Poor nutrition in utero, heavy child tomorrow?

Multiple studies have shown that either underfeeding or overfeeding the fetus during pregnancy can affect how a child's body will respond to food over a lifetime, increasing the risk for diabetes, heart disease and hypertension.

Pioneering research in the late 1980s by British physician David Barker showed that babies weighing 6 pounds or less are more likely to have an increased risk for heart disease, Type 2 diabetes and hypertension. It is the disparity between the prenatal environment and the nutritional environment after birth that appears to cause abnormalities in energy metabolism, endocrine functions and organ development.

Given the modern environment of preschoolers in Western countries -- marked by a lack of exercise, and diets high in calories, fat and sugar -- this disparity creates a problem, Barker and other researchers say.

"The fetus is reading the environment during development and is using that to predict what the environment will be once it's born," says Jerry Heindel, a fetal-programming expert at the National Institute of Environmental Health Sciences. "If the fetus gets poor nutrition, it will set itself up to be able to adjust to that. If it has poor nutrition during life, it will do quite well. But later in life, if nutrition changes and becomes like the food we're eating today, that is a mismatch, and that will increase the susceptibility to disease."

At a recent nutrition conference in Boston sponsored by Tufts University's Friedman School of Nutrition Science and Policy, the audience of nutritionists and nutrition researchers is rapt as Barker elaborates on this provocative message: Attempts to prevent such common chronic diseases as heart disease, stroke, high blood pressure and diabetes have largely failed because the origins of such diseases most likely begin in the womb.

"We were hoping and praying that we could fix chronic illness by fixing the diets of middle-age people," says Barker, an epidemiologist at the University of Southampton, United Kingdom, and Oregon Health & Science University. "But if we want to arrest the epidemic of chronic disease, we need to start early in life."

The idea has been slow to catch on.