Early-life exposures play key roles in the development of metabolic diseases. Whether such effects exist beyond one generation remains unclear. This study aimed to determine the transgenerational association of early-life exposure to the Chinese famine of 1959 to 1962 with the trajectories of body mass index (BMI), waist circumference (WC), and blood pressure (BP) in 2 consecutive generations. We included 21 106 F1 observations born between 1954 and 1967 (median age: 45 years) and 1926 F2 observations (median age: 23 years) from the longitudinal household-based China Health and Nutrition Survey from 1993 to 2015. Trajectories of BMI, WC, systolic BP, and diastolic BP were fitted and compared between groups using linear mixed effect models. Early-life exposure to famine was associated with increased BMI, WC, and BP in 2 consecutive generations with sex and age disparities. In F1, famine was associated with increased BMI, WC, systolic BP, and diastolic BP, especially in men or those aged older than 50 years (
P
ranged from <0.001 to 0.02). In F2 men but not women, the parental exposure to famine was associated with 0.59 kg/m
2
([95% CI, 0.10–1.08],
P
=0.02)
increase in BMI. In F2 aged ≥25 years but not those younger ones, the parental exposure to famine was associated with increased BMI (0.83 kg/m
2
[0.14–1.51]
,
P
=0.03), systolic BP (2.04 mm Hg [0.20–3.88],
P
=0.03), and diastolic BP (1.73 mm Hg [0.28–3.18],
P
=0.02). The effects of an adverse developmental environment through famine in early life on BMI and BP later in life may persist beyond one generation.
Fetal and early life growth and body mass index from birth to early adulthood in 1958 British cohort: longitudinal study