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PapersSizeatbirthandresiliencetoeffectsofpoorlivingconditionsinadultlife:longitudinalstudyDJPBarker,TForsén,AUutela,COsmond,JGErikssonAbstractObjectiveTodeterminewhethermenwhogrewslowlyinuteroorduringinfancyaremorevulnerabletothelatereffectsofpoorlivingconditionsoncoronaryheartdisease.
DesignFollowupstudyofmenforwhomthereweredataonbodysizeatbirthandgrowthandsocialclassduringchildhood,educationallevel,andsocialclassandincomeinadultlife.
SettingHelsinki,Finland.
Participants3676menwhowerebornduring1934-44,attendedchildwelfareclinicsinHelsinki,werestillresidentinFinlandin1971,andforwhomdatafromthe1980censuswereavailable.
MainoutcomemeasuresHospitaladmissionforordeathfromcoronaryheartdisease.
ResultsMenwhohadlowsocialclassorlowhouseholdincomeinadultlifehadincreasedratesofcoronaryheartdisease.
Thehazardratioamongmenwiththelowestannualincome(140(15700)45/7341.
000.
002111-140(15700)61/7761.
34(0.
91to1.
96)96-110(12400)41/5951.
26(0.
82to1.
92)75-95(10700)64/7471.
52(1.
03to2.
22)118(13300)1.
001.
74(1.
03to2.
94)2.
05(1.
20to3.
50)87-118(13300)0.
92(0.
39to2.
14)1.
79(1.
07to2.
99)1.
63(0.
97to2.
74)26.
0(n=2154)Hazardratio(95%CI)Unadjusted(adjusted)PvaluefortrendHazardratio(95%CI)Unadjusted(adjusted)PvaluefortrendInfancyFather'ssocialclass:Uppermiddle1.
000.
06(0.
41*)0.
76(0.
32to1.
84)0.
006(0.
02*)Lowermiddle1.
52(0.
71to3.
27)1.
05(0.
49to2.
27)Labourer1.
86(0.
94to3.
68)1.
60(0.
81to3.
16)EducationLevelofeducation:High1.
000.
0040.
60(0.
30to1.
20)0.
007Middle1.
29(0.
73to2.
27)1.
50(0.
88to2.
55)Low2.
00(1.
17to3.
42)1.
47(0.
86to2.
51)Adultlife(1980)Socialclass:Higherofficial1.
00140(15700)1.
00<0.
0001(0.
0001)1.
19(0.
65to2.
19)0.
75(0.
84)111-140(15700)1.
54(0.
83to2.
87)1.
42(0.
78to2.
57)96-110(12400)1.
07(0.
51to2.
22)1.
66(0.
90to3.
07)76-95(10700)2.
07(1.
13to3.
79)1.
44(0.
79to2.
62)<75(8400)2.
58(1.
45to4.
60)1.
37(0.
75to2.
51)*Adjustedforadultsocialclass.
Adjustedforfather'ssocialclass.
Table4Hazardratiosforcoronaryheartdiseaseinmenwithponderalindexatbirth<26kg/m3,accordingtoadultsocialclassandchangesinbodymassindex(BMI)betweenages1and12yearsSocialclassChangeinSDscoreforBMIDecrease*IncreaseHigherofficial1.
38(0.
55to3.
52)1.
00Lowerofficial1.
14(0.
38to3.
40)1.
84(0.
70to4.
85)Selfemployed0.
69(0.
09to5.
62)2.
93(0.
86to10.
01)Labourer2.
18(0.
88to5.
39)3.
78(1.
68to8.
53)*P=0.
24fortrend.
P<0.
0001fortrend.
Papers3BMJVOLUME3231DECEMBER2001bmj.
comon8November2020byguest.
Protectedbycopyright.
http://www.
bmj.
com/BMJ:firstpublishedas10.
1136/bmj.
323.
7324.
1273on1December2001.
DownloadedfromInfantgrowthandsocialclassAshaspreviouslybeenshown,wefoundthathavingafatherwithlowsocialclassincreasedtheriskofcoron-aryheartdiseaseindependentlyofaman'sownsocialclass.
10–13Growthduringinfancywasreducedinfamiliesoflowsocialclass,andpoorinfantgrowthisassociatedwithincreasedriskofdisease,possiblythroughalteredlivergrowthandconsequentre-programmingoflipidmetabolismandbloodcoagulation.
1415Theeffectsoflowsocialclassoncoronaryheartdisease,however,wereonlypartlyexplainedbytheireffectoninfantgrowth.
Itsothereffectscouldbelinkedtoitsstrongassociationwithpooreducationalattainment.
EducationWefoundthatpooreducationalattainmentwasassoci-atedwithlatercoronaryheartdisease.
Menwhoachievedonlylowlevelsofeducationhadreducedinfantgrowth,butthisexplainedonlyasmallpartoftheassociation.
OnepossibleexplanationhasbeensuggestedbyafollowupstudyofchildrenborninAberdeen,Scotland.
16Thosewhohadlowerscoresinamentalabilitytestat12yearsofagediedyounger.
