David Barker, of the University of Southampton, England, was among the first to argue that impaired fetal growth is an important contributor to coronary heart disease and its metabolic precursors. In the original formulation of the hypothesis, maternal malnutrition in pregnancy was the underlying determinant of suboptimal birth size, and Barker hypothesized that the effect of prenatal malnutrition was trimesterspecific, producing different later metabolic consequences depending on when in pregnancy nutrition was impaired. Small size at age 1 year was also found to be associated with later coronary heart disease, implying a causal role in heart disease of both infant and fetal malnutrition. Barker and his colleagues made ingenious use of several old databases, most notably the records of birthweights and infant weights collected during ...

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