The paper describes two different explanation models for adult disease: programming and the life course approach. In programming, there is a stimulus or insult at an early critical period of development that has lasting significance, whereas a life course approach is the study of long-term effects of exposures during all stages of life. These two ways of explaining adult disease are demonstrated by using elevated blood pressure as an example. We summarize findings in newer studies on how determinants in different stages of life, especially during the earliest years, may influence later blood pressure.
In general, a weak inverse association between birth weight and later blood pressure is found. Breast-feeding is shown to have a weak favourable effect on blood pressure. Early catch-up growth is generally seen having an adverse effect on later blood pressure; it could have some benefits in developing countries, however. BMI is at all ages strongly associated with blood pressure. An interaction between birth weight and adult BMI is also found in certain studies, with the strongest inverse birth weight/adult blood pressure association among those who become obese. Since both blood pressure and BMI show tracking from childhood through to adult life, early prevention is important. In [...]