BMJ 2001;323:1273 ( 1 December )

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Size at birth and resilience to effects of poor living conditions in adult life: longitudinal study

D J P Barker, director, ^a T Forsén, research fellow, ^b A Uutela, head of laboratory, ^b C Osmond, statistician, ^a J G Eriksson, senior researcher. ^b

^a Medical Research Council Environmental Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, ^b National Public Health Institute, Department of Epidemiology and Health Promotion, Mannerheimintie 166, FIN-00300 Helsinki, Finland

Correspondence to: D J P Barker djpb{at}mrc.soton.ac.uk

Objective: To determine whether men who grew slowly in utero or during infancy are more vulnerable to the later effects of poor living conditions on coronary heart disease.
Design: Follow up study of men for whom there were data on body size at birth and growth and social class during childhood, educational level, and social class and income in adult life.
Setting: Helsinki, Finland.
Participants: 3676 men who were born during 1934-44, attended child welfare clinics in Helsinki, were still resident in Finland in 1971, and for whom data from the 1980 census were available.
Main outcome measures: Hospital admission for or death from coronary heart disease.
Results: Men who had low social class or low household income in adult life had increased rates of coronary heart disease. The hazard ratio among men with the lowest annual income (<£8400) was 1.71 (95% confidence interval 1.18 to 2.48) compared with 1.00 in men with incomes above £15 700. These effects were stronger in men who were thin at birth (ponderal index <26 kg/m³): hazard ratio 2.58 (1.45 to 4.60) for men with lowest annual income. Among the men who were thin at birth the effects of low social class were greater in those who had accelerated weight gain between ages 1 and 12 years. Low social class in childhood further increased risk of disease, partly because it was associated with poor growth during infancy. Low educational attainment was associated with increased risk, and low income had no effect once this was taken into account.
Conclusion: Men who grow slowly in utero remain biologically different to other men. They are more vulnerable to the effects of low socioeconomic status and low income on coronary heart disease.

What is already known on this topic People who grow slowly in utero and during infancy remain biologically different through their lives Such people are at increased risk of coronary heart disease What this study adds Among men who were thin at birth the risk of coronary heart disease is further increased if they have poor living standards in adult life Other men tend to be resilient to the adverse effects of poor living standards

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