Famine Exposure During the First 1000 Days and Intellectual Disability

描述（由申请人提供）：我们的目标是促进对生命最初1000天（从受孕到2岁）营养作用的理解，这是大脑发育中的关键和脆弱阶段，对智力和其他残疾，以及对学校教育。我们建议对1959-61年中国饥荒的长期影响进行研究，这是人类历史上最大的饥荒，死亡人数高达3000 - 5000万。饥荒提供了一个准实验环境，以测试长期和严重饥荒对长期营养不良和贫困背景下认知发展的影响，这是人类历史上大多数饥荒以及发达国家和发展中国家贫困人口的共同背景。我们建议使用中国第二次全国残疾人调查（CSNSD）的数据，这是中国最新的全国残疾人调查。我们将采用一种新的方法来测量中国县级饥荒的强度，并应用一种稳健的差分估计器将家庭影响与其他潜在的混杂因素隔离开来。我们将研究出生队列之前（1956-58），期间（1959-61）和之后的饥荒（1962-1964），并探讨如何影响不同的时间暴露于饥荒，性别和城市/农村的起源。共有174，988名男性和173，688名女性将纳入我们的研究。我们的一般假设是，在生命的头1000天（而不是之后）遭受饥荒，导致a）智力残疾和视力、言语、听力、精神和身体残疾的风险更高，受教育的机会更少; B）由于男性的生物脆弱性更大，对男性的影响大于女性;（c）由于农村地区的饥荒更为严重，农村居民受到的影响大于城市居民。我们的研究团队在中国饥荒和队列研究、残疾研究以及CSNSD数据的设计和使用方面提供了广泛的专业知识。我们希望我们的研究结果能够丰富有关营养和认知发展的文献，并可能支持在贫困国家和发达国家（如美国）的高危人群中改善妊娠和幼儿营养的重要性。 公共卫生相关性：该项目将评估1959-61年中国饥荒期间怀孕和生命的前2年对成年智力残疾，视力，言语，听力，精神和身体残疾以及学校教育的影响。这项研究将有助于了解在长期营养不良和贫穷的情况下，长期和严重的饥荒对认知发展的影响，这是发达国家和发展中国家贫穷人口的共同情况。

DESCRIPTION (provided by applicant): Our goal is to advance understanding of the role of nutrition during the first 1000 days of life (conception to age 2y), a critical and vulnerable phas in brain development, on intellectual and other disabilities, as well as on schooling. We propose a study of the long term effects of the 1959-61 Chinese famine, the largest in human history with up to 30-50 million deaths. The famine provides a quasi-experimental setting for testing effects of exposure to prolonged and severe famine on cognitive development in the context of chronic undernutrition and poverty, the context common to most famines in human history and to poor populations in both developed and developing countries. We propose to use the data from the China Second National Survey on Disability (CSNSD), the most up-to-date national survey on disability in China. We will apply a robust difference-in- difference estimator to isolate the famie impact from other potential confounding factors using a novel approach to measuring the intensity of the Chinese famine at county level. We will study birth cohorts born before (1956-58), during (1959-61) and after the famine (1962-1964) and explore how impact varies by timing of exposure to the famine, sex and urban/rural origin. A total of 174,988 men and 173,688 women will be included in our study. Our general hypothesis is that exposure to the famine during the first 1000 days of life, but not later, leads to a) higher risk of intellectual disabiliy and visual, speech, hearing, psychiatric, and physical disabilities, and less schooling; b) larger impact among men than women due to the greater biological vulnerability of men; c) larger impact among rural than urban residents due to the greater severity of the famine in rural areas. Our research team provides extensive expertise in Chinese famine and cohort research, disability research, and design and use of the CSNSD data. We expect our findings to enrich the literature regarding nutrition and cognitive development and possibly to support the importance of improving nutrition in pregnancy and early childhood among high risk population in both poor countries as well as developed countries such as the US. PUBLIC HEALTH RELEVANCE: The project will assess the impact of exposure to the Chinese famine of 1959-61 during pregnancy and the first 2 years of life on adult intellectual disability, visual, speech, hearing, psychiatric, and physical disabilities, and schooling. This study will contribute to the knowledge of effects of exposure to prolonged and severe famine on cognitive development in the context of chronic undernutrition and poverty, the context common to poor populations in both developed and developing countries.