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Does malnutrition in utero determine diabetes and coronary heart disease in adulthood? Results from the Leningrad siege study, a cross sectional study

BMJ 1997; 315 doi: (Published 22 November 1997) Cite this as: BMJ 1997;315:1342
  1. S A Stanner, project coordinator (sstanner{at},
  2. K Bulmer, research techniciana,
  3. C Andrès, research techniciana,
  4. O E Lantseva, endocrinologistb,
  5. V Borodina, biologistb,
  6. V V Poteen, professor of medicinea,
  7. J S Yudkin, professor of medicineb
  1. a Department of Medicine, University College London Medical School, Whittington Hospital, London N19 3UA
  2. b Ott Institute of Obstetrics and Gynaecology, Russian Academy of Medical Science, St Petersburg, Russia
  1. Correspondence to: Ms Stanner
  • Accepted 26 August 1997


Objective: To investigate the relation between decreased maternal food intake and risk factors for coronary heart disease in adult

Design: Cross sectional study.

Subjects: 169 subjects exposed to malnutrition in utero (intrauterine group) during the siege of Leningrad (now St Petersburg) in 1941-4; 192 subjects born in Leningrad just before rationing began, before the siege (infant group); and 188 subjects born concurrently with the first two groups but outside the area of the siege (unexposed group).

Setting: Ott Institute of Obstetrics and Gynaecology, St Petersburg.

Main outcome measures: Development of risk factors for coronary heart disease and diabetes mellitus—obesity, blood pressure, glucose tolerance, insulin concentrations, lipids, albumin excretion rate, and clotting factors.

Results: There was no difference between the subjects exposed to starvation in utero and those starved during infant life in: (a) glucose tolerance (mean fasting glucose: intrauterine group 5.2(95% confidence interval 5.1 to 5.3), infant group 5.3 (5.1 to 5.5), P=0.94; mean 2 hour glucose: intrauterine group 6.1 (5.8 to 6.4), infant group 6.0 (5.7 to 6.3), P=0.99);(b) insulin concentration; (c) blood pressure; (d)lipid concentration; or (e) coagulation factors. Concentrations of von Willebrand factor were raised in the intrauterine group (156.5 (79.1 to 309.5)) compared with the infant group (127.6 (63.9 to 254.8); P<0.001), and female subjects in the intrauterine group had a stronger interaction between obesity and both systolic (P=0.01) and diastolic (P=0.04) blood pressure than in the infant group. Short adult stature was associated with raised concentrations of glucose and insulin 2 hours after a glucose load—independently of siege exposure. Subjects in the unexposed group had non-systematic differences in subscapular to triceps skinfold ratio, diastolic blood pressure, and clotting factors compared with the exposed groups.

Conclusions:Intrauterine malnutrition was not associated with glucose intolerance, dyslipidaemia, hypertension, or cardiovascular disease in adulthood. Subjects exposed to malnutrition showed evidence of endothelial dysfunction and a stronger influence of obesity on blood pressure.

Key messages

  • Relations between intrauterine growth and adult disease such as diabetes and cardiovascular disease have been linked to poor nutrition during pregnancy

  • In this study, however, intrauterine exposure to malnutrition was not associated with glucose intolerance

  • Intrauterine malnutrition did not affect insulin concentration, blood pressure, or concentration of lipids or coagulation factors

  • Concentration of von Willebrand factor, a marker of endothelial damage, was raised in the subjects exposed to intrauterine malnutrition

  • Obesity and blood pressure were more strongly related in subjects exposed to intrauterine malnutrition than in subjects either unexposed to malnutrition or exposed to malnutrition only as infants


  • Accepted 26 August 1997
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