The Developmental Origins of Health and Disease

Abstract

The concept of a 'fetal origins of adult disease' (FOAD) or 'fetal programming' was developed by Barker and colleagues to describe the relationship between birth size and subsequent risks of cardiovascular disease and insulin resistance/Type 2 diabetes mellitus. As a concept, FOAD was initially received with criticism. Some held the view that the answers lay within genetics and the gene; for others that the original epidemiological interpre- tations were flawed. It is now nearly two decades since these landmark observations and concepts first appeared. It is apparent that those original findings have had far-reaching implications regarding human health and lifestyle choices, not only explaining the rapid societal rise in diabetes and obesity, but also covering areas as diverse as osteoporosis, depression and sedentary behaviour. With the wisdom of hindsight, we can see that some of the reluctance to accept the FOAD concept arose precisely from the problem which FOAD addressed: namely that the underlying causes of the common chronic diseases of adulthood (heart disease, diabetes, stroke) could not be explained purely in terms of genetic inheritance or lifestyle factors, such as diet or exercise. That instead, gene-environment interactions would hold the clues. The concept of FOAD has expanded since the initial observations. The term Tetal origins of adult disease' has now been replaced with 'developmental origins of adult disease' (DOHaD) to take into account its influence over an expanded developmental time-frame. Moreover, it has launched a new way of thinking about the evolution of human health and disease, which we refer to as the 'predictive adaptive response' and will be discussed further.