理论基础 150 必生命历程策略 18 138 THELANCET.MAY10,1986 120 Epidemiology 1t8 INFANT MORTALITY,CHILDHOOD 100 NUTRITION,AND ISCHAEMIC HEART DISEASE IN ENGLAND AND WALES 98 D.J.P.BARKER C.OSMOND MRC Environmental Epidemiology Unit,University of Southampton,Southampton General Hospital, 90 Southampion SO9 4XY Summary Although the rise in ischaemic heart disease 78 in England and Wales has been associated 40 58 6078998188118 12 with increasing prosperity,mortality rates are highest in the least affluent areas.On division of the country into two INFANT MORTALITY PER 1000 BIRTHS 1921-25 hundred and twelve local authority areas a strong geographical relation was found between ischaemic heart Fig 1-SMRs for ischaemic heart disease in 1968-78 at ages 35-74, men and infant mortality per 1000 births in 1921-25 in the212 areas disease mortality rates in 1968-78 and infant mortality in of England and Wales. 1921-25.Of the twenty-four other common causes of death only bronchitis,stomach cancer,and rheumatic heart disease (X=CBs,A=LBs,O=urban areas,+=rural areas). were similarly related to infant mortality.These diseases are associated with poor living conditions and mortality from them is declining.Ischaemic heart disease is strongly correlated with both neonatal and postneonatal mortality.It is suggested that poor nutrition in early life increases susceptibility to the effects of an affluent diet. 安强滑科大婴
生命历程策略 理论基础
理论基础 The Lancet Saturday 9 September 1989 必生命历程策略 WEIGHT IN INFANCY AND DEATH FROM Men Women ISCHAEMIC HEART DISEASE 120 120 D.J.P.BARKER P.D.WINTER C.OSMOND B.MARGETTS 100 100 S.J.SIMMONDS 80 80 MRC Enironmental Epidemiology Unit,University of Southampton,Southampton General Hospital,Southampton SO94XY 60 60 Summary Environmental influences that impair 40 40 growth and development in early life may be risk factors for ischaemic heart disease.To test this hypothesis,5654 men born during 1911-30 were traced. 20 20 They were born in six districts of Hertfordshire,England, and their weights in infancy were recorded.924%were -5. 6.5 >9.5 5.5 >9.5 breast fed.Men with the lowest weights at birth and at one year had the highest death rates from ischaemic heart Birthweight (pounds) Birthweight (pounds) disease.The standardised mortality ratios fell from 111 in men who weighed 18pounds(82kg)or less atone year to42 Fig.1.Mortality from coronary heart disease in 15,726 men and women in in those who weighed 27 pounds (123 kg)or more.Hertfordshire. Measures that promote prenatal and postnatal growth may reduce deaths from ischaemic heart disease.Promotion of postnatal growth may be especially important in boys who weigh below 7-5 pounds(3-4 kg)at birth. 安强看科大号
生命历程策略 理论基础
理论基础 Ethel Margaret Burnside的貢献和赫特福蓓都队列所究 20世空朝，人们普避关连第☒人：质亲药见象：出生事一直下降，在10名葵儿中有1名葵儿在1当前死亡，许多存话下来的人进入脱年烟后楼状况爱(Bk任 Dj.2003). Ethel Margaret Bumside(埃委尔·马格用种.伯忽毫袍】是样种福穆杂第一位“首席卫生随访员和女财产士号壹”.1911年，地成立了一支以你，培州护士 为分婉中的妇女提供抄理，让防产士和卫生随访员可以熟综地膏地川分娩及辉丽葵儿，并告知母承如付使葵儿保桥出生后徙廉。地让护士至少提供0个弹瓷 天平，为妹种福穆杂的所有盛儿在出生和】岁叶你里，下图（左）为B5ie于17岁叶拍摄的熙片， England T .￥年4c416凸 .a人，ce ,'s乃 4 全红仁89彩华空勿 Bide鸦保护士的适动都符到记承.每俯一段叶司，卫生随访员都会到每一名葵儿的家中，并在卡片上记承下 长到1岁叶，卡片戴上交称说会，部议会把这些官恩转承为记承表，每一个村都有各自的记承表（见上图右），苦 到1948年筑国楚立国家医疗服并系统之叶，Burside及其团以为妇效保饯事北做出了极大的贡林，为分晚中的归女 重和疾病名称，保样母承和盛儿楼康车工作都是妇纳保使工作的装形，为日后更全面地开腰妇幼保使工作真定了基： David J.Barker和南普薇大竿兖☒医竿研究狸事会(MRC)环境流行病岸组(EEU)利用Burside的工指开恶了 是对基因，答内及产后早期环境和后期怪性疾病病因竿（心血管疾病，2型榈尿病和鹿作：骨质疏松宠，骨关节炎有 的相豆作用进行评估。这项研究的目的是把这些相互关系放入疾病发病机创的生命历程横型中，描进造成橙性统病 徙品素梓生长因子轴的重豆】生狸机制，这些研究导致巴克胶说的出见，巴克戏说阀硬了母来怀孕叶其脂儿楼受的 及骑定后期就对统病的蜀感世（详见第二章）· 8 样种福袍部以列研究前窘性她收案以列中出生：重，】岁叶体重和盛儿爱杀和疾病车资料，是对子宫内和盛儿期疾病风险的长期影件进行观察独一无二的 资源。其次，同叶也痰符了参与者详细的表型杵径，包括生狸测量和为将来的测是储存血游。尊次，对蜀发的临原事件和死亡容进行随疗，最后，HCS税氣 核相核酸(DNA)银行是基因.基因与环境相互作用（如虎形，心血管和代谢性疾病，骨质疏松定肌肉骨鹤统病的危险因素）研究的重要囡家资源，： (改编自：Sydl1HE等.2005.) 安揿滑科火号
理论基础
理论基础 英国Hertfordshiref队列研究(1911-1930年，1.6万人； 1931一1939年更大规模的出生队列) 一低出生体重与青春期前儿童和成年期高血压 一低出生体重与早期发生胰岛素抗性 一低出生体重与冠心病与血脂异常 一低出生体重与多襄卵巢综合征 一低出生体重与代谢综合征 一低出生体重与骨质疏松症 一低出生体重与癌症 一绝经年龄提前 一认知与行为 安强裔科火号
英国 Hertfordshire队列研究（1911－1930年，1.6万人； 1931－1939年更大规模的出生队列） – 低出生体重与青春期前儿童和成年期高血压 – 低出生体重与早期发生胰岛素抗性 – 低出生体重与冠心病与血脂异常 – 低出生体重与多囊卵巢综合征 – 低出生体重与代谢综合征 – 低出生体重与骨质疏松症 – 低出生体重与癌症 – 绝经年龄提前 – 认知与行为 理论基础
理论基础 冬生命历程策略 Barkerz教授和他的MRC环境流行病学小组( 南安普敦大学)基于对Hertfordshire Cohort Study结果，提出“成年人慢性病可能来源于 生命胚胎期” fetal origin hypothesis 奖强看科火学
生命历程策略 fetal origin hypothesis Barker教授和他的MRC环境流行病学小组（ 南安普敦大学）基于对Hertfordshire Cohort Study 结果，提出 “成年人慢性病可能来源于 生命胚胎期 ” 理论基础