How can the Developmental Origins of Health and Disease (DOHaD) hypothesis contribute to improving health in developing countries?

Abstract

The relevance of nutrition during pregnancy and early infancy in defining short-term health and survival has been well established. However, the Developmental Origins of Health and Disease (DOHaD) paradigm provides a framework to assess the effect of early nutrition and growth on long-term health. This body of literature shows that early nutrition has significant consequences on later health and well-being. In this article, we briefly present the main consequences of malnutrition that affect human growth and development and consider how the DOHaD paradigm, with its evolutionary implications, might contribute to better addressing the challenge of improving nutrition. We examine how this paradigm is particularly appropriate in understanding the health and nutrition transition in countries that face the double burden of nutrition-related diseases (acute malnutrition coexisting with obesity and other chronic diseases). We focus on stunting (low height-for-age) to examine the short- as well as long-term consequences of early malnutrition with a life-course, transgenerational, and multidisciplinary perspective. We present current global and regional prevalence of stunting and discuss the need to reposition maternal and infant nutrition not only in health and nutrition intervention programs but also in consideration of the emerging research questions that should be resolved to better orient program and policy decisions.

FIGURE 1

Schema representing short- and long-term consequences of nutrition-gene-environment conditions in early life on relevant health and disease outcomes that have potential social and economic effect. Adapted and modified from reference . HD, heart disease; BP, blood pressure; CHO, carbohydrates.

FIGURE 2

Total cost of undernutrition [in dollars and as a percentage of gross national product (GNP) 2004–2005] for selected Latin-American countries studied by the Economic Commission for Latin America and the Caribbean. Data are based on information on incomes, schooling, and educational costs of each country. Adapted and modified from references and . VEN, Venezuela; CRI, Costa Rica; PAR, Paraguay; PAN, Panama; PER, Peru; COL, Colombia; ECU, Ecuador; RDO, Dominican Republic; NIC, Nicaragua; BOL, Bolivia; ELS, El Salvador; HON, Honduras; GUA, Guatemala.

FIGURE 3

Percentage distribution of the economic costs of undernutrition by specific sector for selected Latin-American countries studied by the Economic Commission for Latin America and the Caribbean. Adapted and modified from references and .