When in gestation do nutritional alterations exert their effects? A focus on the early origins of adult disease

Purpose of reviewWhilst the ‘early origins of adult disease’ hypothesis has focused primarily on the impact of early undernutrition, an increased fat and energy intake has recently become a dominant characteristic of the human diet. This review presents a summary of recent developments in understanding of how maternal overnutrition and undernutrition during critical windows of development program adult metabolic and cardiovascular disease. Recent findingsRecent evidence suggests that exposure to maternal overnutrition results in changes in the development of the energy balance regulating system that may be ‘maladaptive’ for life and result in an intergenerational cycle of obesity. Whilst activation of the fetal hypothalamo–pituitary–adrenal axis in response to a poor nutritional environment confers an early fitness advantage, it also incurs delayed health costs. Recent findings highlight that such tradeoffs may be anticipated from conception as changes in the periconceptional nutritional environment program the developmental trajectory of the hypothalamo–pituitary–adrenal axis. SummaryA better understanding of the long-term impact of overnutrition in early life and of changes in the nutritional environment of the embryo will provide insights into the timing and type of maternal dietary interventions required to improve metabolic health in adult life.