Summary
Two follow-up studies were carried out to determine whether lower birthweight is related to the occurrence of syndrome X — Type 2 (non-insulin-dependent) diabetes mellitus, hypertension and hyperlipidaemia. The first study included 407 men born in Hertfordshire, England between 1920 and 1930 whose weights at birth and at 1 year of age had been recorded by health visitors. The second study included 266 men and women born in Preston, UK, between 1935 and 1943 whose size at birth had been measured in detail. The prevalence of syndrome X fell progressively in both men and women, from those who had the lowest to those who had the highest birthweights. Of 64-year-old men whose birthweights were 2.95 kg (6.5 pounds) or less, 22% had syndrome X. Their risk of developing syndrome X was more than 10 times greater than that of men whose birthweights were more than 4.31 kg (9.5 pounds). The association between syndrome X and low birthweight was independent of duration of gestation and of possible confounding variables including cigarette smoking, alcohol consumption and social class currently or at birth. In addition to low birthweight, subjects with syndrome X had small head circumference and low ponderal index at birth, and low weight and below-average dental eruption at 1 year of age. It is concluded that Type 2 diabetes and hypertension have a common origin in sub-optimal development in utero, and that syndrome X should perhaps be re-named “the small-baby syndrome”.
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Hales CN, Barker DJP, Clark PMS et al. (1991) Fetal and infant growth and impaired glucose tolerance at age 64 years. BMJ 303: 1019–1022
Robinson S, Walton RJ, Clark PM, Barker DJP, Hales CN, Osmond C (1992) The relation of fetal growth to plasma glucose in young men. Diabetologia 35: 444–446
Barker DJP, Osmond C, Golding J, Kuh D, Wadsworth MEJ (1989) Growth in utero, blood pressure in childhood and adult life, and mortality from cardiovascular disease. BMJ 298: 564–567
Barker DJP, Bull AR, Osmond C, Simmonds SJ (1990) Fetal and placental size and risk of hypertension in adult life. BMJ 301: 259–262
Barker DJP, Meade TW, Fall CHD et al. (1992) Relation of fetal and infant growth to plasma fibrinogen and factor VII concentrations in adult life. BMJ 304: 148–152
Stamler J, Rhomberg P, Schroenberger JA et al. (1975) Multivariate analysis of the relationship of seven variables to blood pressure: findings of the Chicago Heart Association detection project in industry. 1967–72. J Chron Dis 28: 527–548
Modan M, Halkin H, Almog S et al. (1985) Hyperinsulinaemia: a link between hypertension obesity and glucose intolerance. J Clin Invest 75: 809–817
Reaven GM (1988) Role of insulin resistance in human disease. Diabetes 37: 1595–1607
Ferrannini E, Haffner SM, Mitchell BD, Stern MP (1991) Hyperinsulinaemia: the key feature of a cardiovascular and metabolic syndrome. Diabetologia 34: 416–422
Yudkin J (1991) Hypertension and non-insulin dependent diabetes. BMJ 303: 730–731
Fontbonne A, Charles MA, Thibult N et al. (1991) Hyperinsulinaemia as a predictor of coronary heart disease mortality in a healthy population: the Paris Prospective Study, 15-year followup. Diabetologia 34: 356–361
Foster DW (1989) Insulin resistance, a secret killer? N Engl J Med 320: 733–734
Hales CN, Barker DJP (1992) Type 2 (non-insulin-dependent) diabetes mellitus: the thrifty phenotype hypothesis. Diabetologia 35: 595–601
Barker DJP, Godfrey KM, Fall C, Osmond C, Winter PD, Shaheen SO (1991) The relation of birth weight and childhood respiratory infection to adult lung function and death from chronic obstructive airways disease. BMJ 303: 671–675
Kunst A, Draeger B, Ziegenhorn J (1983) UV-methods with hexokinase and glucose-6-phosphate dehydrogenase. In: Bergmeyer HU (ed) Methods of enzymatic analysis, Vol VI. Weinheim Verlag Chemie, Deerfield, pp 163–172
Sobey WJ, Beer SF, Carrington CA, Gray IP et al. (1989) Sensitive and specific two-site immuno-radiometric assays for human insulin, proinsulin, 65–66 split and 32–33 split proinsulins. Biochem J 260: 535–541
Alpha B, Cox L, Crowther N, Clark PMS, Hales CN (1992) Sensitive amplified immunoenzymometric assays (IEMA) for human insulin and intact proinsulin. Eur J Clin Chem Biochem 30: 27–32
Allain CC, Poon LS, Chan CSG, Richmond W, Fu PC (1974) Enzymatic determination of serum total cholesterol. Clin Chem 20: 470–475
Lie AF, Schmitz JM, Pierre KJ, Gochman N (1976) Cholesterol oxidase-based determination by continuous flow analysis of total and free cholesterol in serum. Clin Chem 22: 1627–1630
Lopes-Virella MF, Stone P, Ellis S, Colwell JA (1977) Cholesterol determination in high density lipoproteins separated by three different methods. Clin Chem 23: 882–884
Fossati P, Prencipe L (1982) Serum triglycerides determined colorimetrically with an enzyme that produces hydrogen peroxide. Clin Chem 28: 2077–2080
Friedwald WT, Levy RI, Fredrickson DS (1972) Estimation of the concentration of low density lipoprotein cholesterol in plasma without use of the preparative ultracentrifuge. Clin Chem 18: 499–502
Bhatnagar D, Durrington PN (1991) Clinical value of apolipoprotein measurement. Ann Clin Biochem 28: 427–437
Clauss A (1957) Gerinnungsphysiologische Schnellmethode zur Bestimmung des Fibrinogens. Acta Haematol (Basel) 17: 237–246
Brozovic M, Stirling Y, Harricks C, North WRS, Meade TW (1974) Factor VII in an industrial population. Br J Haematol 28: 381–391
Sundell IB, Nilsson TK, Hallmans G, Hellsten G, Dahlen GH (1989) Interrelationships between plasma levels of plasminogen activator inhibitor, tissue plasminogen activator, lipoprotein (a), and established cardiovascular risk factors in a North Swedish population. Atherosclerosis 80: 9–16
Barker DJP (ed) (1992) Fetal and infant origins of adult disease, 1st edn. British Medical Journal, London
Barker DJP, Godfrey KM, Osmond C, Bull A (1992) The relation of fetal length, ponderal index and head circumference to blood pressure and the risk of hypertension in adult life. PaediatrPerinat Epidemiol 6: 35–44
Jarrett RJ (1992) In defence of insulin; a critique of syndrome X. Lancet 340: 469–471
Lucas A (1991) Programming by early nutrition in man. In: Bock GR, Whelan J (eds) The childhood environment and adult disease. Ciba Foundation Symposium 156. John Wiley, Chichester pp 38–55
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Barker, D.J.P., Hales, C.N., Fall, C.H.D. et al. Type 2 (non-insulin-dependent) diabetes mellitus, hypertension and hyperlipidaemia (syndrome X): relation to reduced fetal growth. Diabetologia 36, 62–67 (1993). https://doi.org/10.1007/BF00399095
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DOI: https://doi.org/10.1007/BF00399095