Developmental Origins of Health and Disease: Who knows? Who cares?

Abstract

Developmental Origins of Health and Disease (DOHaD) considers the impact that the early life environment may have upon health and disease in later life. The most complete evidence within this field links birthweight with development of cardiovascular disease and type 2 diabetes in adulthood, with 10–20% higher risk of ischaemic heart disease and 19–30% higher risk of type 2 diabetes for every 1 kg lower birth weight.1, 2 As the combined burden of cardiovascular disease and diabetes accounts for 35% of all deaths worldwide,3 identification of risk factors, including those in early life, and the implementation of prevention and treatment strategies, is of clear relevance to public health. Health-care practitioners play crucial roles in the introduction of prevention and treatment strategies, and are well-placed to integrate early life risk factors into a life-span approach to healthcare. However, little is known about practitioners’ recognition of and attitudes towards DOHaD; essential for translating research into practice. Accordingly, we examined the existing knowledge, acceptance and opinion of DOHaD principles in a cross-sectional survey of Australian healthcare practitioners. We targeted healthcare professionals with an important impact upon the early life environment. General practitioners, physicians, midwives, pharmacists, and dietitians were recruited through newsletters or emails sent by their representative professional associations and invited to complete an online survey. Almost all (98%) of the 208 respondents believed there was a link between early exposure and long-term risk of non-communicable disease, however only 49% recognised the term ‘Developmental Origins of Health and Disease’ or common synonyms. The association of birth weight with cardiovascular disease and type 2 diabetes was recognised by 57% and 82% of respondents, respectively. Fifty-one percent are giving professional advice regarding prevention of non-communicable disease related to early life exposure monthly or more frequently, despite only 25% describing themselves as confident when giving such advice. The vast majority (91%) would be comfortable recommending potential prevention strategies to reduce non-communicable disease related to early life exposure, with lifestyle modification and dietary supplements being the most frequently cited examples. Pregnant women and women planning pregnancy were the most frequently cited target groups for such prevention strategies. Our findings indicate that despite poor name recognition and knowledge of a specific key association, the general concepts of DOHaD are widely accepted by healthcare practitioners in Australia. This suggests that knowledge transfer may be required to facilitate the introduction of evidence-based targeted prevention and treatment strategies.