Diet, Nutrition and Modulation of Genomic Expression in Fetal Origins of Adult Disease

The greatest burden of ill-health for adults in most societies relates to disorders of the cardiovascular system and to cancers [1]. These diseases are caused by lifestyle choices in which poor diet and relatively low levels of activity play a major role [1]. There is a large body of literature which shows that environmental exposures, including nutrition, play a significant role in the etiology of the disease, but there is variable susceptibility amongst individuals exposed to seemingly similar risk factors or environments. Cancer is a condition which results from a derangement in the cellular processes which regulate cell division, terminal differentiation and apoptosis, with damage to the genetic material of the cell being central. Exposures which lead to these derangements usually precede the appearance of the clinical disease by a prolonged period of time, often several decades [2]. While gene mutation has a role in the etiology of cancer, there is increasing evidence showing that epigenetic processes such as DNA methylation and covalent modification to histones are also involved [3]. Epigenetic changes of this kind represent potential for altered gene activity, and hence cellular dysregulation. However, the underlying propensity may only be manifest when the gene is exposed to an appropriate environmental signal with the direction of the response and nature of the cellular dysregulation a function of the specific epigenetic change [4, 5]. It has been known for many years that exposure of the individual to nutritional and other environmental challenges during critical periods of early development can markedly affect later size, shape, structure, function and behavior. However, Barker et al. [6] were the first to provide clear evidence that there might also be a direct link between early nutritional exposure and risk of chronic disease, building the evidence that is supportive of a causal association [6, 7]. In this they have refined a new conceptual approach to the way in which we consider the evolution of this group of diseases based upon a new developmental model, the so called ‘fetal origins hypothesis’. Based initially on ecological observations and later on retrospective cohort studies, there is now a considerable body of epidemiological and experimental data that supports the hypothesis. In the earlier observations, the size and shape of the baby at birth was shown to be related to the risk during adult life of coronary heart disease, hypertension, stroke, type 2 diabetes, obesity and some cancers [6]. These relations were shown to be graded across the usual range of birth weights seen in the population and not a special feature of very high or very low birth weight, indicating that they might be a consequence of the usual range of exposure found within a population [4, 7]. The results have been reproduced across a number of populations, and although there may be some debate around the details, the general principal appears to apply widely [4, 6, 7].