nore likely to develop coronary heart disease in adulthood. These ob- mechanisms, which may determine fetal nutrition and growth, and ovations can even be made in individuals who do have maintained normal body weight later in life. Similar findings were reported for the insulin resistance syndrome, a condition which leads to ept of programming does not dismiss the influences and impor- non-insulin dependent diabetes(Figure 2. 2). More recently, impaired tance of risk factors operating later in life, such as smoking, excessive early growth has been linked with accelerated ageing. a decline in alcohol consumption, inadequate exercise, and obesity, all of which muscular strength(as indicated, for example, by reduced grip strength of contribute to the development of chronic diseases. Instead it proposes the hand) is a marker of ageing, and was found to be more pronounced that these environmental factors amplify the disadvantages that may have among men and w who had low weight at birth. A specific occurred in fetal life. This has important implications for countries where nutritional deficiency is maternal iodine deficiency, which leads to fetal growth retardation is common and rates of smoking, obesity and a hypothyroidism(and subsequently cretinism)in the newborn, if it remaIns sedentary life style are increasing ving fetal development by Figure 2. 2: Prevalence of insulin resistance syndrome in British men aged 64 years according to birthweight targeting health promotion activities at improvement of health and nutrition of girls, young women, and mothers during pregnancy and lactation, especially social groups where fetal growth retar promoting the adoption and maintenance of a healthy life style (chapter 4), with special emphasis on people undernourished while the womb =5.56.5-7.5 2.2 Congenital disorders rthmwe ight (pound s Permanent physical or mental defects in the newborn can be caused by (Source: Barker DIP. Mothers, Babies and Health in Later Life. Churchill Livingston, 1998) genetic disorders, by exposure to toxins, or through infections during pregnancy. Examples of genetic diseases are pheny ketonuria(a metabolic disorder that, if left untreated, can lead to mental retardation), or familial Moreover, the effects of our own fetal development may be carried into hypercholesterolaemia (high cholesterol levels predisposing to the following generation. It has been shown that the two main cardiovascular disease in adult life determinants of a baby's weight are the mother's weight before she conceives and her own birthweight. It may therefore take several Exposure to toxins, such as smoking, drug misuse and excessive alcohol generations before nutrition in the womb can be optimised. Further in- consumption during pregnancy may cause growth impairment and mental tensive research is needed to establish the cellular and molecular retardation in the newborn. Common infections, which may cause long6 more likely to develop coronary heart disease in adulthood. These ob￾servations can even be made in individuals who do not smoke and who have maintained normal body weight later in life. Similar findings were reported for the insulin resistance syndrome, a condition which leads to non-insulin dependent diabetes (Figure 2.2). More recently, impaired early growth has been linked with accelerated ageing. A decline in muscular strength (as indicated, for example, by reduced grip strength of the hand) is a marker of ageing, and was found to be more pronounced among men and women who had low weight at birth. A specific nutritional deficiency is maternal iodine deficiency, which leads to hypothyroidism (and subsequently cretinism) in the newborn, if it remains untreated. mechanisms, which may determine fetal nutrition and growth, and therefore guide interventions. The concept of programming does not dismiss the influences and impor￾tance of risk factors operating later in life, such as smoking, excessive alcohol consumption, inadequate exercise, and obesity, all of which contribute to the development of chronic diseases. Instead it proposes that these environmental factors amplify the disadvantages that may have occurred in fetal life. This has important implications for countries where fetal growth retardation is common and rates of smoking, obesity and a sedentary life style are increasing. Improving fetal development by l targeting health promotion activities at improvement of health and nutrition of girls, young women, and mothers during pregnancy and lactation, especially in countries and/or social groups where fetal growth retardation prevails l promoting the adoption and maintenance of a healthy life style (chapter 4), with special emphasis on people undernourished while in the womb 2.2 Congenital disorders Permanent physical or mental defects in the newborn can be caused by genetic disorders, by exposure to toxins, or through infections during pregnancy. Examples of genetic diseases are phenylketonuria (a metabolic disorder that, if left untreated, can lead to mental retardation), or familial hypercholesterolaemia (high cholesterol levels predisposing to cardiovascular disease in adult life). Exposure to toxins, such as smoking, drug misuse and excessive alcohol consumption during pregnancy may cause growth impairment and mental retardation in the newborn. Common infections, which may cause long- (Source: Barker DJP. Mothers, Babies and Health in Later Life. Churchill Livingston, 1998) Figure 2.2: Prevalence of insulin resistance syndrome in British men aged 64 years according to birthweight            ! %LUWKZHLJKWSRXQGV 2GGVUDWLRIRULQVXOLQUHVLVWDQFHV\QGURPHDGMXVWHGIRU%0, Moreover, the effects of our own fetal development may be carried into the following generation. It has been shown that the two main determinants of a baby’s weight are the mother’s weight before she conceives and her own birthweight. It may therefore take several generations before nutrition in the womb can be optimised. Further in￾tensive research is needed to establish the cellular and molecular