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Biomedical subjects

D J Barker

Publications and source records attributed to D J Barker.

At least 163 records · Page 9Linked to original sources
PubMed1992

The fetal origins of adult hypertension.

AIM: To elucidate the fetal origins of hypertension. METHODS: A systematic search was made for records of early growth, comprising measurements taken either at birth and/or during infancy, for groups of men and women now in middle-late life. Over 25,000 men and women born before 1931 were successfully traced. RESULTS: Retarded growth in fetal life was strongly related to high blood pressure in adult life. CONCLUSION: Hypertension is programmed by an adverse environment in utero. It is linked to impaired development in both early and late gestation.

Aged↗
PubMed1991

Fetal and infant growth and impaired glucose tolerance at age 64.

OBJECTIVE: To discover whether reduced fetal and infant growth is associated with non-insulin dependent diabetes and impaired glucose tolerance in adult life. DESIGN: Follow up study of men born during 1920-30 whose birth weights and weights at 1 year were known. SETTING: Hertfordshire, England. SUBJECTS: 468 men born in east Hertfordshire and still living there. MAIN OUTCOME MEASURES: Fasting plasma glucose, insulin, proinsulin, and 32-33 split pro-insulin concentrations and plasma glucose and insulin concentrations 30 and 120 minutes after a 75 g glucose drink. RESULTS: 93 men had impaired glucose tolerance or hitherto undiagnosed diabetes. They had had a lower mean birth weight and a lower weight at 1 year. The proportion of men with impaired glucose tolerance fell progressively from 26% (6/23) among those who had weighted 18 lb (8.16 kg) or less at 1 year to 13% (3/24) among those who had weighed 27 lb (12.25 kg) or more. Corresponding figures for diabetes were 17% (4/23) and nil (0/24). Plasma glucose concentrations at 30 and 120 minutes fell with increasing birth weight and weight at 1 year. Plasma 32-33 split proinsulin concentration fell with increasing weight at 1 year. All these trends were significant and independent of current body mass. Blood pressure was inversely related to birth weight and strongly related to plasma glucose and 32-33 split proinsulin concentrations. CONCLUSIONS: Reduced growth in early life is strongly linked with impaired glucose tolerance and non-insulin dependent diabetes. Reduced early growth is also related to a raised plasma concentration of 32-33 split proinsulin, which is interpreted as a sign of beta cell dysfunction. Reduced intrauterine growth is linked with high blood pressure, which may explain the association between hypertension and impaired glucose tolerance.

Aged↗
PubMed1991

Relation of birth weight and childhood respiratory infection to adult lung function and death from chronic obstructive airways disease.

OBJECTIVE: To examine whether birth weight, infant weight, and childhood respiratory infection are associated with adult lung function and death from chronic obstructive airways disease. DESIGN: Follow up study of men born during 1911-30 whose birth weights, weights at 1 year, and childhood illnesses were recorded at the time by health visitors. SETTING: Hertfordshire, England. SUBJECTS: 5718 men born in the county during 1911-30 and a subgroup of 825 men born in the county during 1920-30 and still living there. MAIN OUTCOME MEASURES: Death from chronic obstructive airways disease, mean forced expiratory volume in one second (FEV1) and forced vital capacity (FVC), and respiratory symptoms. RESULTS: 55 men died of chronic obstructive airways disease. Death rates fell with increasing birth weight and weight at 1 year. Mean FEV1 at age 59 to 70 years, adjusted for height and age, rose by 0.06 litre (95% confidence interval 0.02 to 0.09) with each pound (450 g) increase in birth weight, independently of smoking habit and social class. Bronchitis or pneumonia in infancy was associated with a 0.17 litre (0.02 to 0.32) reduction in adult FEV1 and with an increased odds ratio of wheezing and persistent sputum production in adult life independently of birth weight, smoking habit, and social class. Whooping cough in infancy was associated with a 0.22 litre (0.02 to 0.42) reduction in adult FEV1. CONCLUSIONS: Lower birth weight was associated with worse adult lung function. Intrauterine influences which retard fetal weight gain may irrecoverably constrain the growth of the airways. Bronchitis, pneumonia, or whooping cough in infancy further reduced adult lung function. They also retarded infant weight gain. Consistent with this, death from chronic obstructive airways disease in adult life was associated with lower birth weight and weight at 1 year. Promoting lung growth in fetuses and infants and reducing the incidence of lower respiratory tract infection in infancy may reduce the incidence of chronic obstructive airways disease in the next generation.

Adult↗
PubMed1991

The intrauterine environment and adult cardiovascular disease.

