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SEX- AND AGE-RELATED MORTALITY PROFILES DURING FAMINE: TESTING THE ‘BODY FAT’ HYPOTHESIS

Published online by Cambridge University Press:  10 January 2013

JOHN R. SPEAKMAN
JOHN R. SPEAKMAN*
Affiliation:
Key State Laboratory of Molecular and Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, China Institute of Biological and Environmental Sciences, University of Aberdeen, Aberdeen, UK
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Summary

During famines females generally have a mortality advantage relative to males, and the highest levels of mortality occur in the very young and the elderly. One popular hypothesis is that the sex differential in mortality may reflect the greater body fatness combined with lower metabolism of females, which may also underpin the age-related patterns of mortality among adults. This study evaluated the ‘body fat’ hypothesis using a previously published and validated mathematical model of survival during total starvation. The model shows that at a given body weight females would indeed be expected to survive considerably longer than males in the absence of food. At a mass of 70 kg for example a female aged 30 would survive for 144 days compared with life expectancy of only 95 days for a male of the same age and weight. This effect is contributed to by both the higher body fatness and lower metabolism of the females at a given body weight. However, females are generally smaller than males and in addition to a sex effect there was also a major effect of body size – heavier individuals survive longer. When this body size effect was removed by considering survival in relation to BMI the sex effect was much reduced, and could be offset by a relatively small difference in pre-famine BMI between the sexes. Nevertheless, combining these predictions with observed mean BMIs of males and females across 48 countries at the low end of the obesity spectrum suggests that in the complete absence of food females would survive on average about 40% longer (range 6 to 64.5%) than males. The energy balance model also predicted that older adult individuals should survive much longer than younger adult individuals, by virtue of their lower resting metabolic rates and lower activity levels. Observations of the female survival advantage in multiple famines span a much wider range than the model prediction (5% to 210%). This suggests in some famines body fatness may be a significant factor influencing the mortality differential between the sexes, but in other famines other factors are likely to be more important. Moreover, the pattern of mortality in relation to age is completely opposite that predicted. These data emphasize the complex nature of famine mortality and suggest that a simple model of energy utilization alone is inadequate to explain the major aspects of this phenomenon.

Type
Articles
Information
Journal of Biosocial Science , Volume 45 , Issue 6 , November 2013 , pp. 823 - 840
Copyright
Copyright © Cambridge University Press 2013 

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References

Adamets, S. (2002) Famine in nineteenth and twentieth century Russia: mortality by age, cause and gender. In Dyson, T. & O'Grada, C. (eds) Famine Demography. Perspectives from the Past and Present. International Studies in Demography Series, Oxford University Press, Oxford, Chapter 8, pp. 158–180.CrossRefGoogle Scholar
Ballor, D. L. & Keesey, R. E. (1991) A meta-analysis of the factors affecting exercise-induced changes in body mass, fat mass and fat-free mass in males and females. International Journal of Obesity 15, 717–726.Google ScholarPubMed
Biellik, R. J. & Henderson, P. L. (1981) Mortality, nutritional status and diet during the famine in Karamoja, Uganda, 1980. Lancet 8259, 1330–1333.CrossRefGoogle Scholar
Black, A. E., Coward, W. A., Cole, T. J. & Prentice, A. M. (1996) Human energy expenditure in affluent societies: an analysis of 574 doubly-labelled water studies. European Journal of Clinical Nutrition 50, 72–92.Google Scholar
