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Experimental and Human Evidence of Fetal Programming for Metabolic Syndrome

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Experimental and Human Evidence of Fetal Programming for Metabolic Syndrome Journal of Human Hypertension (2012) 26, 405–419 & 2012 Macmillan Publishers Limited All rights reserved 0950-9240/12 www.nature.com/jhh REVIEW Developmental origins of health and disease: experimental and human evidence of fetal programming for metabolic syndrome ML de Gusma˜o Correia, AM Volpato, MB A´ guila and CA Mandarim-de-Lacerda Department of Anatomy, Institute of Biology, State University of Rio de Janeiro, Rio de Janeiro, Brazil The concept of developmental origins of health and rodents are associated with fetal and neonatal program- disease has been defined as the process through which ming for metabolic syndrome. In this paper, recent the environment encountered before birth, or in infancy, experimental models and human epidemiological stu- shapes the long-term control of tissue physiology and dies providing evidence for the fetal programming homeostasis. The evidence for programming derives associated with the development of metabolic syndrome from a large number of experimental and epidemiologi- and related diseases are revisited. cal observations. Several nutritional interventions dur- Journal of Human Hypertension (2012) 26, 405–419; ing diverse phases of pregnancy and lactation in doi:10.1038/jhh.2011.61; published online 23 June 2011 Keywords: fetal programming; developmental origins of disease; metabolic syndrome; obesity Introduction Metabolic syndrome is an aggregation of risk factors (that is, overweight, abdominal obesity, The concept of developmental origins of health and hypertension, dyslipidaemia and glucose intoler- disease (a.k.a. fetal programming) was first proposed by 1 2 ance) that strongly correlates with cardiovascular David Barker and later defined by Alan Lucas as the disease. Several nutritional interventions during permanent response of an organism to a stimulus or diverse phases of pregnancy and lactation in rodents insult during critical periods of development. The are associated with fetal and neonatal programming concept of programming was later expanded and for metabolic syndrome. In humans, both small and defined as the process through which the environment large for gestational age newborns have been shown encountered before birth, or in infancy, shapes the long- 3 to develop features of metabolic syndrome during term control of tissue physiology and homeostasis. growth and adulthood. Such adaptive responses often cause several diseases in In this paper, recent experimental and epidemiolo- adult life. The evidence for fetal programming comes gical studies providing evidence for the fetal pro- from a large number of experimental and epidemiolo- 4 gramming associated with the development of gical observations. Barraclough demonstrated that metabolic syndrome and related diseases were re- neonatal administration of testosterone to female rats viewed. First, associations between birth weight and causes ovulation failure and sterility, which are not the increase in cardiovascular risk in humans based observed if the hormone is given later in life. 5 on epidemiological observations were discussed. Importantly, Rose et al. firstreportedthattheriskof Second, we revisited evidence linking maternal low- ischaemic heart disease doubled in human subjects protein diet with development of metabolic syndrome whose siblings were still born or died in early child- in rodents. Finally, recent experimental studies hood, suggesting that adverse exposures during preg- showing the effects of maternal overnutrition in the nancy could cause diseases in adulthood. adult offspring were presented. Cardiovascular risk and fetal program- Correspondence: Professor ML de Gusma˜o Correia, Laboratory of ming in humans: early evidence Morphology, Department of Anatomy, Institute of Biology, State University of Rio de Janeiro, Boulevard 28 de Setembro, 87 fds, Several epidemiological reports have shown asso- 20551-030 Rio de Janeiro, RJ, Brazil. E-mail: [email protected] ciations between prenatal and postnatal exposures Received 13 May 2010; revised 20 February 2011; accepted 9 May and the development of metabolic syndrome in 2011; published online 23 June 2011 adult life. Although genomically imprinted genes Fetal programming for metabolic syndrome ML de Gusma˜o Correia et al 406 could potentially determine programming, several accelerate their growth rate if adequate nutrition is epigenetic mechanisms have been associated with provided after birth (that is, catch-up). This growth altered genetic expression and the development of pattern has been associated with an increased risk disease in adult life.6 for coronary heart disease and higher cardiovascular Times of famine caused by human conflicts