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The paper below appears to be a continuing saga witnessed by a
Pubmed "painter-rc" search for Painter-rc of the health
disaster occurring
with extreme DR with poor nutrition. The below reports on
heart health
risks of starving mothers for their fetuses in later life.
Inserting ^s in
tables was difficult.

JAMA. 2006;296:628.
Rebecca C Painter, Susanne R de Rooij, CRON4healthyfuture M Bossuyt,
Timothy A Simmers,
Clive Osmond, David J Barker, Otto P Bleker, and Tessa J
Roseboom
Early onset of coronary artery disease after prenatal
exposure to the Dutch
famine
Am J Clin Nutr 2006 84: 322-327.
... coronary artery disease (CAD). ... We compared the
age at onset and
cumulative incidence of CAD between persons born as term
singletons who were
exposed to the 1944-1945 Dutch famine during late (n = 160),
mid- (n = 138),
or early (n = 87) gestation and 590 unexposed subjects at
age 50 or 58 y.
... Of the 83 CAD cases identified, persons conceived during
the famine were
3 y younger than the unexposed persons at the time of CAD
diagnosis (47 y
compared with 50 y) and had a higher cumulative incidence of
CAD [13%;
hazard ratio (HR) adjusted for sex: 1.9; 95% CI: 1.0, 3.8]
than did the
unexposed persons. The HR changed little after adjustment
for smoking (HR:
1.8), social class (HR: 2.0), or size at birth (HR: 2.0).
... We found an
earlier onset of CAD among persons conceived during the
famine, which
suggests that maternal nutrition in early gestation may play
a role in the
onset of CAD. This finding agrees with evidence from animal
experiments that
identify periconceptional maternal diet as important in the
offspring's
adult health.
... previous findings ... Dutch famine in late
gestation was associated
with decreased glucose tolerance (5), whereas more
microalbuminuria (6) was
present among subjects exposed during midgestation. The most
marked effects
were described in the group of subjects conceived during the
famine and
include a more atherogenic lipid profile (7), altered
clotting (8), more
obesity (9), and a tripling of CAD prevalence at age 50 y (10).
.... Infants born after exposure to famine in late and
midgestation
were lighter and smaller than the unexposed infants, and
their mothers
weighed less at the end of gestation (Table 1).

TABLE 1 Maternal, birth, and coronary artery disease
characteristics of men
and women who participated in the Dutch Famine Birth Cohort
Study at age 50
or 58 y
=============================================================
---Time of exposure to famine---
Born before famine---Late gestation Midgestation Early
gestation---Conceived
after famine All Total, n
=============================================================
General
No. of subjects 289 160 138 87 301 - 975
Men (%) 48 44 39 44 53 47 975
Maternal characteristics
Maternal age (y) 29 31^1 29 27^1 28 29±6^2 975
Weight at the end of gestation (kg) 67 62^1 63^1 68 69
66±8.7 854
Weight gain in the last trimester (kg) 3.2 0.0^1 5.0^1
5.5^1 4.3 3.4±3.2
682
Occupation of head of family, manual (%) 83 71 70 62^1
69 73 809
Primiparous (%) 35 24^1 34 39 39 34 975
Birth characteristics
Birth weight (g) 3396 3183^3 3195^3 3437 3449 3353±467 975
Head circumference (cm) 32.8 32.4^3 32.13 32.8 33.2
32.8±1.6 965
Ponderal index (kg/m3) 26.2 26.0^3 25.73 26.0 26.7
26.2±2.4 966
Coronary artery disease
No. of cases 24 12 11 11 25 83 -
Cumulative incidence (%) 8 8 8 13^4 8 9 975
Age at onset (y)5 51 50 50 47^4 49 49 (45-56) 81
=============================================================
1 Significantly different from those born before or
conceived after the
famine, P < 0.05 (linear or logistic regression).
2 Chui^2 ±SD (all such values).
3,4 Significantly different from those born before or
conceived after
the famine after adjustment for sex:
3 P < 0.05 (linear or logistic regression)
4 P < 0.05 (Cox regression).
5 Mean after quadratic transformation; interquartile
range in
parentheses.