Boyle, P. B. & O'Grada, C. (1986) Fertility trends, excess mortality and the great Irish famine. Demography 23, 543–562.CrossRefGoogle ScholarPubMed
Brewis, A. A. (2010) Obesity: Cultural and Bio-Cultural Perspectives. Rutgers University Press, New York.Google Scholar
Cai, Y. & Feng, W. (2005) Famine, social disruption, and involuntary fetal loss: evidence from Chinese survey data. Demography 42, 301–322.CrossRefGoogle ScholarPubMed
Chen, L. C. & Chowdhury, A. K. M. A. (1977) The Dynamics of Contemporary Famine. Mexico International Population Conference, Vol. 1, Liege International Union for the Scientific Study of Population, pp. 409–426.Google Scholar
Chen, L. C., Huq, E. & D'Souza, S. (1981) Sex bias in the family allocation of food and health care in rural Bangladesh. Population and Development Review 7, 55–70.CrossRefGoogle Scholar
Collins, S. (1995) The limits of human adaptation to starvation. Nature Medicine 1, 810–814.CrossRefGoogle ScholarPubMed
de Waal, A. (1989) Famine that Kills: Darfur Sudan 1984–5. Clarendon Press, Oxford.Google Scholar
Deurenberg, P., Westrate, J. A. & Seidell, J. C. (1991) Body mass index as a measure of body fatness: age and sex specific prediction formulas. British Journal of Nutrition 65, 105–114.CrossRefGoogle ScholarPubMed
Durnin, J. V. G. A & Womersley, J. (1974) Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 Years. British Journal of Nutrition 32, 77–97.CrossRefGoogle ScholarPubMed
Elia, M. (2000) Hunger disease. Clinical Nutrition 19, 379–386.CrossRefGoogle ScholarPubMed
Faggioni, R., Feingold, K. R. & Grunfeld, C. (2001) Leptin regulation of the immune response and the immunodeficiency of malnutrition. FASEB Journal 15, 2565–2571.CrossRefGoogle ScholarPubMed
Ferraro, R., Lillioja, S., Fontvielle, A. M., Rising, R., Bogardus, C. & Ravussin, E. (1992) Lower sedentary metabolic rate in women compared with men. Journal of Clinical Investigation 90, 780–784.CrossRefGoogle ScholarPubMed
Gallagher, D., Ruts, E., Visser, M., Heshka, S., Baumgartner, R. N., Wang, J.et al. (2000) Weight stability masks sarcopenia in elderly men and women. American Journal of Physiology 279, E366–375.Google ScholarPubMed
Garenne, M., Waltisperger, D., Cantelle, P. & Ralijaona, O. (2002) The demographic impact of a mild famine in an African city: the case of Antananarivo, 1985–7. In Dyson, T. & O'Grada, C. (eds) Famine Demography. Perspectives from the Past and Present. International Studies in Demography Series, Oxford University Press, Oxford, Chapter 10, pp. 204–217.CrossRefGoogle Scholar
Goran, M. I. & Poehlman, E. T. (1992) Total energy expenditure and energy requirements in healthy elderly persons. Metabolism – Clinical and Experimental 41, 733–753.CrossRefGoogle ScholarPubMed
Hall, K. H., Heymsfield, S., Kemnitz, J., Klein, S., Schoeller, D. A. & Speakman, J. R. (2012) Energy balance and body weight regulation: a useful concept for understanding the obesity epidemic. American Journal of Clinical Nutrition 95, 989–994.CrossRefGoogle Scholar
Hamilton, W. D. (1964) Genetical evolution of social behavior 2. Journal of Theoretical Biology 7, 17–24.CrossRefGoogle Scholar
Harrison, G. A. (ed.) (1988) Famine. Oxford University Press, Oxford.Google Scholar
Henry, C. J. K. (1990) Body mass index and the limits to human survival. European Journal of Clinical Nutrition 44, 329–335.Google ScholarPubMed
Hionidou, V. (2002a) Send us either food or coffins: the 1941–2 famine on the Agean island of Syros. In Dyson, T. & O'Grada, C. (eds) Famine Demography. Perspectives from the Past and Present. International Studies in Demography Series, Oxford University Press, Oxford, pp. 181–203.CrossRefGoogle Scholar
Hionidou, V. (2002b) Why do people die in famines? Evidence from three island populations. Population Studies 56, 65–80.CrossRefGoogle ScholarPubMed
