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Developmental origins of health and disease: reducing the burden of chronic disease in the next generation

DOI: 10.1186/gm135

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The concept of developmental origins of health and disease is predicated upon the assumption that environmental factors acting early in life (usually in fetal life) have profound effects on vulnerability to disease later in life, often in adulthood. The range of experimental, clinical and epidemiological data linking conditions in early life to later health is now overwhelming [1]. Initially, the focus was on a small fraction of children -those who were born small - but it is now clear that the environment impacts on the development of every child [2]. Observations and experimental approaches have generally considered nutritional changes or, classically, alterations in glucocorticosteroid exposure, reflecting the critical maturational events linked to such events. Indeed, the placenta is in a critical position to cause or modify such challenges by altering nutritional transport functions or the pattern and nature of endocrine signals impacting the fetus. Nor does the story end at birth, because epigenetic development can be influenced by how the infant is fed, and perhaps how its gut is colonized with commensal bacteria.Yet there has been considerable resistance to these ideas. Medicine is replete with reductionist biomedical thinking and this has, in some ways, limited not only our understanding but also our ability to address the challenge of some contemporary health problems. Nowhere is this clearer than in the outcomes of genome-wide association studies where, despite substantial investment, only a relatively small proportion of risk of common non-communicable diseases (NCDs) - such as cardiovascular disease and diabetes - is explained [3]. The economic and humanitarian costs of NCDs are enormous in both the developed and the developing world, and indeed they may destabilize the economies of low-income countries where recent data show that risk markers for these diseases become evident early in the process of socioeconomic improvement, and well below the level o


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