In 1984 a British doctor noticed a curious relationship between the elevated
death rate among newborn babies in an impoverished region in the
1900s and a high incidence of heart disease in the same area decades
later. What piqued David Barkers interest was that neonatal
mortality is a sign of poverty, but heart disease is considered
an affliction brought on by an affluent, cholesterol-rich and
Perhaps, thought Dr Barker, the search for the causes of heart
disease should not just focus on adult proclivities to exercise
little, eat too much rich food and poison the body with nicotine
and alcohol. Perhaps it should begin much earlier, when a cluster
of tiny, nutrient-hungry cells begins the process of dividing
and subdividing to form a human being.
Thus began an epidemiological revolution that has profound implications
for our ageing world. "Advances in public health, better
nutrition and improved immunization mean that more babies survive
into adulthood," says Prakash Shetty, an FAO nutritionist.
"But we have compelling evidence to show that undernutrition
in the womb could sentence adults to a life of vulnerability to
diseases like heart disease, cancer, diabetes and obesity."
Ripe old age for some a rotten future for others
These are debilitating, chronic diseases that require much more
extensive health care systems than exist in developing countries.
Moreover, these diseases undermine a persons capacity to
work and a nations ability to create such systems. As Gro
Harlem Brundtland, head of the World Health Organization (WHO),
told the recent World Assembly on Ageing in Madrid, "While
the developed countries became rich before they became old, developing
countries will become old before they become rich."
If current trends continue, the Madrid conference heard, the world
will see a 300 percent increase in people over the age of 60 over
the next half-century -- outnumbering the worlds youth.
Most of these people will be concentrated in developed countries,
but developing nations will see the same or higher rates of increase
meaning that societies already weakened by poverty and
AIDS will be expected to bear the added burden of geriatric diseases
with fewer resources. "And fewer resources mean poorer foetal
nutrition, perpetuating this dangerous cycle," says Dr Shetty.
And it gets worse.
Rerouting the roadmap of life
"Undernutrition seems to affect the physiology of the growing
foetus, influencing its genetic blueprint," says Dr Shetty.
"The deleterious effect is not as clear-cut as, say, that
of smoking on foetal health, whereby toxins impede cell division
and growth. An undernourished foetus adapts to the environment
in the womb in a much more subtle way that affects the baby even
if it subsequently gains weight."
The relationship between low birth weight and high infant death
rates is well known. "Full-term babies who weigh below 2.5
kg at birth are much more likely to die within their first few
months than heavier babies," says Dr Shetty.
"But what is surprising is that foetal adaptations to gestational
conditions seem to be permanent. Even if a baby is born with adequate
weight, if it was significantly undernourished during gestation,
the damage may have already been done."
In the 1960s, researchers studying prenatal nutrition found that
a foetus deprived of nutrients early in gestation, but adequately
nourished later on, grew into an adult with an increased risk
of obesity. "It seems that they developed thrifty phenotypes,"
says Dr Shetty. "These geared the metabolism to conserve
every calorie and to direct available nutrients to the brain at
the expense of other organs. This also increases the risk of diabetes
in middle age."
These other organs include the liver, which has an important role
in regulating cholesterol, the heart and the kidneys. "Each
of these organs has a critical growth period," says Dr Shetty.
"If the foetus is starved of nutrients during that period,
its response is to slow the rate of cell division in that organ."
Developing countries face another demographic change that also
affects foetal nutrition urbanization. By the end of the
decade, more than half the worlds population will be living
in urban areas, most of them in developing countries, where they
will have to deal with changing diets.
"The rapidly expanding urban middle class in developing countries
is especially prone to chronic, degenerative diseases," says
Dr Shetty. "Its not just that they are eating more
Western food and smoking, but they are living long enough for
the dietary errors of the past to catch up with them."
These dietary errors are caused by maternal malnutrition. And
this is why FAO is working with WHO and the United Nations Childrens
Fund to promote better nutrition for pregnant women. "Its
an axiom of development to say that women are the linchpin of
sustainable growth," says Dr Shetty. "The research on
foetal undernutrition reinforces that message, because what hunger
does to a foetus will shackle the adult to ill-health for life."