The reason that starvation in utero is associated with a higher risk of type 2 diabetes in later life is that the fetus prepares for its likely adult environment which is not encountered (thrifty phenotype). These epigenetic changes are due to increased gene activity and expression rather than by starvation induced changes in the DNA sequence.5

Therefore, after 33 years, I believe it is time to reinterpret Crawford’s data and conclude that the large increases in death from diabetes during nineteenth century in Ireland was due to the in utero effects of starvation during the Irish Potato Famine and not due to increases in the intake of fat and sugar.