Book review

It is increasingly realized that exposures during early life have consequences for lifelong health and disease. This rapidly expanding research field may have wide-ranging implication for concepts of preventive medicine. During recent years, Peter Gluckman and Mark Hanson decisively contributed to the establishment of this field and successfully promoted its world-wide recognition. Now they edited a book entirely devoted to the topic of “developmental origins of health and disease (DOHaD)”. Its 37 chapters span from conceptional papers to articles dealing with the early origins of particular diseases like obesity, cardiovascular diseases, or allergy. As it is impossible to discuss all of them, a very few chapters that appear particularly remarkable to the reviewers are highlighted briefly in the following.

A first impression of the book is that nearly all chapters are focussed on the consequences of “low birth weight”. However, exposure to stress, altered sex steroids, or maternal diseases would far better and much more causally fit with the general aim, approach, and hypothesis of “predictive adaptive responses”, which is of key importance for the most noteworthy conceptual framework of Gluckman and Hanson, as outlined in chapter 3. On the other hand, it is strength of the book that it includes a chapter on the role of exposure to environmental chemicals (chapter 7).

Keeping in mind the above-mentioned focus on “low birth weight”, as a presumed indicator of in-utero undernutrition, it seems mandatory to particularly point to chapter 8 by Morton who reviews the literature on the impact of maternal (under-)nutrition on birth weight coming, however, to the conclusion that “… the effect seems to be modest, at best …”. One chapter is devoted to obesity (chapter 18), concluding that “… the overall consensus from epidemiological studies is that being either small or large at birth predicts later obesity …”. Surprisingly, however, it is not considered and discussed by the authors that rather no evidence exists that being small at birth independently predicts obesity.

It is hard to understand why the volume lacks a chapter on maternal diabetes, which has to be considered one of the best-known and longest investigated examples for DOHaD in humans as well as animal models since about 30 years. Explicit consideration of this topic which has decisively contributed to our understanding of mechanisms of “programming” would have further improved this comprehensive book.

A very worthwhile highlight of the volume are the closing five chapters (chapters 33–37) on more general topics related to DOHaD, especially on its important role for public health and primary prevention of chronic diseases, including a chapter on the potentially wide-ranging ethical and social dimensions.

Taken together, this is a broad and fascinating overview on the rapidly expanding field of DOHaD, written by some of the international experts in this field. Although the reviewers disagree with Barker's first sentence in the final chapter (chapter 37) that “… the idea that common chronic diseases are initiated through developmental processes that begin before birth arose … 20 years ago …” (it is, in fact, at least further two decades older), we completely agree with one of his last sentences: “… an alternative first rule (of public health) might be not to stand idly by while bad things, which are remediable, are happening …”. In this sense, much will be achieved when books like this one will ultimately lead to the development of new measures of primary prevention and better policies to improve developmental health.