WhalleyandDrearyproposedthatperformanceinintelligencetestsmightreflectgeneralaspectsofchild-hoodfitnessrelatedtolongtermhealth.
Greaterintel-ligenceandhigherlevelsofeducationcouldalsobeassociatedwithhealthierbehaviourinadultlife.
LivingstandardsinadultlifeAsexpected,lowsocialclassandlowincomewereassociatedwithincreasedratesofcoronaryheartdisease.
71718Wefound,however,thattheseeffectswerestrongerinmenwhowerethinatbirth,especiallyiftheyhadhadacceleratedweightgaininchildhood.
Taxablehouseholdincomewasstronglyrelatedtoeducationalattainment.
Wefoundthatbetteredu-cationalattainmentprotectedmenfromtheharmfuleffectsoflowincome.
Thewayinwhichlowincomemayincreasecardiovascularriskiscontroversial.
Lynchetalhaveemphasisedthematerialconsequencesoflowincomeonlivingconditions.
19Whilebettereduca-tionmayenablepeopletoreducetheeffectsoflowincomeontheirlivingstandards,itissurprisingthatwefoundnoeffectofincomeonceeducationwastakenintoaccount.
MarmotandWilkinsonhaveemphasisedthepsychosocialconsequencesofalowpositioninthesocialhierarchy,asindicatedbylowincome,andsuggestedthatperceptionsoflowsocialstatusandlackofsuccessleadtochangesinneuroendocrinepathwaysandhencetodisease.
20Ourfindingsseemconsistentwiththishypothesis,althoughtheypointtotheimportanceofahierarchydefinedbyeducationratherthanincome.
Thehypothesiscouldalsoexplainwhy,inourstudy,lowincomewasassociatedwithcoronaryheartdiseaseonlyinavulnerablegroupdefinedbylowratesofintrauterinegrowth.
Peoplewhoaresmallatbirthareknowntohavepersistingalterationsinresponsestostress,includingraisedserumcortisolconcentrations.
21Rapidchildhoodweightgainmayexacerbatetheadverseeffectsofsmallsizeatbirth.
22ConclusionOurresultsshowthatstudiesofthedevelopmentalori-ginsofcoronaryheartdiseasemayrevealnewbiologi-calpathwaysthroughwhichsocialinfluencesaffecttheriskofdisease.
23Peoplewhoserateofgrowthinfetallife,infancy,andchildhooddiffersfromthenormremainbiologicallydifferentandareatincreasedriskofcoronaryheartdisease.
Socialinfluencesthataltergrowthmaythereforealtertheriskofdisease.
Conversely,alteredearlygrowthmayincreasevulner-abilitytotheeffectsofpoorlivingstandardsinadultlife.
Therefore,improvementsinfetal,infant,andchildgrowthmaypreventcoronaryheartdiseaseinthenextgenerationbyimprovingthebody'sfitnessandmakingitresilienttolatersocialadversity.
WethankTerttuNopanen,TiinaSaarinen,Hillevifverstrm-Anttila,ArjaPurtonen,TiinaValle,HannaPehkonen,andUllaTarvainenforabstractingthedatafromtherecords.
SigridRos-tenwasresponsiblefordatamanagement.
LiisaToivanencoor-dinateddataabstraction.
Contributors:Alltheauthorstookpartinthedesignandanalysisofthestudyandjointlywrotethepaper.
ThedataabstractionandlinkageweresupervisedbyJGEandTF.
JGE,CO,andDJPBwillactasguarantorsforthepaper.
Funding:BritishHeartFoundation,JahnssonFoundation,FinskaLkaresllskapet,NovoFoundation.
Competinginterests:Nonedeclared.
1MarmotMG,ShipleyMJ,RoseG.
Inequalitiesindeath—specificexplana-tionsofageneralpatternLancet1984;i:1003-6.
2WaalerHT.
Height,weightandmortality.
TheNorwegianexperience.
ActaMedScandSuppl1984;679:1-56.
3BarkerDJP,WinterPD,OsmondC,MargettsB,SimmondsSJ.
Weightininfancyanddeathfromischaemicheartdisease.
Lancet1989;ii:577-80.
4LeonDA,LithellHO,VageroD,KoupilovaI,MohsenR,BerglundL,etal.
Reducedfetalgrowthrateandincreasedriskofdeathfromischaemicheartdisease:cohortstudyof15000Swedishmenandwomenborn1915-29.
BMJ1998;317:241-5.
5ErikssonJG,ForsenT,TuomilehtoJ,WinterPD,OsmondC,BarkerDJP.
Catch-upgrowthinchildhoodanddeathfromcoronaryheartdisease:longitudinalstudy.
BMJ1999;318:427-31.
6ErikssonJG,ForsenT,TuomilehtoJ,OsmondC,BarkerDJP.
Earlygrowthandcoronaryheartdiseaseinlaterlife:longitudinalstudy.
BMJ2001;322:949-53.
7AchesonD.
Independentinquiryintoinequalitiesinhealth.
London:HMStationeryOffice,1998.
