Fetal growth and later diseaseEpidemiological evidence gathered over the past 15 yearshas shown that impaired fetal growth affects susceptibilityto cardiovascular disease and type II diabetes in adult life.Across a wide variety of populations, lower birth weight,and thinness at birth, is associated with an increased risk ofdevelopment of these conditions. These associations areevident within the normal range of birth weight, and are notexplained by effects of extreme growth retardation, bydifferences in gestational age at birth, or by differences inadult lifestyle [1].Interaction of fetal with postnatal experiencein influencing disease risk in adult lifeIn recent studies of individuals whose postnatal growth wasdescribed in detail, the effects of poor fetal growth on laterdisease have been shown to be compounded by continuedpoor growth in infancy, but followed by rapid weight gainin childhood. Amongst Finnish men and women, anincreased risk of coronary heart disease was seen in thosewho were thin at birth and in infancy, but who gainedweight rapidly after the age of 2 years [3].The influence of different pathways of growth on laterhealth has also been described in a study of young Indianadults [4]. The pattern of growth associated with impairedglucose tolerance or diabetes in adult life was characterisedby thinness between birth and the age of 2 years, but fol-lowed by rapid weight gain in childhood and a relativelyhigh body mass index at the age of 12 years.The significance of a single measure of BMI, or of beingoverweight, at any age, in relation to cardiovascular diseaseand impaired glucose tolerance, therefore differs accordingto earlier pathways of growth—and some individuals maybe more vulnerable to the effects of excess body weight asa result of their early experience.Vulnerability to stressors in adult lifeFollow-up of individuals who differ according to theirpathways of fetal and postnatal growth has provided evi-dence that responses, and therefore vulnerability, to theeffects of adverse influences in adult life are conditioned byearly growth. For example, in the American nurses’ healthstudy, the highest risk of coronary heart disease was foundamong women who had low birth weight but who had ahigh body mass index as adults [7].Among a group of Finnish men born between 1934–1944, low income was associated with increased rates ofcoronary heart disease as would be expected [2]. However,the association differed according to thinness at birth,defined by the ponderal index (birth weight/length