Wit J M
Leids Universitair Medisch Centrum, afd. Kindergeneeskunde, J6-S, Postbus 9600, 2300 RC Leiden.
Ned Tijdschr Geneeskd. 2000 Dec 23;144(52):2491-5.
The Barker hypothesis states that there are foetal origins of adult disease. The hypothesis is primarily based on epidemiological associations between indicators of foetal malnutrition and mortality and morbidity in adulthood. The first association reported was between birth weight and coronary heart disease. Similar associations were found between birth weight and stroke, hypertension, type 2 diabetes mellitus, insulin resistance, serum lipids, and premature pubarche. In non-industrialized countries the associations appear to be even stronger. Although the Barker hypothesis has been criticized, the evidence from epidemiological studies and animal experiments appears sufficient to test it further and to consider the possible consequences for the physician. The first consequence could be that in taking a medical history from adults the physician should collect information about intrauterine growth. To facilitate this, communication between obstetricians, specialists in preventive child health care and paediatricians on the one hand and general practitioners and physicians on the other ought to be improved. A low birth weight, particularly smallness for gestational age, can be communicated to the adult patient as a potential risk factor for the diseases mentioned above and an extra reason to abstain from smoking and to avoid overweight.
巴克假说指出，成人疾病存在胎儿起源。该假说主要基于胎儿营养不良指标与成人死亡率和发病率之间的流行病学关联。首次报道的关联是出生体重与冠心病之间的关联。在出生体重与中风、高血压、2型糖尿病、胰岛素抵抗、血脂以及青春期早熟之间也发现了类似的关联。在非工业化国家，这些关联似乎更强。尽管巴克假说受到了批评，但流行病学研究和动物实验的证据似乎足以进一步对其进行检验，并考虑其对医生可能产生的影响。第一个影响可能是，医生在为成年人采集病史时，应收集有关子宫内生长的信息。为便于做到这一点，一方面产科医生、儿童预防保健专家和儿科医生，另一方面全科医生和其他医生之间的沟通应得到改善。低出生体重，尤其是小于胎龄儿，可以告知成年患者，这是上述疾病的潜在危险因素，也是戒烟和避免超重的额外理由。
