Association between famine exposure and type 2 diabetes mellitus over the last three decades: a systematic review and meta-analysis.

Early-life nutritional deprivation from famine may increase lifelong vulnerability to Type 2 Diabetes Mellitus (T2DM). This Systematic Review and Meta-Analysis evaluated studies published over the past three decades to assess and appraise the association between famine exposure across developmental stages and T2DM risk. PubMed, Embase, Web of Science, and the Cochrane Library identified observational studies published between 1995 and 2025. Studies reporting risk estimates or data enabling calculation of risk ratios (RRs) were included, followed by pooled estimates were generated. Methodological quality was assessed using the Newcastle-Ottawa Scale. Subgroup analyses, meta-regression and sensitivity analyses were conducted to explore heterogeneity. Of 6311 identified articles, 40 met the inclusion criteria. Overall, famine exposure was associated with 43 % higher risk of T2DM (95 % CI: 1.30-1.56; I2 = 96.7 %). The pooled risk increased to 47 % in studies published between 2016 and 2025. Longer famine duration (RR = 1.79) and females (RR = 1.52) showed comparatively higher risk. Higher famine severity and exposures during the fetal stage indicated greater susceptibility. Thus, famine exposure is consistently associated with increased risk of T2DM, particularly with prolonged or severe exposure and among women. Nutritional deprivation during key developmental periods may have lasting metabolic effects.