Perinatal and Childhood Precursors of Adult Cardiovascular Disease

1. Longitudinal studies from the US, Australia and Europe have demonstrated tracking of childhood risk factors for cardiovascular disease from adolescence into adult life. These factors include obesity, blood cholesterol levels, blood pressure and measures of insulin resistance. Worldwide increases in childhood obesity and overweight are already resulting in increases in adolescent diabetes and are likely to translate into earlier onset hypertension and cardiovascular disease in adults.2. Low birth weight has also been associated with increased risk of adult cardiovascular disease, diabetes and high blood pressure, but there is considerable debate as to the relative importance of pre- and postnatal influences.3. These issues are discussed in the context of results of a longitudinal cohort study of cardiovascular and metabolic risk factors in Western Australia, the 'Raine' childhood cohort, which showed that in a well-nourished Australian population at age 8 there was a U-shaped relationship between birth weight and a cluster of factors predisposing to adult cardiovascular disease, with postnatal weight gain being the dominant factor.4. Future public health programmes should focus on both pre- and early postnatal factors predisposing to obesity, hypertension and diabetes.