Background: Exposures during early life are increasingly being recognised as factors that play an important role in the aetiology of chronic non-communicable diseases (NCDs). The “Developmental Origins of Health and Disease” (DOHaD) hypothesis asserts that adverse early-life exposures - most notably unbalanced nutrition - leads to an increased risk for a range of NCDs and that disease risk is highest when there is a “mismatch” between the early- and later-life environments. Thus, the DOHaD hypothesis would predict highest risk in settings undergoing a rapid nutrition transition. Summary: We investigated the link between early-life nutritional exposures and long-term health in rural Gambia, West Africa. Using demographic data dating back to the 1940s, the follow-up of randomised controlled trials of nutritional supplementation in pregnancy, and the “experiment of nature” that seasonality in this region provides, we investigated the DOHaD hypothesis in a population with high rates of maternal and infant under-nutrition, a high burden from infectious disease, and an emerging risk of NCDs. Key Messages: Our work in rural Gambia suggests that in populations with high rates of under-nutrition in early life, the immune system may be sensitive to nutritional deficiencies early in life, resulting in a greater susceptibility to infection-related morbidity and mortality.

Keywords:
Developmental origins of health and disease, Gambia, Immunology and inflammation, Reproduction/pregnancy/lactation, Human nutrition
1.
Hanson MA, Gluckman PD: Early developmental conditioning of later health and disease: physiology or pathophysiology? Physiol Rev 2014;94:1027-1076.
2.
Corvalan C, Kain J, Weisstaub G, Uauy R: Impact of growth patterns and early diet on obesity and cardiovascular risk factors in young children from developing countries. Proc Nutr Soc 2009;68:327-337.
3.
Prentice AM, Rayco-Solon P, Moore SE: Insights from the developing world: thrifty genotypes and thrifty phenotypes. Proc Nutr Soc 2005;64:153-161.
4.
Hennig BJ, Unger SA, Dondeh BL, Hassan J, Hawkesworth S, Jarjou L, et al: Cohort profile: the Kiang West Longitudinal Population Study (KWLPS) - a platform for integrated research and health care provision in rural Gambia. Int J Epidemiol 2015;pii:dyv206.
5.
Rayco-Solon P, Fulford AJ, Prentice AM: Differential effects of seasonality on preterm birth and intrauterine growth restriction in rural Africans. Am J Clin Nutr 2005;81:134-139.
6.
Moore SE, Halsall I, Howarth D, Poskitt EM, Prentice AM: Glucose, insulin and lipid metabolism in rural Gambians exposed to early malnutrition. Diabet Med 2001;18:646-653.
7.
Moore SE, Cole TJ, Collinson AC, Poskitt EM, McGregor IA, Prentice AM: Prenatal or early postnatal events predict infectious deaths in young adulthood in rural Africa. Int J Epidemiol 1999;28:1088-1095.
8.
Moore SE, Cole TJ, Poskitt EM, Sonko BJ, Whitehead RG, McGregor IA, et al: Season of birth predicts mortality in rural Gambia. Nature 1997;388:434.
9.
Prentice AM. The thymus: a barometer of malnutrition. Br J Nutr 1999;81:345-347.
10.
Hasselbalch H, Nielsen MB, Jeppesen D, Pedersen JF, Karkov J: Sonographic measurement of the thymus in infants. Eur Radiol 1996;6:700-703.
11.
Hasselbalch H, Jeppesen DL, Engelmann MD, Michaelsen KF, Nielsen MB: Decreased thymus size in formula-fed infants compared with breastfed infants. Acta Paediatr 1996;85:1029-1032.
12.
Collinson AC, Moore SE, Cole TJ, Prentice AM: Birth season and environmental influences on patterns of thymic growth in rural Gambian infants. Acta Paediatr 2003;92:1014-1020.
13.
Moore SE, Prentice AM, Wagatsuma Y, Fulford AJ, Collinson AC, Raqib R, et al: Early-life nutritional and environmental determinants of thymic size in infants born in rural Bangladesh. Acta Paediatr 2009;98:1168-1175.
14.
Aaby P, Marx C, Trautner S, Rudaa D, Hasselbalch H, Jensen H, et al: Thymus size at birth is associated with infant mortality: a community study from Guinea-Bissau. Acta Paediatr 2002;91:698-703.
15.
Garly ML, Trautner SL, Marx C, Danebod K, Nielsen J, Ravn H, et al: Thymus size at 6 months of age and subsequent child mortality. J Pediatr 2008;153:683-688, 688.e1-e3.
16.
Moore SE, Fulford AJ, Wagatsuma Y, Persson LA, Arifeen SE, Prentice AM: Thymus development and infant and child mortality in rural Bangladesh. Int J Epidemiol 2014;43:216-223.
17.
Collinson AC, Ngom PT, Moore SE, Morgan G, Prentice AM: Birth season and environmental influences on blood leucocyte and lymphocyte subpopulations in rural Gambian infants. BMC Immunol 2008;9:18.
18.
Ngom PT, Collinson AC, Pido-Lopez J, Henson SM, Prentice AM, Aspinall R: Improved thymic function in exclusively breastfed infants is associated with higher interleukin 7 concentrations in their mothers' breast milk. Am J Clin Nutr 2004;80:722-728.
19.
Moore SE, Collinson AC, Prentice AM: Immune function in rural Gambian children is not related to season of birth, birth size, or maternal supplementation status. Am J Clin Nutr 2001;74:840-847.
20.
Ceesay SM, Prentice AM, Cole TJ, Foord F, Weaver LT, Poskitt EM, et al: Effects on birth weight and perinatal mortality of maternal dietary supplements in rural Gambia: 5 year randomised controlled trial. BMJ 1997;315:786-790.
21.
Moore SE, Fulford AJ, Darboe MK, Jobarteh ML, Jarjou LM, Prentice AM: A randomized trial to investigate the effects of pre-natal and infant nutritional supplementation on infant immune development in rural Gambia: the ENID trial: early nutrition and immune development. BMC Pregnancy Childbirth 2012;12:107.
22.
Moore SE, Jalil F, Ashraf R, Szu SC, Prentice AM, Hanson LA; Birth weight predicts response to vaccination in adults born in an urban slum in Lahore, Pakistan. Am J Clin Nutr 2004;80:453-459.
23.
Ngom PT, Solon J, Moore SE, Morgan G, Prentice AM, Aspinall R; Thymic function and T cell parameters in a natural human experimental model of seasonal infectious diseases and nutritional burden. J Biomed Sci 2011;18:41.
© 2017 S. Karger AG, Basel
2017
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