Early Life Nutrition and Lifelong Health - Derbyshire Local Medical ...

BMA Board of ScienceChapter 2: Fetal nutrition: impact ondevelopment and later lifeHaving a nutritious diet during pregnancy helps to protect the mother’s health and to control herlevel of weight gain. Current UK recommendations for diet before and during pregnancy are givenin Appendix 3. The embryo and fetus receive all their nutrients directly from the mother; goodmaternal nutrition is therefore imperative for optimal prenatal development. Unbalanced nutritionwill also cause metabolic and hormonal changes in the mother. In animal models this can affectthe allocation of stem cells, embryonic and placental lineages, and have long-term effects onoffspring growth and health. In humans, maternal diet and body composition affect the growth ofthe early embryo making a focus on diet before pregnancy as important as that during pregnancy.Later in gestation, when fetal growth is maximal, undernutrition leads to a range of adaptiveresponses such as redistribution of blood flow in the fetal body and changes in the production offetal and placental hormones which control growth. 30 These responses may include changes inplacental transport function, an area of research about which we currently know relatively little. 31Even without changes in overall fetal body size, the growth of certain organs such as the heart andkidney can be altered. Thus even fetuses of normal birth size may have mounted adaptiveresponses to unbalanced nutrition and are therefore phenotypically altered. If the nutritionalchallenge is too great or too prolonged for these adaptive responses to cope, eventually slowing inoverall fetal body growth must result, leading to low birth weight. In late gestation this growthrestriction is likely to be asymmetrical, with the head being less affected than the body.Impact of fetal nutrition on health in later life: the developmentalorigins conceptThe developmental origins of disease concept has a long history. The seminal studies of Dorner andcolleagues linked pre- and postnatal nutrition to later risks of obesity, 32 arteriosclerosis 33 anddiabetes 34, 35 and Gennser et al showed that blood pressure was higher in men of low birthweight. 36 Forsdahl’s study of Norwegian populations showed that a poor childhood environmentwas associated with increased chronic adult disease, even if the person’s circumstances improved inlater years. 37 Similarly, Lucas had proposed that detrimental influences in early life may increase riskfor later disease. 38 The most well-known reports, however, are those from Barker and hiscolleagues in the 1980s, showing an association between low birth weight and risk of latercardiovascular disease in middle-aged men and women in the UK for whom detailed birth recordswere available. 39 These early papers from Barker and colleagues were followed by others showingthat low birth weight was not only associated with increased risk of death from cardiovasculardisease but of also hypertension, insulin resistance, type 2 diabetes, dyslipidaemia and centralobesity; in fact each of the criteria which define the metabolic syndrome. 40Key messageLow birth weight is associated with increased risk of death from cardiovascular disease,hypertension, insulin resistance, type 2 diabetes, dyslipidaemia and central obesity.Early life nutrition and lifelong health 15