Fetal origins of coronary heart disease

BMJ 1995;311:171-174 (15 July)

Education and debate

Fetal origins of coronary heart disease

D J P Barker, director ^a

^a MRC Environmental Epidemiology Unit, University of Southampton, Southampton SO16 6YD

The fetal origins hypothesis states that fetal undernutrition in middle to late gestation, which leads to disproportionate fetal growth, programmes later coronary heart disease. Animal studies have shown that undernutrition before birth programmes persisting changes in a range of metabolic, physiological, and structural parameters. Studies in humans have shown that men and women whose birth weights were at the lower end of the normal range, who were thin or short at birth, or who were small in relation to placental size have increased rates of coronary heart disease. We are beginning to understand something of the mechanisms underlying these associations. The programming of blood pressure, insulin responses to glucose, cholesterol metabolism, blood coagulation, and hormonal settings are all areas of active research.The BMJ's recent editorial on the fetal origins hypothesis statedthat it rests only on the "very general" proposition that fetalundernutrition causes coronary heart disease.¹ . . . [Full text of this article]

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