International Journal of Epidemiology, Vol 28, 1088-1095, Copyright © 1999 by International Epidemiological Association
SE Moore, TJ Cole, AC Collinson, EM Poskitt, IA McGregor and AM Prentice
BACKGROUND: Research over the past decade has suggested that prenatal and
early postnatal nutrition influence the risk of developing chronic
degenerative diseases up to 60 years later. We now present evidence that
risk of death from infectious diseases in young adulthood is similarly
programmed by early life events. METHODS: In three rural Gambian villages,
affected by a marked annual seasonality in diet and disease, we have kept
detailed demographic, anthropometric and health records since 1949. Fate
was known with certainty for 3,162 individuals (2,059 alive/1,103 dead,
most dying in childhood). For this case- control analysis of antecedent
predictors of premature mortality, all adult deaths (n = 61) were paired
with two randomly selected controls matched for sex and year of birth.
RESULTS: Mean age at death was 25 (SD: 8) years. Adult death was associated
with a profound bias in month of birth with 49 cases born in the
nutritionally-debilitating hungry season (Jul-Dec) versus 12 in the harvest
season (Jan-Jun). Relative to harvest season the hazard ratio for early
death in hungry-season births rose from 3.7 (for deaths >14.5 years, P =
0.000013) to 10.3 (for deaths >25 years, P = 0.00002). Anthropometric
and haematological status at 18 months of age was identical in cases and
controls, indicating an earlier origin to the defect. Most deaths for which
cause was known had a definite or possible infectious aetiology; none were
from degenerative diseases of affluence. CONCLUSIONS: Early life exposures,
correlated with season of birth, strongly influence susceptibility to fatal
infections in young adulthood. The evidence suggests that
nutritionally-mediated intrauterine growth retardation may permanently
impair the development of immune function.
Prenatal or early postnatal events predict infectious deaths in young adulthood in rural Africa
Medical Research Council, Keneba, The Gambia.
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