have mortality.11 In line with these results and using low provided unique opportunities for the study of the birth weight as a surrogate of intra-uterine slow impact of undernourishment during pregnancy on growth, the Hertfordshire and Sheffield cohort of the development of disease in the adult progeny. neonates born between 1911 and 1930 has shown Two events are remarkable in this regard: the siege of that birth weights o2.5 kg were associated with Leningrad and the Dutch famine, which occurred increased coronary artery disease and stroke mor- during World War II. Stanner et al.7 have studied tality, and augmented prevalence of diabetes. adult subjects exposed to malnutrition during Indeed, 1 s.d. increase in birth weight reduces all- gestation and afterwards, and those only exposed cause mortality at the age of 75 years old by 0.86% after birth during the siege of Leningrad by the in men and women.12 These results appear to be German army between 1941 and 1944. These independent of social class but are potentiated in subjects were compared with control individuals women.12–15 born concurrently but outside the area of the siege and not exposed to starvation. It was found that obesity-related changes in blood pressure and Metabolic syndrome programming in endothelial dysfunction were more prevalent in small for gestational age humans the exposed groups. Nevertheless, glucose intoler- ance, dyslipidaemia, hypertension, obesity or cardi- Programming for metabolic syndrome in adulthood ovascular diseases were not more prevalent among of infants born small for gestational age could adults exposed to siege’s nutritional conditions. potentially increase cardiovascular risk. However, The Dutch famine occurred in the harsh winter of metabolic syndrome as a consequence of program- 1944–1945 after a food embargo imposed by Ger- ming has been seldom studied. Although low birth many in retaliation to a rail strike. Unlike the siege weight has been inconsistently linked with later of Leningrad, the Dutch famine was short (that is, 5 development of metabolic syndrome,16–18 a much to 7 months) and allowed the study of malnutrition larger number of studies have reported programming around fertilization or later in pregnancy. It has been for its main individual components. For instance, observed that malnutrition during the first and hypertension, the most prevalent component of second trimesters were associated with an increased metabolic syndrome, develops more often in small prevalence of obesity whereas exposure in the third newborns who catch-up between 1 and 5 years of trimester correlated with lower to normal weight in age. Interestingly, low birth weight was also corre- adult life.8,9 In addition, subjects exposed to mal- lated with increased adiposity in adulthood, which nutrition in early pregnancy exhibited atherogenic partly explains the development of systolic hyper- lipid profile, higher plasma fibrinogen, reduced tension in these subjects.19 The relevance of the concentrations of factor VII and higher risk of catch-up growth has been largely confirmed by the coronary heart disease. In contrast, the progeny United States Collaborative Perinatal Project, which exposed to famine in late or mid gestation had studied 455 000 pregnancies in an observational impaired glucose tolerance.10 Therefore, these re- multi-centre cohort between 1959 and 1974. In this sults indicate that malnutrition exposure during study, low birth weight was not associated with diverse periods of pregnancy increases the risk of increased risk of hypertension at the age of 7 years metabolic syndrome differentially in the adult off- old, except in infants who gained weight faster than spring, obesity and coronary heart disease being predicted by growth charts and were at increased more common in subjects exposed to malnutrition risk for higher systolic blood pressure.20 Moreover, during the first half of gestation, whereas insulin in one important clinical trial, small for gestational resistance appears to be more common during late age newborns were either assigned to standard or pregnancy exposure. high-protein diet. Infants in the high-protein diet Of note, the adult phenotypes of the progeny born exhibited faster weight gain, which was associated in Leningrad and Holland are substantially different with elevated diastolic, mean but not systolic blood given that glucose intolerance, dyslipidaemia, obe- pressures.21 The lack of differences in regard to sity or cardiovascular disease was less prevalent in systolic blood pressures in this study might have the first population. One possibility for these been due to the high-protein diet chosen in a differences is that infants born in Leningrad were clinical trial setting. Overall, increased adiposity exposed to malnutrition for a prolonged period of later in life in small for gestational age
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