Long Term Implications for Adult Health

Abstract

Recent research suggests that a number of the major diseases of later life, including coronary heart disease, hypertension and non-insulin-dependent diabetes, originate through restriction of intrauterine growth and development. These diseases may be consequences of “programming”, whereby a stimulus or insult at a critical, sensitive period of early life has permanent effects on body size and proportions, and on a range of physiological processes. Evidence that coronary heart disease, hypertension and diabetes are programmed came from longitudinal studies of men and women in which size at birth was related to the occurrence of the disease in middle age. People who were small or disproportionate (thin or short) at birth had high rates of coronary heart disease, raised blood pressure and cholesterol levels, and abnormal glucose-insulin metabolism. Constraint of intrauterine growth and development seems to be widespread in the population, affecting many babies whose birthweights are within the normal range. Although the influences that impair fetal development and programme adult cardio-vascular disease remain to be defined, there are strong pointers to the importance of the maternoplacental capacity to satisfy the fetal nutrient requirement. Maternal nutrition can exert important effects on both the fetal nutrient demand and the maternoplacental supply capacity and may have hitherto unrecognised effects on both intrauterine development and health in later adult life.