However, it is important to note that the effects of nutritional status in early pregnancy on long-term metabolic risk may be independent of altered size at birth. Follow-up of offspring of women exposed to the Dutch Famine at the end of World War II found increased risks of heart disease, hyperlipidaemia and obesity in those conceived during the famine and impaired glucose tolerance in those exposed to famine in utero in late gestation, while only the latter group showed reduction in birthweight.