New insights into ending chronic disease.
Dr. David Barker is a physician and researcher. In 1989, with colleagues at the MRC Unit, University of Southampton, he discovered the relationship between birth weight and the lifetime risk for coronary heart disease. He showed that the lower the weight of a baby at birth and during infancy, the higher the risk for coronary heart disease in later life. The risk of heart disease falls across the entire range of birth weight. This implies that normal variations in the transfer of food from mothers to babies have profound long-term implications for the health of the next generation. Later studies showed that low birth weight is associated with an increased risk of hypertension, stroke and type 2 diabetes. This led to the 'Fetal Origins Hypothesis,' which proposes that coronary heart disease, and the diseases related to it, originates through responses to under nutrition during fetal life and infancy. These responses permanently change the body’s structure, physiology and metabolism. The hypothesis is strongly supported by studies in animals. David Barker has published more than three hundred papers and written or edited five books about the developmental origins of chronic disease.
Recent findings have shown that a woman’s body composition and diet at the time of conception and during pregnancy have important effects on the subsequent health of her offspring. The risk of later chronic disease is further increased if a baby has low weight gain after birth so that at two years it is thin or stunted. After the age of two, rapid gain in fatness further increases the risk of later coronary heart disease, hypertension and type 2 diabetes. These finding point to the importance of:
- protecting the nutrition and health of young women before and during pregnancy,
- protecting the growth of infants,
- avoiding rapid increase in fatness after the age of two years, especially in children who were thin at around two years of age, as part of the strategy to prevent chronic disease in later life.
Dr. Barker has been recognized internationally for his work: In 1998, he was elected as a Fellow of the Royal Society of London. He has received many honors and international awards. In 2003, by Her Royal Highness Princess Anne presented him with a personal award.
In his book, Nutrition In The Womb, he sets out how mother’s diets and children’s growth can protect against disease in later life.
In 1989 Dr. David Barker, working with colleagues at the Medical Research Council Unit, University of Southampton, showed for the first time that coronary heart disease, stroke and diabetes are more common in people who were born at term with low birthweight. Over the next twenty years he developed the concept that these diseases are initiated by malnutrition in the womb through a phenomenon known as “fetal programming”. This is now widely accepted. He retired as director of the MRC Unit in 2003, but remains a faculty member at Southampton University where he works with Professor Clive Osmond in continuing analyses of the Helsinki Birth Cohort. With his daughter Dr. Mary Barker he has established the Food Choice Group, an international network studying the food choices made by young women, and how these can be improved.
Dr. Barker has collaborated with Dr. Johan Eriksson and colleagues at the National Public Health Institute in Finland. The Helsinki Birth Cohort comprises 20,000 men and women who were born in Helsinki between 1924 and 1944. Each person has detailed information on their size at birth and growth through childhood. Their illnesses have been documented. To date these studies have produced 90 published papers. They have shown how the increased risk of coronary heart disease, type 2 diabetes, hypertension and stroke among people who were small at birth is modified by the way they grew as children. Recent publications focus on the way the mother’s body composition and diet combine with the shape and size of the placenta to program the baby. The group were recently awarded an NIH grant to study the developmental origins of ageing.
Seven years ago Dr. David Barker came to work with Dr. Kent Thornburg at the Heart Research Center, Oregon Health and Science University. The focus of their research is how the growth of the placenta, together with the mother’s nutrition, program the baby. The research combines continuing studies of the Helsinki Birth Cohort, which show the long term effects of placental size and maternal body size on later disease, and examination of placental growth and gene expression in pregnancies today. An ongoing study of mother’s nutrition and placental function has been established at Klamath Falls, in southern Oregon. In collaboration with Southampton the food choices of young women in Klamath Falls have been studied; and ways of improving these choices are now being explored.
Another part of the research at OHSU is the study of hormone levels in early pregnancy. New findings from the Helsinki cohort suggest that a female embryos exposure to sex hormones in the mothers’ blood may initiate cancers of the breast and ovary in later life.
With Dr. Dan Lackland and colleagues at the Medical University of South Carolina Dr. Barker has shown that people who had low birthweight are at increased risk of kidney failure. Another study has suggested that, when infant girls are malnourished, the way they handle food is changed in such a way that, as adults, they are less able to nourish their babies in the womb. The growth of the babies brain is impaired and their risk of stroke in later life is increased.
USA, Emory University. Dr Barker is collaborating with Professor Michelle Lampl at Emory University in studying how the growth of babies and children is controlled. Professor Lampl is known for her discovery that on most days children do not grow. Rather, they grow in short bursts, lasting a day or so. On other days they do not grow but accumulate food stores to prepare for these bursts of growth. This phenomenon is known as “saltatory growth”.
Much of our knowledge of what constitute optimal paths of early growth and development comes from studies of people born 50 and more years ago. The pattern of human growth has changed since that time, for example puberty occurs earlier. More data on today’s young people is needed. French children have detailed records of their growth from birth onwards. Dr. Barker is collaborating with Professor Umberto Simeoni and colleagues at the University of Marseille in a study of young adults that relates their childhood growth to their body composition, metabolic status and to the structure and function of their hearts, blood vessels and kidneys.
