Siân Robinson

MRC Lifecourse Epidemiology Unit

University of Southampton

An introduction to early life and

later disease

Early life and later disease

history – back to the 1980s and beyond

inequalities in health

early experience: insights from epidemiological

studies: prenatal life

early experience: insights from epidemiological

studies: infancy & early childhood

taking a lifecourse approach: ‘memories’ of early life

and mechanisms

relevance for today?

Background: 1980s

cardiovascular disease (coronary heart disease and

stroke) leading causes of death in UK

distribution and time trends

Background: 1980s

Standardised CHD mortality rates1970-89 in European countries (Committee on

Medical Aspects of Food Policy, Nutritional Aspects of Cardiovascular Disease, 1994)

Standardised mortality ratios for coronary heart disease

among men aged 35-74 (1968-78)

medium

low

high

Barker DJP (1998) Mothers babies and health in later life

Coronary heart disease mortality (1979-83) for men

in England & Wales, according to social class

0

50

100

150

200

250

300

350

I II IIIN IIIM IV V

Standardised

Mortality

Rate

coronary heart disease

Early life and later disease

a role of events earlier in the lifecourse?

could cardiovascular disease be linked to adverse

influences in childood?

effects of growing up in poverty?

Correlation between current mortality rate for heart

disease in Norwegian counties (1964-67) in men,

and past infant mortality rates (1896-25)

Infant mortality 1896-1925 Forsdahl A. Br J Prev Soc Med. 1977;31: 91

Death

s fro

m a

rteri

oscle

roti

c

heart

dis

ease/100,0

00 p

er

year

Infant mortality

(1901-10)

medium

high

low

Barker DJP (1998) Mothers babies and health in later life

infant mortality per 1000 births 1921-25

Standardised mortality ratios for coronary heart

disease in men during 1968 - 78 and infant mortality

rate during 1921-25 in England and Wales

Barker DJP & Osmond C (1986) JECH 40:37

The Hertfordshire Cohort Study 1911-1948

Int J Epidemiol 2012;41:386-9.

Standardised mortality ratios for coronary heart disease

below 65 years, according to birthweight (Hertfordshire)

Osmond et al BMJ 1993;307:1519

Birthweight (pounds)

0

20

40

60

80

100

-5.5 -6.5 -7.5 -8.5 -9.5 >10

0

20

40

60

80

100

-5.5 -6.5 -7.5 -8.5 -9.5 >10

10141 men 5585 women

- -

Cumulative incidence of coronary artery disease in men and

women born before the Dutch Hunger Winter famine, exposed

in early, mid or late gestation, or conceived after the famine

Painter et al. Am J Clin Nutr 2006;84:322

Risk of coronary heart disease in men, according to

ponderal index at birth: Helsinki cohort 1924-33

0

0.5

1

1.5

2

2.5

-25 -27 -29 >29

hazard

ratio

ponderal index kg/m3

Eriksson et al BMJ 1999;318:427

Early life and later disease

prenatal vs postnatal experience?

0.2

-0.3

-0.2

-0.1

0

0.1

Age (months)

0 6 12 18 2 4 6 8 10

Height

BMI

Weight

Age (years)

Cohort

z-score

Barker et al (2005) NEJM 353:17

Growth of boys who later developed coronary heart

disease: Helsinki cohort 1934-44

Programming

‘an event at a critical time in development,

which permanently alters structure and

function’

Lucas 1991

Casein content of maternal diet

SBP

mmHg

Systolic blood pressure of female offspring of rats fed

diets of differing protein content during pregnancy

* *

*

Langley & Jackson (1994) Clin Sci 86: 217-22

Widdowson & McCance (1963) Proc Roy Soc Lond B 158: 329-42

Widdowson & McCance (1963) Proc Roy Soc Lond B 158: 329-42

Brain growth spurt: ‘ a period of enhanced vulnerability

to nutritional and other growth restriction’

Early Human Development1979;311: 79

Epigenetics

Two main components of the

epigenetic code – DNA

methylation and histone

modification.

These processes can affect

gene expression, and hence

development and phenotypic

characteristics,

without altering

the genomic DNA

code itself.

Early life and later disease

relevant today?

Findings from the Southampton Women’s Survey

1 family in 5 was food insecure

young children growing up in food

insecure homes had poorer diets – characterised by

greater consumption of refined cereals, processed

meat, chips, crisps and soft drinks – and lower

consumption of wholegrain cereals and vegetables

dietary patterns ‘track’ from mother to child –

and throughout childhood

Pilgrim et al J Epidemiol Community Health 2012;66:e6

‘The life-course

approach suggests that

many of the risk and

protective

factors that influence

health and wellbeing

across the lifespan also

play an important

role in birth outcomes

and in health and

quality of life beyond

the initial years’

‘The future health and wellbeing

of the UK is linked to how

successfully we manage the

health and wellbeing of today’s

children’.

BMA Board of Science May 2013