Long term mortality after starvation during the Leningrad siege: Crucial confounding factor was overlooked

doi:10.1136/bmj.328.7435.346

BMJ 2004;328:346 (7 February), doi:10.1136/bmj.328.7435.346

Letter

Long term mortality after starvation during the Leningrad siege

Crucial confounding factor was overlooked

The first 150 words of the full text of this article appear below.

EDITOR—Sparén et al retrospectively analysed outcomes,in terms of cardiovascular mortality, in siege survivors andhave selected as controls men of similar age who did not experiencethe siege.¹ The data show that survivors have a higher riskof cardiovascular disease. The authors conclude that the processof starvation has adversely affected the physiology of the menwho experienced food shortages at a critical stage of theirdevelopment.

This conclusion could be drawn if the mortality of the starvationprocess itself could be shown to have been applicable to allphysiological types equally. People with greater fat reservesseem likely to outlive people with less in periods of famine,and that ability to withstand protracted famine is probablyrelated to an efficient metabolism, which is substantially geneticallyinherited. This cohort of siege survivors may owe its survivalto the possibility that its members, if not overweight themselvesat . . . [Full text of this article]

Michael D Croft, salaried general practitioner

Gateways Surgery, Shenley, Hertfordshire WD7 9LP michael.croft@hertsmere-pct.nhs.uk

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