Hionidou, V. (2004) The position of the elderly in Greece prior to World War Two. Evidence from three island populations. In Kreager, P. & Schroeder-Butterfill, E. (eds) Ageing Without Children: European and Asian Perspectives on Elderly Access to Support Networks. Berghahn Books, Oxford, pp. 244–267.Google Scholar
Jackson, C. (1996) Rescuing gender from the poverty trap. World Development 24, 489–504.CrossRefGoogle Scholar
Janssen, I., Heymsfield, S. B., Wang, Z. M. & Ross, R. (2000) Skeletal muscle mass and distribution in 468 men and women aged 18–88 yr. Journal of Applied Physiology 89, 81–88.CrossRefGoogle ScholarPubMed
Johnstone, A. M., Murison, S. D., Duncan, J. S., Rance, K. A. & Speakman, J. R. (2005) Factors influencing variation in basal metabolic rate include fat-free mass, fat mass, age, and circulating thyroxine but not sex, circulating leptin, or triiodothyronine. American Journal of Clinical Nutrition 82, 941–948.CrossRefGoogle ScholarPubMed
Kane, P. (1988) Famine in China: 1951–61: Demographic and Social Implications. St Martins Press, London.Google Scholar
Keys, A. J., Brozek, J., Henschel, O., Michelson, O. & Taylor, H. L. (1950) The Biology of Human Starvation, Vol. 1. University of Minnesota Press, Minnesota.CrossRefGoogle Scholar
Klausen, B., Toubro, S. & Astrup, A. (1997) Age and sex effects on energy expenditure. American Journal of Clinical Nutrition 65, 895–907.CrossRefGoogle ScholarPubMed
Krishnaji, N. (1987) Poverty and sex ratio: some data and speculations. Economic and Political Weekly 22, 892–897.Google Scholar
Kuk, J. L., Lee, S., Heymsfield, S. B. & Ross, R. (2005) Waist circumference and abdominal tissue distribution: influence of age and sex. American Journal of Clinical Nutrition 81, 1330–1334.CrossRefGoogle ScholarPubMed
Lindtjorn, B. (1990) Famine in southern Ethiopia, 1985–86: population structure, nutritional state and incidence of death. British Medical Journal 301, 1123–1127.CrossRefGoogle Scholar
Livi-Bacci, M. (1991) Population and Nutrition: An Essay on European Demographic History. Cambridge University Press, Cambridge.CrossRefGoogle Scholar
Livi-Bacci, M. (1993) On the human costs of collectivization in the Soviet Union. Population and Development Review 19, 743–766.CrossRefGoogle Scholar
Lord, G. M., Matarese, G., Howard, L. K., Baker, R. J., Bloom, S. R. & Lechler, R. I. (1998) Leptin modeulates T-cell immune response and reverse starvation induced immunosuppression. Nature 394, 897–901.CrossRefGoogle ScholarPubMed
McAlpin, M. B. (1983) Subject to Famine: Food Crises and Economic Change in Western India, 1886–1920. Princeton University Press, Princeton.CrossRefGoogle Scholar
McCance, R. A. (1975) Famines of history and of today. Proceedings of the Nutrition Society 34, 161–166.CrossRefGoogle ScholarPubMed
McCurdy, S. A. (1994) Epidemiology of a disaster. The Donner party (1846–47). Western Journal of Medicine 160, 338–342.Google Scholar
Macintyre, K. (2002) Famine and the female mortality advantage. In Dyson, T. & O'Grada, C. (eds) Famine Demography. Perspectives from the Past and Present. International Studies in Demography Series, Oxford University Press Oxford, Chapter 12, pp. 240–260.CrossRefGoogle Scholar
Mammo, A. (1993) Factors responsible for childhood mortality variation in rural Ethiopia. Journal of Biosocial Science 25, 223–238.CrossRefGoogle ScholarPubMed
Matarese, G. (2000) Leptin and the immune system: how nutritional status influences the immune response. European Cytokine Network 11, 7–13.Google ScholarPubMed
Menken, J. & Campbell, C. (1992) Forum: on the demography of South Asian famines. Health Transition Review 2, 91–108.Google Scholar
Mokyr, J. & O'Grada, C. (1999) Famine disease and famine mortality: lessons from Ireland, 1845–1850. Centre for Economic Research Working Paper 99/12, University College Dublin.Google Scholar
Moore, P. S., Marfin, A. A., Quenenmoen, L. E., Gessner, B. D., Ayub, Y. S., Miller, D. S.et al. (1993) Mortality rates in displaced and resident populations of central Somalia during 1992 famine. Lancet 341, 935–938.CrossRefGoogle ScholarPubMed