... Persons exposed to famine in early gestation had
the highest
cumulative incidence of CAD (13%; sex-adjusted HR compared
with unexposed
persons: 1.9; 95% CI: 1.0, 3.8) (Table 1). The cumulative
incidence of CAD
in those exposed to famine in late gestation (sex-adjusted
HR: 0.8; 95% CI
0.4 to 1.6) and midgestation (sex-adjusted HR: 1.1; 95% CI:
0.6, 2.1) did
not differ significantly from that of those unexposed to
famine (8% after
exposure in mid- and late gestation compared with 8% in
unexposed persons).
On average, CAD manifested 3 y earlier in those exposed to
famine in early
gestation (mean age: 47 y; interquartile range: 45-51 y)
than in those
unexposed to famine (mean age: 50 y; interquartile range:
45-57 y) (Figure
1).
Men and women with CAD were lighter (3275 compared
with 3360 g) and
thinner (25.9 compared with 26.3 kg/m3) at birth and had a
smaller head
circumference (32.5 compared with 32.8 cm) at birth,
although none of these
differences was significant. After size at birth was
adjusted for, the
association between famine exposure in early gestation and
CAD was not
attenuated (HR: 2.0; 95% CI: 1.0, 3.8).
Coronary artery disease risk factors ... The
distribution of
cardiovascular disease risk factors according to famine
exposure during
various stages of gestation among subjects at age 58 y is
shown in Table 2.

TABLE 2 Characteristics of men and women who participated in
the Dutch
Famine Birth Cohort Study at age 58 y^1 Born before famine
=============================================================
---Time of exposure to famine---
Born before famine---Late gestation Midgestation Early
gestation---Conceived
after famine All Total, n
=============================================================
Glucose at 120 min (mmol/L) 5.8 6.0 6.1 6.2 5.8 5.9±2.4 632
Insulin at 120 min (pmol/L) 243 247 251 264 236 245±294 627
Triacylglycerol (g/L) 1.2 1.3 1.3 1.3 1.3 1.3±1.0 724
LDL:HDL 2.3 2.5^2 2.3 2.6^2 2.4 2.4±1.0 720
BMI (kg/m2) 28.4 28.1 27.9 28.0 28.6 28.3±4.8 726
Ever smoked (%) 64 62 66 76^2 59 63 727
SES^3 46 50^2 49 45 48 48±14 721
=============================================================
1 All values, except for "ever smoking," are geometric
or geometric ±SD.
2 Significantly different from those born before or
conceived after the
famine after adjustment for sex, P < 0.05 (linear or
logistic regression).
3 Socioeconomic status.

In addition to the results shown in Table 2, famine
exposure during any
period of gestation was associated with elevated glucose
concentrations at
120 min (P = 0.04; adjusted for sex and body mass index) and
an elevated
ratio of LDL to HDL (P = 0.03; adjusted for sex). Adjustment
for the 2
social risk factors in Table 2, smoking (adjusted HR: 1.8;
95% CI: 0.9, 3.5)
and low SES (adjusted HR: 2.0; 95% CI: 1.0, 3.8), had little
effect on the
association between famine exposure in early gestation and CAD.
Maternal constitution and fertility ... There were no
significant
differences in maternal weight, age, parity, or SES at birth
between persons
with or without CAD. When these variables were entered into
a multivariable
Cox model, the association between exposure to famine in
early gestation and
CAD was little changed (multivariable-adjusted HR: 1.8; 95%
CI: 0.9, 3.6).
... In summary, our findings suggest that maternal
nutrition in early
gestation may play an important role in the course of CAD.
This suggestion
is in line with evidence from animal experiments that
identified
preconceptional and preimplantation maternal diet as
important for the
offspring's adult health (11-14).