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Epidemiology and Population Health

Association of exposure to famine early in life with indicators of obesity in adulthood: testosterone as a potential mediator?

International Journal of Obesity (2025)Cite this article

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Abstract

Background

The Chinese famine occurred between 1959 and 1961. Findings on early exposure to famine on obesity have been inconsistent. Therefore, this study aimed to assess the effect of early exposure to famine on obesity and the mediating role of testosterone.

Methods

The design enrolled 2667 participants from the Henan Rural Cohort Study. The associations between early famine exposure and indicators of obesity and obesity were explored using generalized linear models and logistic regression models, respectively. Stratified analyses by sex were performed to account for potential sex-specific effects. Mediation analyses were applied to address the contribution of testosterone in mediating the impact of early-life famines on obesity and its indicators.

Results

The median age of the study participants was 54 (range: 48–64) years old. Fetal famine exposure was positively associated with central obesity (waist circumference (WC) and waist-to-hip ratio (WHR)) in both sexes. Nevertheless, childhood famine exposure (3–9 years old after 3-year famine) was negatively associated with general obesity (body mass index (BMI)), and central obesity (WC) in males. In contrast, childhood famine exposure in females was positively associated with central obesity (WHR and waist-to-height ratio (WHtR)). Mediation analyses suggested that testosterone partially mediated the association of childhood famine exposure with central obesity (WC), BMI, WC, and WHtR in males, with mediation effect proportions ranging from 3.27% to 11.85%. In females, testosterone mediates the role of childhood famine in increasing the risk of central obesity (WHR), WHR, and WHtR, with mediating effect proportions of 5.50%, 3.60%, and 7.17%, respectively.

Conclusion

Fetal famine exposure increases the risk of central obesity. Childhood famine exposure showed sex-specific effects on central obesity, with a negative association in males and a positive association in females. Additionally, testosterone has been found for the first time to partially mediate the positive association of childhood famine on obesity.

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Fig. 1: Fully adjusted results of the association of fetal famine exposure with obesity and obesity indicators in different populations.
Fig. 2: Results of the association between childhood famine exposure and obesity and obesity indicators among different populations.
Fig. 3: The mediating role of testosterone in the link between childhood famine exposure and obesity and obesity indicators.

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Data availability

The datasets generated during and analyzed during the current study are available from the corresponding author on reasonable request, pending application.

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Acknowledgements

We thank all participants, facilitators and regulators for their assistance during the research.

Funding

This work was funded by the Postdoctoral Science Foundation of China (grant number 2021M702934), the National Natural Science Foundation of China (grant number 42177415), the Scientific and Technological Innovation of Colleges and Universities in Henan Province Talent Support Programme (grant number 22HASTIT044), the Excellent Youth Development Foundation of Zhengzhou University (grant number 2021ZDGGJS057) and the Young Backbone Teachers Program of Colleges and Universities in Henan Province (grant number 2021GGJS015).

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Authors and Affiliations

  1. Department of Environmental Health, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China

    Qingqing Cao, Zexin Jia, Changsheng Huan, Qian Gao, Pengcheng Yuan, Xin Li, Zhen Ma & Wenqian Huo

  2. Department of Computer and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China

    Zhenxing Mao

  3. Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China

    Chongjian Wang

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Contributions

QC and WH designed research, analyzed data and wrote the paper; ZJ: investigation, data curation, formal analysis, writing—review & editing. CH, QG XL, PY and ZM: visualization, writing—review & editing. ZM: investigation, data curation, writing—review & editing. CW: investigation, writing—review & editing. WH: investigation, writing—review & editing, conceptualization, methodology, investigation, validation, supervision, funding acquisition, project administration, writing—review & editing.

Corresponding author

Correspondence to Wenqian Huo.

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The study was approved by the Life Sciences Ethics Review Committee of Zhengzhou University (Code: [2015] MEC(S1)), and all participants signed informed consent forms. All methods were performed in accordance with the relevant guidelines and regulations.

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Cao, Q., Jia, Z., Huan, C. et al. Association of exposure to famine early in life with indicators of obesity in adulthood: testosterone as a potential mediator?. Int J Obes (2025). https://doi.org/10.1038/s41366-025-01876-5

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