Murray, M. J., Murray, A. B., Murray, M. B. & Murray, C. J. (1976) Somali food shelters in the Ogaden famine and their impact on health. Lancet 332, 1283–1285.CrossRefGoogle Scholar
Nelson, K. M., Weinsier, R. L., Long, C. L. & Schutz, Y. (1992) Prediction of resting energy expenditure from fat-free mass and fat mass. American Journal of Clinical Nutrition 56, 848–856.CrossRefGoogle ScholarPubMed
O'Grada, C. (1999) Black '47 and Beyond: The Great Irish Famine in History, Economy and Memory. Princeton University Press, Princeton.CrossRefGoogle Scholar
O'Grada, C. & Dyson, T. (2002) Introduction. In Dyson, T. & O'Grada, C. (eds) Famine Demography. Perspectives from the Past and Present. International Studies in Demography Series, Oxford University Press, Oxford, Chapter 1, pp. 1–18.Google Scholar
Piers, L. S., Soares, M. J., McCormack, L. M. & O'Dea, K. (1998) Is there evidence for an age-related reduction in metabolic rate? Journal of Applied Physiology 85, 2196–2204.CrossRefGoogle ScholarPubMed
Pitkanen, K. J. (2002) Famine mortality in nineteenth century Finland: is there a sex bias? In Dyson, T. & O'Grada, C. (eds) Famine Demography. Perspectives from the Past and Present. International Studies in Demography Series, Oxford University Press Oxford, Chapter 4, pp. 65–92.CrossRefGoogle Scholar
Prentice, A. M. (2005) Starvation in humans: evolutionary background and contemporary implications. Mechanisms of Ageing and Development 126, 976–981.CrossRefGoogle ScholarPubMed
Razzaque, A. (1988) Effect of famine on fertility in a rural area of Bangladesh. Journal of Biosocial Science 20, 287–294.CrossRefGoogle Scholar
Razzaque, A. (1989) Socio-demographic differentials in mortality during the 1974–5 famine in a rural area of Bangladesh. Journal of Biosocial Science 21, 13–22.CrossRefGoogle Scholar
Rivers, J. P. W. (1982) Women and children last: an essay on sex discrimination in disasters. Disasters 6, 259–263.CrossRefGoogle Scholar
Rivers, J. P. W. (1988) The nutritional biology of famine. In Harrison, G. A. (ed.) Famine. Oxford University Press, Oxford.Google Scholar
Saad, M. F., Damani, S., Gingericj, R. L., Riadgabriel, M. G., Khan, A., Boyadjian, R. J.et al. (1997) Sexual dimorphism in plasma leptin concentration. Journal of Clinical Endocrinology and Metabolism 82, 579–584.Google ScholarPubMed
Scott, S., Duncan, S. R. & Duncan, C. J. (1995) Infant mortality and famine – a study in historical epidemiology in northern England. Journal of Epidemiology and Community Health 49, 245–252.CrossRefGoogle ScholarPubMed
Sen, A. (1981) Poverty and Famines: an Essay on Entitlement and Deprivation. Clarendon Press, Oxford.Google Scholar
Shetty, P. (2005) Energy requirements of adults. Public Health Nutrition 8, 994–1009.CrossRefGoogle ScholarPubMed
Speakman, J. R. & Westerterp, K. R. (2010) Associations between energy demands, physical activity and body composition in adult humans between 18 and 96 years of age. American Journal of Clinical Nutrition 92, 826–834.CrossRefGoogle Scholar
Speakman, J. R. & Westerterp, K. R. (2012) A mathematical model of weight loss under total starvation and implications of the genetic architecture of the modern obesity epidemic for the thrifty-gene hypothesis. Disease Models and Mechanisms DOI: 10.1242/dmm.010009.CrossRefGoogle Scholar
Toole, M. J. & Waldman, R. J. (1988) An analysis of mortality trends among refugee populations in Somalia, Sudan, and Thailand. Bulletin of the World Health Organization 66, 237–247.Google ScholarPubMed
Vaughan, L., Zurlo, F. & Ravussin, E. (1991) Aging and energy expenditure. American Journal of Clinical Nutrition 53, 821–825.CrossRefGoogle ScholarPubMed
Watkins, S. C. & Menken, J. (1985) Famines in historical perspective. Population and Development Review 11, 647–675.CrossRefGoogle Scholar
Westerterp, K. R. & Speakman, J. R. (2008) Physical activity energy expenditure has not declined since the 1980s and matches energy expenditure of wild mammals. International Journal of Obesity 32, 1256–1263.CrossRefGoogle Scholar