Developmental origins of health and disease
Sub-optimal nutrition during foetal and infant development is associated with an increased risk of non-communicable diseases (NCDs) in adult life. Animal experiments show that this results from permanent effects on the structure and function of tissues and hormone systems (‘metabolic programming’), probably mediated by epigenetic changes. NCD risk is increased further by adiposity and/or unhealthy lifestyles in childhood or adulthood. Apart from nutrition, other early life environmental influences can programme later disease, including foetal ‘over-nutrition’ (maternal diabetes or obesity) and exposure to maternal smoking, environmental pollutants, and pregnancy complications. The concept that improving the nutrition and health of mothers pre-conceptionally and during pregnancy could prevent common NCDs has huge public health implications. However, unlike the robust demonstration of programming in experimental animals, the evidence in humans rests mainly on observational research. Intervention studies are ongoing to strengthen the evidence and to identify ways to improve early development and prevent NCDs.