LAUSR

Epidemiology Famine extends its dangerous reach across generations: Witness the epigenetic effects of the Dutch famine in 1944–1955, which led to diabetes and metabolic disease among the grandchildren of those affected. Sixty years ago (1958–1962), a great famine caused by a collapse of the food system prevailed across China. Cheng et al. investigated whether the high levels of pulmonary tuberculosis (TB) currently found in Sichuan Province might be a consequence of that famine two generations later. The authors accessed more than 1 million TB cases diagnosed between 2005 and 2018 and identified 12,000 cases that could be attributable to the famine . Malnutrition and accompanying immune suppression are likely to activate latent TB. Subsequently, among the low-birthweight famine cohort (F1), starvation was associated with greater risk of adult TB emerging and, furthermore, of an increased risk of adult TB emerging in their children (F2). This effect is most likely mediated by intergenerational damage to immune responses and lung anatomy rather than just exposure to infected family members. The work starkly shows how societal shocks can cut across generations. Proc. Natl. Acad. Sci. U.S.A. 10.1073/pnas.2008336117 (2020).