Two recent findings suggest that maternal nutrition, and fetal and infant growth, have an important effect on the risk of cardiovascular disease in adult life. (1) Among 5225 men who were born in Hertfordshire, England during 1911-1930 and who were breast fed, those who had the lowest weights at birth and at one year had the highest death rates from cardiovascular disease. The differences were large and were reflected in differences in life expectancy. (2) In England and Wales there is a close geographical association between high death rates from cardiovascular disease, and poor maternal physique and health, and poor fetal growth. These findings raise the question of what processes link the intrauterine and early postnatal environment with risk of cardiovascular disease. Blood pressure, a known risk factor for cardiovascular disease, is one link. A recent study of 449 men and women now aged 50 showed that measurements at birth predicted blood pressure more strongly than current measures such as body mass. Levels of clotting factors in the blood and serum cholesterol (two other risk factors) may also be links.

Aged↗
PubMed1991

The relation of maternal weight to the blood pressures of Gambian children.

The objective of the study was to relate blood pressure levels in children to their mother's weight in pregnancy. The blood pressures of 675 children aged from one to nine years in three villages in rural Gambia were measured. They were matched to antenatal clinic data which had been collected from all pregnant women in the three villages since 1980. Among children under eight years of age those born in the dry season had the highest blood pressures and were heavier. Their blood pressures were positively related to body weight and to mothers' weight at six months of pregnancy. These relationships were independent of mothers' age and parity, birthweight, gestational age, and placental weight. Among older children, aged eight and nine years, those born in the rainy season had the highest blood pressures. Their blood pressures were not related to their mothers' weight at six months of pregnancy. Rather they were inversely related to mothers' weight gain in the last trimester. An interpretation of these findings is that among young children differences in blood pressure are largely determined by rates of maturation. However, the long-term effects of adverse intra-uterine influences which elevate blood pressure become apparent in older children.

Age Factors↗
PubMed1991

The effect of maternal anaemia and iron deficiency on the ratio of fetal weight to placental weight.

OBJECTIVE: To examine the maternal influences which determine large placental weight and a high ratio of placental weight to birthweight. These are known predictors of adult blood pressure. DESIGN: Retrospective analysis of routine obstetric and haematology department records for a large cohort of pregnant women. SETTING: John Radcliffe Hospital, Oxford. SUBJECTS: 8684 pregnant women who were delivered between January 1987 and January 1989 and whose records could be linked to the results of two or more pregnancy blood counts. MAIN OUTCOME MEASURES: Placental weight and the ratio of placental weight to birthweight. RESULTS: Large placental weight was associated with a low maternal haemoglobin and a fall in maternal mean cell volume during pregnancy. The highest ratio of placental weight to birthweight occurred in the most anaemic women with the largest falls in mean cell volume. Large placental weight and a high ratio of placental weight to birthweight were also independently associated with a high maternal body mass index. Maternal smoking reduced placental weight, but increased the ratio of placental weight to birthweight. CONCLUSIONS: Anaemia and iron deficiency during pregnancy are associated with large placental weight and a high ratio of placental weight to birthweight. This points to maternal nutritional deficiency as a cause for discordance between placental and fetal growth. This may have important implications for the prevention of adult hypertension, which appears to have its origin in fetal life.

Anemia↗
PubMed1991

Fetal heart rate and intrauterine growth.

OBJECTIVE: To assess whether fetal heart rate in early and late pregnancy relates to size at birth. DESIGN: Prospective study of fetal heart rates in early and late pregnancy. SETTING: Princess Anne Hospital, Southampton. SUBJECTS: 63 primigravid women. MAIN OUTCOME MEASURES: Anthropometric measurements made on the newborn infant. RESULTS: There were no differences in heart rate between the sexes at 18 weeks gestation but by 36 weeks the boys had rates which were 4.4 beats lower than those of the girls. Higher fetal heart rate at 18 weeks was associated with lower ponderal index, smaller head circumference and smaller mid-arm circumference. There were no trends in fetal heart rate at 36 weeks with any birth measurements. CONCLUSION: Babies born at term who have a pattern of neonatal measurements which reflect growth retardation have raised heart rates in early pregnancy. Influences which impair fetal growth appear to take effect early in gestation.

Anthropometry↗
PubMed1991

Maternal and fetal influences on blood pressure.

To study maternal and fetal influences on blood pressure in childhood 405 children aged 4 years who were born and still resident in the Salisbury health district were visited at home for blood pressure and growth measurements. Information on the pregnancy, delivery, and baby was abstracted from the routine obstetric notes. Similar to recent findings in adults, the child's systolic pressure was inversely related to birth weight and positively related to placental weight. Systolic pressure at 4 years increased by 1.2 mm Hg for every SD decrease in the ratio of head circumference to length at birth, and by 1.1 mm Hg for every SD decrease in ponderal index at birth. Mothers whose haemoglobin concentrations fell below 100g/l during pregnancy had children whose systolic pressures were on average 2.9 mm Hg higher than the children of mothers with higher haemoglobin concentrations. Patterns of placental weight, birth weight, head circumference, and length that are associated with high blood pressure in adults are also associated with higher blood pressure in 4 year old children. Identification of the intrauterine influences that lead to these patterns of fetal growth could lead to the primary prevention of hypertension.

