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Ukrainian famine of 1932-1933 Mykola Khalangot, Institute of Endocrinology Alexander Vaiserman, Institute of Gerontology, Kiev, Ukraine Famine in Ukraine (1932-33, 1946) z Estimated death tolls: 2.2-3.5 million die of starvation in 1932-1933 [1,2] Up to 1 million starves to death in 1946 [3] Investigation tool: Diabetes Mellitus (DM) registers of 3 regions exposed to 1932-33 famine z z n = 64,496, aged 40-79 Total population: n = 1,946,078 aged 40-79 DM registers for 2 Ukrainian regions unexposed to 1932-33 famine z z n =27,719, aged 40-79. Total population: n = 864,801, aged 40-79. We have gathered and analyzed Ukrainian Diabetes Mellitus (DM) data z z z According to the year of birth According to gender According to being part of USSR before/after 1939 A comparison to national diabetic register in Denmark had also been made (Dr. Bendix Carstensen, Copenhagen) Total population of 5 Ukrainian regions 60000 40000 30000 20000 Female Male 10000 0 19 27 19 29 19 31 19 33 19 35 19 37 19 39 19 41 19 43 19 45 19 47 19 49 19 51 19 53 19 55 19 57 19 59 19 61 19 63 19 65 Population 50000 Birth year Population in 3 Ukrainian regions included into USSR before (black) and 2 regions included after (green) 1939 80000 70000 Crimea, Khersonska, Chernihyvska Volynska, Rivnenska 50000 40000 30000 20000 10000 Birth year 19 61 19 63 19 65 19 53 19 55 19 57 19 59 19 45 19 47 19 49 19 51 19 37 19 39 19 41 19 43 19 29 19 31 19 33 19 35 0 19 27 Population 60000 Age/Gender-Related DM Prevalence in 5 Ukrainian regions in relation to Denmark (in cooperation with Dr. Bendix Carstensen, Copenhagen) DM prevalence in Ukrainian regions included into USSR before (red) and after (blue) 1939 No age-related prevalence peak for patients born between 1933-1937 16 14 Crimea, Kherson, Chernihyv 12 Volyn, Rivne 10 8 6 4 2 79 76 73 70 67 64 61 58 55 52 49 46 43 0 40 z Thrifty Genotype z z z z Thrifty alleles – ancient evolutionary adjustment to feast/famine conditions Diabetics may carry thrifty alleles that make them extremely efficient in food intake/utilization Not advantageous in modern food-abundant environment (4) Non-thrifty genotypes carriers dyed in 1932-1933? Thrifty Phenotype z z z Results from nutritional deficiency in gestational and early postnatal period Maintained for life Cause of type 2 DM if food-abundant lifestyle is encountered later in life (5) Thrifty Epigenotype z z z DM 2 susceptibility is predominantly determined by epigenetic variations Such epigenotypes are inherited Leptin is a candidate gene for thrifty epigenotype aquisition (6) References 1. 2. 3. 4. 5. 6. France Meslé, Gilles Pison, Jacques Vallin France-Ukraine: Demographic Twins Separated by History, Population and societies, N°413, June 2005 Stephen G. Wheatcroft, On demographic evidence of the tragedy of the Soviet village in 1931-1933), V.P. Danilov et al, eds. [The Tragedy of the Soviet Village: Collectivization and Dekulakization: Documents and Materials, 1927-39, vol. 3, Konets 1930-1933, Moscow, 2001, pp. 866-886. Veselova, O. et al (eds). Holod v Ukraïni, 1946–1947: Dokumenty i materialy (Kyiv–New York 1996) Neel JV. 1962. Diabetes mellitus: a ‘‘thrifty’’ genotype rendered detrimental by ‘‘progress’’? Am J Hum Genet 14:353–362. Hales CN, Barker DJ. 1992. Type 2 (non-insulin-dependent) diabetes mellitus: the thrifty phenotype hypothesis. Diabetologia 35:595–601. Stöger R.. The thrifty epigenotype: an acquired and heritable predisposition for obesity and diabetes? Bioessays. 2008 Feb;30(2):156-66 Age/Gender-Related DM Prevalence in Ukraine Two peaks of DM prevalence among Ukrainians from regions which were a part of USSR before 1939 • • Patients born between 1933-1937 Patients born between 1946-1947 Female domination in all age groups Age/Gender-Related DM Prevalence in Denmark z z Linear increase of age-related DM prevalence Male domination in all age groups