1. Death rates from Coronary Heart Disease in men 1968-78
Gardner MJ et al Atlas of mortality from selected diseases in England and Wales, John Wiley, Chichester.

3. Mortality from coronary heart disease in
15726 men and women in Hertfordshire

4. Hazard ratios for coronary heart disease in men

5. Developmental plasticity
“The ability of a single genotype to produce more than one alternative form of structure, physiological state and behaviour in response to environmental conditions”
Adaptation
Developmental plasticity
Constraint

7. The fetal origins theory
Coronary heart disease, stroke, type 2 diabetes, hypertension and osteoporosis, originate through developmental plasticity, in response to malnutrition during fetal life and infancy.
Certain cancers,including breast cancer,also originate in fetal life.

8. Before I got married I had six theories about bringing up children: now I have six children and no theories.
John Wilmot, Earl of Rochester

9. Undernutrition,
stress, hypoxia
Critical window
of development
Altered gene expression
Adaptation
Gene defect
Fewer cells,
altered structure
DISEASE

11. Phenotypic plasticity and the adult environment
Gene-environment interactions during development alter responses to the environment in adult life

12. Hazard ratios for coronary heart disease (hospital admission or death) in 3676 men
3.0
0.5
1.0
1.5
2.0
2.5
Ponderal index
<26 kg/m3
>26 kg/m3
>15,700
-15,700
-12,400
-10,700
-8,400
Hazard
ratio
Household income (pounds sterling,1980)
p for interaction=0.005

14. Weight gain in childhood and later disease
Severe hypertension
or CHD
Mild hypertension or stroke
Normotensive
z score

15. Prevalence of hypertension
Birth
-weight
(kg) %
Fifths of current weight (kg)
-74.8
-62.6
-81.5
-68.7
-88.0
-75.2
-96.5
-83.9
>96.5
>83.9 M F 20 40 60 80
>4.0
-4.0
-3.5
-3.0

16. Associations between early growth and later disease extend across the range of fetal and infant growth. This implies that what are regarded as normal variations in the supply of nutrients to the baby have important long–term effects.

19. Pelvic diameters

20. The external conjugate diameter is the distance between the spine of the fifth lumbar vertebra and the front of the pubic bone. A diameter of less than 18 centimetres (7 inches) was used as a marker of a “flat” pelvis, the result of rickets or lesser degrees of malnutrition in early childhood.

21. Odds ratios (95% confidence intervals) for stroke and hypertension
Mother’s pelvic external conjugate diameter
(cm)
-18
1.62
(1.30 to 2.02)
1.89
(1.30 to 2.76)
>19
1.0

22. In a simultaneous regression of the effects of height and external conjugate on newly diagnosed hypertension, only the trend with external conjugate remained statistically significant (p=0.009)

23. 32 percent of mothers born during December and January had external conjugate diameters of less than 18 centimetres compared with 20 percent among mothers born in the remaining months (p=0.0005)

24. Conclusion
Malnutrition during infancy, including lack of Vitamin D, leads to persisting changes in protein metabolism which prejudice the early nutrition and growth of the next generation and lead, in adult life, to an atherogenic lipid profile, hypertension and stroke.

25. The intercristal diameter is the maximal distance between the iliac crests, while the interspinous diameter is the distance between the anterior superior iliac spines. The intercristal is usually 2.5 cm (one inch) longer than the interspinous. The more the intercristal diameter exceeds the interspinous, the rounder the iliac crest.

26. The pubertal growth of girls is characterized by a disproportionate increase in the intercristal diameter and rounding of the iliac crests. This female pattern of hip growth is under the control of estrogens, though other hormones including growth hormone also play a role.

27. Hazard ratios for breast cancer
All mothers
Multiparous mothers
Hazard ratio
40
<40
40
<40
Length of gestation (weeks)
Mothers’ intercristal diameter (cm) >30

28. Conclusion
Breast cancer is initiated by hormonal events during the mother’s puberty which lead to round, wide hips. The daughters of mothers with such hips are at increased risk of breast cancer because their mothers have an estrogen profile that adversely affects early mammary development.

29. Ovarian Cancer
The hazard ratio for ovarian cancer was 3.3 (95% CI 1.6 to 7.0, p=0.004) in the daughters of mothers whose interspinous diameter was greater than 27 cm

30. Hazard ratios for ovarian cancer according to mothers’ interspinous diameter and age at menarche
Menarche at age 14 years or less
p for trend 0.002
Menarche at age 15 years or more
p for trend 0.63
Interspinous diameter (cm)
Hazard ratio 

31.   Hazard ratios (95% CI) for ovarian cancer among women whose mother’s age at menarche was 14 years or less
Mother’s height (cm)
Interspinous diameter
160
>160
>26cm
9.7
(1.9 to 49)
1.5
(0.3 to 6.8)
p = 0.001
p = 0.25

32. www. Barker.org

33. The Cycle of Inequality
Mother
Adult
Infant
Child
Embryo
Fetus
Men
Women
slow growth
functional incapacity
metabolic incompetence
fat accumulation
cardiovascular disease
type 2 diabetes
osteoporosis
poor cognitive development
poor living
conditions
excess calories
unbalanced/
unvaried diet
The
Cycle of
Inequality 
unbalanced/unvaried diet