Birth Weight↗
PubMed1991

Ischaemic heart disease in England and Wales around the year 2000.

STUDY OBJECTIVE: The aim was to predict death rates from ischaemic heart disease in England and Wales during the next 20 years. STUDY DESIGN: Age and sex specific death rates for 1968-1987 were used to predict national and regional trends until 2007. SETTING: The nine standard regions of England and Wales. RESULTS: There will be a large fall in deaths from ischaemic heart disease. The fall will be greater in men and women below 65 years of age. There will, however, be a sharp worsening of the north/south divide. The largest fall in any region will be in Wales. CONCLUSION: The campaign to change the national diet should give highest priority to the norther regions. Because infant growth is inversely related to adult risk of ischaemic heart disease, the poor growth of young children in some northern areas is a cause for concern.

Adult↗
PubMed1991

Housing and appendicitis in Anglesey.

STUDY OBJECTIVE: The aim was to test the hypothesis that provision of household amenities such as domestic hot water systems and bathrooms changed hygiene which thereby triggered the epidemic of appendicitis in Anglesey after the second world war. DESIGN: The study was a cross sectional survey with histories of housing and appendicectomy obtained from Anglesey residents by postal questionnaire. The main outcome measure was reported appendicectomy. SETTING: Four general practices in Anglesey. SUBJECTS: 2531 men and women born during 1923-62 and randomly selected from age-sex registers. Overall response rate was 73.7%. MAIN RESULTS: Subjects born into households with amenities--piped water, hot water systems, and bathrooms had, if anything, a reduced risk of appendicectomy. However, those who subsequently moved to houses that lacked amenities were at significantly higher risk than people born into houses without amenities who later acquired them. CONCLUSIONS: Provision of household amenities was not the important trigger to the epidemic of appendicitis which occurred in Anglesey after the second world war. Rather, the trigger may have been reduction in domestic crowding caused by the falling birth rate. Findings among those who moved house support other evidence that after infancy household amenities protect against appendicitis and contributed to the fall in appendicitis rates in Anglesey after 1965.

Adult↗
PubMed1990

Fetal and placental size and risk of hypertension in adult life.

OBJECTIVE: To study the effect of intrauterine growth and maternal physique on blood pressure in adult life. DESIGN: A follow up study of infants born 50 years previously whose measurements at birth were recorded in detail. SETTING: Preston, Lancashire. SUBJECTS: 449 Men and women born in hospital in Preston during 1935-43 and still living in Lancashire. MAIN OUTCOME MEASURES: Placental weight, birth weight, and blood pressure at age 46 to 54 years. RESULTS: In both sexes systolic and diastolic pressures were strongly related to placental weight and birth weight. Mean systolic pressure rose by 15 mm Hg as placental weight increased from less than or equal to 1 lb (0.45 kg) to greater than 1.5 lb and fell by 11 mm Hg as birth weight increased from less than or equal to 5.5 lb to greater than 7.5 lb. These relations were independent so that the highest blood pressures occurred in people who had been small babies with large placentas. Higher body mass index and alcohol consumption were also associated with higher blood pressure, but the relations of placental weight and birth weight to blood pressure and hypertension were independent of these influences. CONCLUSIONS: These findings show for the first time that the intrauterine environment has an important effect on blood pressure and hypertension in adults. The highest blood pressures occurred in men and women who had been small babies with large placentas. Such discordance between placental and fetal size may lead to circulatory adaptation in the fetus, altered arterial structure in the child, and hypertension in the adult. Prevention of hypertension may depend on improving the nutrition and health of mothers.

Alcohol Drinking↗
PubMed1990

Stomach cancer and migration within England and Wales.

Rates of stomach cancer vary from place to place within England and Wales. To determine whether this reflects influences acting earlier or later in life, we have analysed mortality from the disease by county of birth and county of death. Among 749,035 men and women who died during 1969-72 in a different county from that in which they were born, proportional mortality from stomach cancer was more closely related to county of birth than of death. This association with place of birth was found in migrants both out of and into high-risk areas. We conclude that studies seeking to explain local differences in the incidence of stomach cancer within England and Wales should focus on the environment of patients in their youth.

England↗
PubMed1990

Poor housing in childhood and high rates of stomach cancer in England and Wales.

In a search for aetiological processes which might explain the association of stomach cancer with poverty, we have related mortality from the disease in the local authority areas of England and Wales during 1968-78 to indices of living standards derived from the 1971, 1951 and 1931 censuses. We have also analysed recently released data from a national survey of overcrowding carried out in 1936. Geographical differences in stomach cancer were most closely related to occupationally derived indices of socio-economic structure from the 1971 census, and to measures of domestic crowding from the 1931 census and 1936 survey. Unlike other indices of poor living standards, levels of past domestic crowding in north-west Wales were consistent with its previously unexplained high death rates from stomach cancer. We conclude that overcrowding in the home during childhood may be a major determinant of stomach cancer, and might act by promoting the transmission of causative organisms.

Adult↗