Because nutrition in the womb is important for long term health people whose mothers were severely malnourished during pregnancy are likely to have poor health. With Dr. Tessa Roseboom and colleagues at the Amsterdam Medical Centre, Dr. Barker has studied 1,000 men and women who were conceived around the time of the war-time famine in Holland. The studies show that these people have higher rates of diabetes and heart disease. The current focus of these studies is the effect of famine on placental programming.
In India many mothers are malnourished and the birth weights of most babies are towards the lower end of the range of birth weights seen in western countries. There are rising epidemics of diabetes and heart disease. Dr. Barker has collaborated with the SNEHA research group in India, which is coordinated by Dr. Caroline Fall from Southampton University. Their studies have shown that, similarly to western countries, small size at birth, and rapid weight gain after two years of age, are associated with an increased risk of diabetes. Dr. Barker is on the advisory board of the first randomized trial of preconception food supplementation for young women, which is being carried out in Mumbai.
Historically mothers in China have been severely malnourished and many babies born there today are small by western standards. Dr. Barker has collaborated with the Peking Union Medical College in studies of a group of men and women who were born in the hospital around 1950. The study showed for the first time that if mothers are thin during pregnancy their offspring have a greater risk of developing diabetes in later life.
In collaboration with the University of Southampton Dr. Barker assisted with the analysis of data from the Thai Longitudinal Study. These data comprise detailed records of the growth and development of 5000 children born in five different areas of Thailand in 2000. The focus of the study is how their growth, nutrition and activities influenced their cognitive development.
Dr. Barker is assisting Dr. Saleh Al-Wasel at the King Saud University, Riyadh, studying how maternal body composition and diet affect fetal and placental growth and placental gene expression.
Dr Barker is advising the Government’s Health Promotion Board on ways to improve the nutrition of girls and young women and hence to improve fetal nutrition across the country.
Until 2003, David Barker was Director of the Medical Research Council Environmental Epidemiology Unit and a Consultant Physician at Southampton University Hospitals. He trained as a physician at Guy’s Hospital, London, and thereafter at the Queen Elizabeth Centre, Birmingham. In 1966, he became a Lecturer in Clinical Medicine at the University of Birmingham. In 1969, he became a Lecturer in Preventive Medicine at Makerere University, Uganda. After 3 years, he moved to the University of Southampton, where he has remained. He continues to be Professor of Clinical Epidemiology at the University of Southampton, but in 2003, he was appointed Professor in Cardiovascular Medicine at Oregon Health & Science University.
BSc, First Class Hons (London)
PhD, MD, FRCP, FRS
Professor in Cardiovascular Medicine, Oregon Health & Science University
Professor of Clinical Epidemiology, University of Southampton
Director, MRC Environmental Epidemiology Unit, University of Southampton
Royal Society Wellcome Gold Medal - 1994
Royal College of Physicians Lord Rayner Medal - 1994
Caroline Walker Trust Science Award - 1994
Feldberg Foundation Medical and Biological Science Prize - 1995
Prince Mahidol Award - 2000
Danone International Nutrition Award - 2005
Arzobisro Gandarillas Medal, Catholic University of Chile - 2006
Fondation Ipsen Prize, Paris - 2007
Butterfield Award, NICHD, U.S. - 2007
Agnes Higgins Award, March of Dimes - 2010
The Gopalan Award, Nutrition Society of India - 2010
CBE - 2005
DSc, University of Birmingham - 2003
Royal College of Physicians - 1978
Travelling Fellowship, Royal College of Physicians - 1991
Honorary Fellow, Royal College of Obstetricians and Gynaecologists - 1993
Travelling Fellowship, Australian Academy of Science - 1994
Fellow of the Royal Society of London - 1998
Fellow of the Academy of Medical Science - 1999
Honorary Fellow of the Royal College of Pediatrics and Child Health - 2003
Honorary Fellow of the American Obstetrical and Gynecological Society - 2010
Presentations Since 2000
141 International invited guest speaker lectures
Recent Named Lectures
Spinoza Professor, University of Amsterdam, Netherlands - 2002
Robb Lecturer, University of Auckland, New Zealand - 2002
Croonian Lecturer, Royal College of Physicians, London - 2003
Shaw Lecturer, Royal College of Obstetricians and Gynaecologists, London - 2003
Tooley Lecture, University of California - 2003
Macallum Lecturer, University of Toronto - 2005
John Hunter Memorial Lecture, University of Newcastle, Australia - 2005
Kesten Lecturer, University of Southern California - 2006
Butterfield Award Lecture, Aspen Perinantal Biology Symposium - 2007
Ipsen Prize Lecture, American Gerontological Society - 2008
Cascade Lecture, International Congress of Nutrition - 2009
Brackington Lecture, University of Kindston, Canada - 2010
Agnes Higgins Award Lecture, American Public Health Association - 2010
Gopalan Oration, Nutrition Society of India - 2010
Committees and Societies
Society for Social Medicine
Association of Physicians of Britain and Ireland
MRC Physiological Systems and Disorders Board - 1988-1993
Independent Inquiry in to Inequalities in Health - 1998-1999
Council, Royal Society - 2000-2003