QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Barker, D. J. P. Search for Related Content PubMed Articles by Barker, D. J. P.

---

Symposium: Novel Concepts in the Developmental Origins of Adult Health and Disease

Introduction: The Window of Opportunity^1,2

University of Southampton, Southampton SO16 5YA, UK and Oregon Health and Science University, Portland, OR 97229

^* To whom correspondence should be addressed. E-mail: david{at}barkertheory.com.

The United Nations Standing Committee on Nutrition recently stated that "while undernutrition kills in early life, it also leads to a high risk of disease and death later in life. This double burden of malnutrition has common causes, inadequate fetal and infant and young child nutrition followed by exposure (including through marketing practices) to unhealthy energy dense nutrient poor foods and lack of physical activity. The window of opportunity lies from pre-pregnancy to around 24 mo of a child's age."

Figure 1 illustrates the kind of epidemiological data on which this important conclusion is based. The data come from a follow-up study of 4630 boys and 4130 girls who were born in Helsinki during 1934–1944 (1). The figure shows the growth of those boys and girls who later developed coronary heart disease. It includes mean height, weight, and body mass index (weight/height²) at each month from birth to 2 y of age and at each year from 2 to 11 y of age. The mean value for each measurement among all the children is set at zero, with deviations from the mean expressed as standard deviations (z-scores). Children maintaining a steady position as tall or short and fat or thin in relation to other children would follow a horizontal path on the figure.

View larger version (17K): [in this window] [in a new window]   Figure 1  Mean z scores for height, weight, and body mass index in the first 11 y after birth among boys and girls who had coronary heart disease as adults. The mean values for all boys and all girls are set at zero, with deviations from the mean expressed as standard deviations (z scores).

Low birth weight is now known to be associated with a range of chronic diseases, including stroke, hypertension, and type 2 diabetes. The Helsinki studies allow us to quantify the strength of these effects. For example, if each person in the cohort had been in the highest third of birth weight (above 8 lb or 3.6 kg) and had lowered their z-score for body mass index between 2 and 11 y, the incidence of type 2 diabetes would have been halved (2). We are beginning to understand the processes by which early growth, during what the UN calls the "window of opportunity," establishes chronic disease risk. For example the path of growth shown in Fig. 1 leads to a body composition with low muscle but high fat, which is associated with insulin resistance (1). Muscle has a critical period of development before birth and during the first 6 mo afterwards. Failure of growth at this time is associated with a life-long reduction in muscle. All organs and systems of the body have critical windows of time in which they develop. Failure of development at this time leads to persisting impairment.

The prediction of chronic disease by paths of early growth reflects the phenomenon of developmental plasticity. This is defined as the ability of a single genotype, all the genes acquired at conception, to produce more than 1 alternative form of structure, physiological state, and behavior in response to environmental conditions. The association between low birth weight and increased risk of chronic disease extends across the range of birth weights, so that the 7-lb baby is at a lower risk than the 6-lb baby, and the 8-lb baby is at lower risk than the 7-lb baby. This implies that what are regarded as normal variations in the supply of nutrients from normal healthy mothers to normal healthy babies have profound long-term effects.

The National Institute of Child Health Strategic Plan for 2005–2010 states that "coronary heart disease, the number one cause of death among men and women, is more closely related to low birth weight than to known behavioral risk factors. Thus a significant portion of the disease burden borne by adults may have roots in antenatal nutrition and in poor transgenerational maternal health history."

	FOOTNOTES

 
¹ Presented as part of the symposium "Novel Concepts in the Developmental Origins of Adult Health and Disease" given at the 2006 Experimental Biology meeting on April 2, 2006, San Francisco, CA. The symposium was sponsored by the American Society for Nutrition and the Danone Institute International. This supplement is the responsibility of the Guest Editors to whom the Editor of The Journal of Nutrition has delegated supervision of both technical conformity to the published regulations of The Journal of Nutrition and general oversight of the scientific merit of each article. The opinions expressed in this publication are those of the authors and are not attributable to the sponsors or the publisher, Editor, or Editorial Board of The Journal of Nutrition. The Guest Editors for the symposium publication are Dennis Bier, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates St., Houston, TX 77030 and Emanuel Lebenthal, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel.

² Supported by the Northwest Foundation.

	LITERATURE CITED

TOP LITERATURE CITED

 

1. Barker DJP, Osmond C, Forsén TJ, Kajantie E, Eriksson JG. Trajectories of growth among children who have coronary events as adults. N Engl J Med. 2005;353:1802–9.[Abstract/Free Full Text]

2. Barker DJP, Eriksson JG, Forsén T, Osmond C. Fetal origins of adult disease: Strength of effects and biological basis. Int J Epidemiol. 2002;31:1235–9.[Abstract/Free Full Text]

This article has been cited by other articles:

				F. Mardones, L. Villarroel, L. Karzulovic, S. Barja, P. Arnaiz, M. Taibo, and F. Mardones-Restat Association of perinatal factors and obesity in 6- to 8-year-old Chilean children Int. J. Epidemiol., August 1, 2008; 37(4): 902 - 910. [Abstract] [Full Text] [PDF]

This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Barker, D. J. P. Search for Related Content PubMed Articles by Barker, D. J. P.