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Events before birth remain important, but we need to consider later modifiers too
E pidemiological studies have largely contributed to our understanding of the natural history of coronary heart disease. Although clinical manifestations of the disease usually become evident in adult life, early signs are recognisable in childhood. The discovery that individuals who develop coronary heart disease grow differently during early life has led to the recognition of new developmental models for the disease. In 1995 David Barker wrote: "The fetal origins hypothesis states that fetal undernutrition in middle to late gestation, which leads to disproportionate fetal growth, programmes later coronary heart disease." 1 Now, 10 years later, the importance of events before birth for lifetime health has been confirmed in many populations. 2 â[euro]" 4 In humans, birth size serves as a marker of the intrauterine environment. Considering that birth size is just one snapshot of the trajectory of fetal growth it is fascinating that long term health outcomes are predicted by the body size of the newborn.
The association between birth size and cardiovascular morbidity is largely modified by growth later in life. The highest risk of coronary heart disease is seen among individuals who were born small and became heavier during childhood. 4 â[euro]" 6 Most previous studies have been done in males but in this issue we have a paper based on findings from the nurses' health study following up over 66 000 female nurses. 7 This study confirms the inverse associations between birth weight and risk of cardiovascular disease in women. Risk of coronary heart disease was highest among women who were smaller at birth and who grew up to be heavier adults. The risk of...