Fetal origins vs. Adult lifestyle--competing epidemiologies of chronic disease

What can we do? For a defined audience (or for each of a few defined audiences, e.g., policy makers, doctors, young women yet to be mothers, drug companies, epidemiologists, newspaper readers,...), explain the contrasting positions and their significance.

"Although the rise in ischaemic heart disease in England and Wales has been associated with increasing prosperity, mortality rates are highest in the least affluent areas… Ischaemic heart disease is strongly correlated with both neonatal and postneonatal mortality. It is suggested that poor nutrition in early life increases susceptibility to the effects of an affluent diet."
Barker & Osmond, The Lancet, 1986

"Although the customary explanation for the difference in people’s blood pressure is that they depend on the environment during adult life, the findings described [here] raise the possibility that the intrauterine environment has a dominant effect. Birth measurements are associated with adult blood pressure, independently of current body weight or alcohol consumption. Research into the adult environment and hypertension has focused on salt. A cross-cultural study in 52 centres [shows] a small effect compared to those associated with fetal growth… Adult body mass, however, is strongly correlated with blood pressure, and it remains to be seen whether this association reflects diet and other aspects of adult lifestyle which influence weight, or settings of hormonal output and metabolism which are programmed in utero."
Barker, Mothers, Babies, and Health in Later Life, 1998

"Over 500 delegates from around the world attended the First World Congress on Fetal Origins of Adult Disease in Mumbai, India, last month [Feb. 2001]. The meeting was jointly organized by the University's MRC Environmental Epidemiology Unit, Sneha-India, the Centre for the Study of Social Change, and the International Council for Research into the Fetal Origins of Adult Disease.

The Congress brought together scientists, clinicians, epidemiologists and public health specialists to share knowledge and plan future research and public health action. Poor nutrition of mothers-to-be in countries such as India may explain the steep rise in the incidence of heart disease and diabetes, when fetal undernutrition is followed by overweight in childhood and adult life.

Strong evidence was presented that many major adult diseases—from coronary heart disease to some forms of cancer and depression—have their origins in impaired growth before birth. Five scientists from the University of Southampton gave plenary lectures, while a further four convened free communication sessions.

In the final plenary session, chaired by Dr Eileen Kennedy from the US Department of Agriculture, representatives from UNICEF, the World Health Organisation, US National Institutes of Health, the British Heart Foundation and Medical Research Council discussed the implications for public health policy worldwide."

"The evidence reviewed here suggests that claims of a strong inverse association between birthweight and subsequent blood pressure may chiefly reflect the failure to take sufficient account of the impact of random error, the selective emphasis of particular results, and the inappropriate and inadequate adjustment for potential confounders. Since this association has been described previously as providing some of the strongest, and most consistent, support for the fetal origins hypothesis, it would seem prudent to subject other supporting evidence to similar critical appraisal."
Huxley, Neil, Collins, The Lancet, 2002

(original page by pjt)