Objectives Although early-life nutritional deprivation has been linked to multiple chronic conditions in adulthood, its relationship with frailty remains insufficiently explored. This study aimed to investigate whether exposure to the Chinese Great Famine during critical developmental stages is associated with an increased risk of frailty among middle-aged and older adults.Methods This cross-sectional study included 6,021 participants aged 45 years and above from the 2011 wave of the China Health and Retirement Longitudinal Study (CHARLS). Participants were categorized into exposure groups according to birth cohorts corresponding to different stages of famine exposure. Frailty was assessed using a deficit accumulation index constructed from 32 health variables. Multivariable logistic regression models were employed to evaluate associations between famine exposure and frailty after adjusting for demographic, socioeconomic, and health-related covariates. Stratified analyses were further conducted by sex and regional famine severity.Results The prevalence of frailty showed a stepwise increase across exposure categories. After controlling for potential confounders, individuals exposed to famine during fetal and early childhood periods had significantly higher odds of frailty compared with those unexposed. The association was more pronounced among women and in regions that experienced severe famine. In contrast, the association was weaker and less consistent among men and in less severely affected areas.Conclusions Exposure to severe nutritional deprivation during early life is associated with an elevated risk of frailty in later life, particularly among women. These findings provide further evidence supporting the long-term impact of early-life conditions on aging-related health outcomes.