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Good fetal growth and resilience to poor living standards
Men who have high rates of growth in utero can withstand the negative
effects of low socioeconomic status and low income on coronary heart
disease. Conversely men who were thin at birth are vulnerable,
especially if they experienced rapid weight gain during childhood. It
has already been established that people who grow slowly in utero and
during infancy remain biologically different to other people and are at
increased risk of coronary heart disease. This further study by Barker
and colleagues (p 1273) examined detailed growth and socioeconomic data
from Finland to add to our knowledge of the effects of early
development on later health.
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Follow up data on outcome in children who were born premature and
required time in neonatal intensive care are difficult to obtain. Such
data are important so the impact of medical interventions in early life
on the later health of children can be assessed. In a study by Field
and colleagues of two methods of obtaining such data
either from
parents or from documents generated after routine clinical
contactsneither approach offered an instant solution (p 1276). Both
methods, however, had potential for improvement. The usefulness of
existing surveillance data could be greatly enhanced by the
introduction of a standardised approach to data collection and
recording. Without such steps clinical governance and service
development relating to perinatal care will continue to rely on
inappropriate measures of outcome.
A long term follow up study has thrown doubt on the assumption that fat
children become fat adults. Wright and colleagues (p 1280) followed up
412 members of a 1947 birth cohort until the age of 50. Although
children with high body mass index aged 9 were more likely to have high
body mass index as adults, they did not have higher percentage body
fat. This suggests that it may be build that tracks to adulthood rather
than obesity. Teenagers with a high body mass index at 13 were twice as
likely to have a high body mass index as adults but did not have higher
risk factors for disease. For every level of adult fatness, those
thinnest in childhood tended to have the highest risk. Being a thin
child and obese adult seems to be the worst
combination.
The finding in a free living population of a measurable independent
relation between eating frequency and lipid concentrations shows that
we need to consider not only what we eat but how often we eat. In men
and women in the EPIC-Norfolk cohort, concentrations of total
cholesterol and low density lipoprotein cholesterol were inversely
related to eating frequency despite higher intakes of energy and
nutrients in people eating more frequently. Titan et al (p 1286) found
that this association remained after adjustment for these and other
possible confounding factors, including obesity, alcohol intake,
cigarette smoking, and physical activity.
Infertility clinics are generally biased against patients infected with
HIV, with under half of units in the UK saying that they would treat a
couple when only the man was infected with HIV. In this situation sperm
washing and donor insemination is safe. For couples who are both
infected with HIV, prescribing the mother antiretroviral drugs during
pregnancy and labour, having a caesarean section, avoiding breast
feeding and the child receiving antiretroviral therapy can reduce the
risk of the virus being transmitted to the child. Apoola and colleagues
(p 1285) sent a questionnaire to all British clinics offering such
techniques and found that 72% had a policy on treating patients
infected with HIV.
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