutritional Sciences at Pennsylvania State University. The researchers had no financial conflicts to disclose.

Commentary

“The etiology of RA and interaction between genetic and environmental risk factors are as yet unknown. In this study, the effects of a particular form of “early life adversity,” namely the Great Chinese Famine of 1959-1961, was studied with respect to risk of development of RA in adulthood. Over 101,000 participants in the Kailuan study were recruited to complete a questionnaire at baseline and every 2 years and were classified as exposed to the famine based on birth year (in utero, in years 0-3, years 3-6, or after 6 years old); those born after 1961 were used as the reference (not exposed) group. Among study participants, 187 RA cases were identified; the group of patients born just before the famine (0-3 years old during the famine) had the highest prevalence of RA compared to the reference group (OR 4.53); both the younger participants (born after 1961) and the oldest participants (born before 1953) had a lower prevalence of RA. Whether famine exposure in early life and associated malnutrition affect the immune system in ways that predispose to RA or whether these are linked to other environmental stressors or physiologic effects that are more directly predisposing is as yet unknown. Early childhood events deserve more scrutiny regarding their potential roles as risk factors for RA.”