Getting to the roots: early life intervention and adult health.

Abstract

Many adverse life outcomes have been shown to have their roots in the earliest years of life. Chronic diseases, including cardiovascular disease, diabetes, depression, and substance abuse, as well as life skills, such as educational and vocational attainment and the ability to form meaningful relationships, are all made more or less likely depending on the quality of in utero and early childhood experiences (1). Giventheenormityoftheseissuesinthelivesofindividuals as well as the costs to society when they go awry, as they frequently do, it is imperative that their common early life roots be understood and that successful interventions be developed, tested, and widely disseminated with adaptations for populations with different backgrounds and risk factors. The evidence is now clear that adverse early life exposures increase disease risk, not only through an increase in unhealthy behaviors, but alsothrough mechanisms intimately tied to physiologic regulation and brain development (2). Landmark research such as the Adverse Childhood Experiences Study and the Dunedin Multidisciplinary Health and Development Study have shown that childhood abuse and neglect are associated with increased risk in adulthood for conditions as diverse as cardiovascular disease, obesity, depression,substanceabuse,andsmoking(3,4).Theseandother studies have shown that childhood poverty, maternal stress during pregnancy, poor maternal-child attachment, and inadequate access to quality nutrition in the in utero and early childhood periods all convey increased risk for later disease (1, 5, 6). Scientific advances are elucidating the physiological, developmental, and epigenetic programming of early life experiences and the mechanisms by which they contribute to adult conditions decades later (6, 7). Given the strong science linking early life exposures and adverse adult outcomes, attention has been turning to developing and studying interventions that may prevent or at least reduce early life adversities. Because of the long lag time between early life exposures and adverse adult outcomes, it is necessary to look at interventions that were done longenoughagotodeterminewhetherareductionindisease