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February 16, 2000

Does Prenatal Famine Cause Later Antisocial Behaviors?—Reply

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor

JAMA. 2000;283(7):887-888. doi:10.1001/jama.283.7.882

In Reply: Dr Shiwach asks whether our findings on maternal nutritional deficiency during the Dutch Hunger Winter (1944-1945) and offspring risk for ASPD apply to today's poorer developing countries. If so, Shiwach posits that these societies should exhibit a "clear excess" of ASPD. The presumed lack of such excess prompts him to question the likely generalizability of our findings to these disadvantaged societies.

Our findings pertain strictly to severe (1000 Kcal/d [<4200 kJ/d]) not moderate (1000-1500 Kcal/d [4200-6300 kJ/d]) maternal nutritional deficiency. While 1000 Kcal/d (4200 kJ/d) probably does not represent a specific protective nutritional threshold, clearly we cannot assume, in the absence of further research, that our results extend to less severe levels of undernutrition and certain forms of malnutrition. However, the claim that developing societies do not have increased rates of ASPD lacks empirical foundation because there are no epidemiological studies of ASPD in these settings.1 We do not think that crude rate comparisons between developed and developing countries would prove especially informative on this issue. In our view, the marked social and regional variations in rates of antisocial behaviors within each industrialized societies implicate complex environmental factors, as well as genes and the intrauterine environment, as determinants of these rates. Hence, even studies reporting comparatively low rates of ASPD in famine-affected regions in developing countries would not directly contradict hypotheses about prenatal nutrition. Finally, maternal nutritional status is associated with numerous reproductive outcomes both in developed and developing societies.2 Consequently, there are no compelling reasons to think that a prenatal nutritional mechanism for ASPD would not also operate in low-income countries.

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