Author(s): MENG, Q., FENG, Q., ZHU, J., ZHANG, X., WANG, J., Institution: CHINA INSTITUTE OF SPORT SCIENCE, Country: CHINA, Abstract-ID: 1354

INTRODUCTION:
Lower-limb endurance and strength are core components of functional capacity in older adults and predict disability and mortality. The Developmental Origins of Health and Disease (DOHaD) framework proposes that early-life undernutrition may program long-term health, yet stage-specific evidence linking famine exposure to objective late-life functional fitness is limited. Using the 1959–1961 Chinese Great Famine as a natural experiment, we tested whether famine exposure during fetal life, infancy, or preschool years was associated with impaired lower-limb endurance and strength in adults aged 60–79 years, independent of adult lifestyle and socioeconomic factors.
METHODS:
Design/participants: Cross-sectional analysis of the 2025 China National Physical Fitness Surveillance (n=17,639; women n=8,841; 65.1±2.8 years). Birthdate-defined groups were fetal (Oct 1959–Sep 1961; n=3,811), infant (Jan–Dec 1958; n=2,578), preschool (Jan 1956–Dec 1957; n=5,236), and unexposed controls (Oct 1962–Sep 1964; n=6,014).
Outcomes: (1) 2-min step test: “low endurance” = sex- and age-specific lowest quartile (≤25th percentile) based on Rikli & Jones[1]. (2) 30-s chair stand: relative power (W·kg⁻¹) estimated via the Alcazar equation; “low strength” defined by validated sex-specific cut-points (men ≤2.53; women ≤2.01 W·kg⁻¹).
Analysis: Multivariable logistic regression estimated prevalence odds ratios (POR) and 95% CI adjusted for age, sex, BMI, physical activity, smoking, alcohol use, education[2], and occupation; population attributable risk percent (ARP) was calculated. Sex and urban/rural stratified analyses were conducted (p<0.05).
RESULTS:
Unexposed participants had the lowest prevalence of low endurance (24.8%) and low strength (30.6%). After full adjustment, fetal exposure was associated with low endurance (POR=1.10, 95% CI 1.00–1.21; ARP=7.6%) but not low strength (POR=1.06, 0.97–1.16). Infant and preschool exposure were associated with higher risk of both outcomes (infant: POR=1.13 for endurance; 1.31 for strength; preschool: POR=1.12 and 1.29; all p<0.05), with ARP around 10% for endurance and ~17% for strength. Stratified analyses indicated stronger associations for strength among rural residents across exposure windows, and sex heterogeneity: in men, infant/preschool exposure related to low strength; in women, infancy exposure showed the strongest associations.
CONCLUSION:
Early-life famine exposure was independently associated with poorer lower-limb functional fitness decades later in a stage-specific pattern, highlighting infancy and preschool years as sensitive windows. Findings support DOHaD and suggest brief field tests may aid low-cost community screening and risk stratification in ageing and health-promotion settings.

References
1. Rikli RE, Jones CJ. Senior fitness test manual. Champaign (IL): Human Kinetics; 2001.
2. Garcia-Aguirre M et al. Low relative sit-to-stand power and adverse outcomes in older adults. J Sport Health Sci. 2025.