The fetal origins hypothesis and the Hmong diaspora: Effects of warfare, early malnutrition, and later modernization on adult health
Author(s):
Clarkin, Patrick Francis
Format:
Thesis
Degree granted:
Ph.D.
Publisher:
Ann Arbor : State University of New York at Binghamton, 2004.
Pages:
311
Language:
English
Abstract:
A fetus or infant exposed to malnutrition may reduce its rate of growth in order to adapt to inadequate resources. However, the fetal origins hypothesis predicts that such reductions in growth may leave various organ systems functionally compromised, increasing the risk for obesity, type 2 diabetes, and cardiovascular disease later in life. Simultaneously, these conditions have long been associated with modernization. This dissertation explored how early malnutrition and later modernization affected chronic disease markers in Hmong refugees in French Guiana and the United States. The Hmong diaspora has its origins in Laos, where the Second Indochina War (1958–1975) disrupted food production practices for much of the rural population. This study included 288 Hmong males and females (180 in French Guiana, 108 in the United States) aged 18–51 years who were born during the war. Individuals born in high-conflict areas were presumed to have experienced prenatal malnutrition, while those who were displaced from their village before age 2 years were presumed to have experienced malnutrition in infancy. Individuals who resided in the United States were considered to have more exposure to modernization compared to those in French Guiana. In a stepwise regression analysis, Hmong who resided in the U.S. had a significantly higher central skinfold ratio and lower arm muscle area, while age at first resettlement was positively associated with higher blood pressure and shorter stature. Individuals born in a war zone had a significantly higher body mass index, abdominal/hip ratio, and a central skinfold ratio than those born in a safe zone. Also, Hmong who were displaced from their village before age 2 years had higher blood pressure and shorter stature than those who were not. It appears that early malnutrition resulting from conditions of war has had detrimental effects on growth and development after controlling for degree of modernization in adulthood. Finally, Hmong in the United States had a higher adjusted odds ratio for pre-hypertension in a logistic regression analysis, indicating that modernization is also a factor in chronic disease development.