Literature review for - Flourish Paediatrics

These adaptations permanently ‘re-program’ the physiology of the body. Influences on foetal
programming include the mother’s body composition before, during and after pregnancy; diet during
pregnancy; and postnatal nutrition and growth. The documentation of epigenetic mechanisms and their
testing on animal models has increased understanding of these aetiological factors (Weaver,
2009)(Bruce and Hanson 2010; Groom, Elliott et al. 2010). These studies demonstrate that an
epigenetic state of a gene can be established through early in life experience, and is potentially
reversible in adult life. The epigenetic modifications in response to environmental influences may ensure
stable yet dynamic regulation that mediates persistent changes in phenotype over the lifespan. (Weaver
2009)
The gradual understanding of epigenetic, biochemical and endocrine mechanisms has added to the body
of evidence. The challenge is to discover more about the cellular and molecular mechanisms giving rise
to these associations. But, while the mechanisms are not yet fully understood, it is not too early to begin
to apply the findings to public health interventions. Evaluation of appropriate interventions could expand
our knowledge of the mechanisms involved.
One interesting aspect of the foetal origins hypothesis is its ability to explain differences in the
prevalence and timing of chronic disease epidemics in different countries. For some time
epidemiologists have been puzzled by the ‘French paradox’, whereby mortality from ischaemic heart
disease in France is about a quarter of that in Britain but the major risk factors are similar. It is thought
that under-certification of ischaemic heart disease in France could account for about 20 per cent of the
difference and that the high consumption of alcohol in France—and of red wine in particular—could
explain a small amount of the difference. However, Barker has reviewed the development of maternal
nutrition programs in the two countries and suggests that the earlier concern of the French with
improving nutrition has protected them from this chronic disease epidemic. 1
Optimising the trajectory of growth for long term outcomes
There have now been a number of direct studies of breastfeeding and health outcomes and long term
health (Horta, Bahl et al. 2007; Ip, Chung et al. 2007). On this basis it appears that breastfeeding
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