8HavenH.
EducationinFinland.
Helsinki:PainoCenterrOy,1998(OfficialStatisticsofFinland).
9CoxDR.
Regressionmodelsandlife-tables.
JRStatSoc[SerB]1972;34:187-220.
10ForsdahlA.
ArepoorlivingconditionsinchildhoodandadolescenceanimportantriskfactorforarterioscleroticheartdiseaseBrJPrevSocMed1977;31:91-5.
11LynchJW,KaplanGA,CohenRD,KauhanenJ,WilsonTW,SmithNL,etal.
ChildhoodandadultsocioeconomicstatusaspredictorsofmortalityinFinland.
Lancet1994;343:524-7.
12WannametheeSG,WhincupPH,ShaperG,WalkerM.
Influenceoffathers'socialclassoncardiovasculardiseaseinmiddle-agedmen.
Lancet1996;348:1259-63.
13DaveySmithG,HartC,BlaneD,HoleD.
Adversesocioeconomiccondi-tionsinchildhoodandcausespecificadultmortality:prospectiveobser-vationalstudy.
BMJ1998;316:1631-5.
14FallCHD,BarkerDJP,OsmondC,WinterPD,ClarkPMS,HalesCN.
Relationofinfantfeedingtoadultserumcholesterolconcentrationanddeathfromischaemicheartdisease.
BMJ1992;304:801-5.
WhatisalreadyknownonthistopicPeoplewhogrowslowlyinuteroandduringinfancyremainbiologicallydifferentthroughtheirlivesSuchpeopleareatincreasedriskofcoronaryheartdiseaseWhatthisstudyaddsAmongmenwhowerethinatbirththeriskofcoronaryheartdiseaseisfurtherincreasediftheyhavepoorlivingstandardsinadultlifeOthermentendtoberesilienttotheadverseeffectsofpoorlivingstandardsPapers4BMJVOLUME3231DECEMBER2001bmj.
comon8November2020byguest.
Protectedbycopyright.
http://www.
bmj.
com/BMJ:firstpublishedas10.
1136/bmj.
323.
7324.
1273on1December2001.
Downloadedfrom15BarkerDJP,MeadeTW,FallCHD,LeeA,OsmondC,PhippsK,etal.
RelationoffetalandinfantgrowthtoplasmafibrinogenandfactorVIIconcentrationsinadultlife.
BMJ1992;304:148-52.
16WhalleyLJ,DearyIJ.
LongitudinalcohortstudyofchildhoodIQandsur-vivaluptoage76.
BMJ2001;322:819-22.
17MarmotM,McDowellME.
Mortalitydeclineandwideningsocialinequalities.
Lancet1986;ii:274-6.
18MacintyreK,StewartS,ChalmersJ,PellJ,FinlaysonA,BoydJ,etal.
Rela-tionbetweensocioeconomicdeprivationanddeathfromafirstmyocar-dialinfarctioninScotland:populationbasedanalysis.
BMJ2001;322:1152-3.
19LynchJW,DaveySmithG,KaplanGA,HouseJS.
Incomeinequalityandmortality:importancetohealthofindividualincome,psychosocialenvi-ronment,ormaterialconditions.
BMJ2000;320:1200-4.
20MarmotM,WilkinsonRG.
Psychosocialandmaterialpathwaysintherelationbetweenincomeandhealth:aresponsetoLynchetal.
BMJ2001;322:1233-6.
21PhillipsDIW,WalkerBR,ReynoldsRM,FlanaghanDEH,WoodPJ,OsmondC,etal.
Lowbirthweightpredictselevatedplasmacortisolcon-centrationsinadultsfrom3populations.
Hypertension2000;35:1301-6.
22ForsenT,ErikssonJ,TuomilhetoJ,ReunanenA,OsmondC,BarkerDJP.
Thefetalandchildhoodgrowthofpersonswhodeveloptype2diabetes.
AnnInternMed2000;133:176-82.
23DickensP.
Linkingthesocialandnaturalsciences:iscapitalmodifyinghumanbiologyinitsownimage.
Sociology2001;35:93-110.
(Accepted29August2001)Papers5BMJVOLUME3231DECEMBER2001bmj.
comon8November2020byguest.
Protectedbycopyright.
http://www.
bmj.
com/BMJ:firstpublishedas10.
1136/bmj.
323.
7324.
1273on1December2001.
Downloadedfrom
DesignFollowupstudyofmenforwhomthereweredataonbodysizeatbirthandgrowthandsocialclassduringchildhood,educationallevel,andsocialclassandincomeinadultlife.
SettingHelsinki,Finland.
Participants3676menwhowerebornduring1934-44,attendedchildwelfareclinicsinHelsinki,werestillresidentinFinlandin1971,andforwhomdatafromthe1980censuswereavailable.
MainoutcomemeasuresHospitaladmissionforordeathfromcoronaryheartdisease.
ResultsMenwhohadlowsocialclassorlowhouseholdincomeinadultlifehadincreasedratesofcoronaryheartdisease.
Thehazardratioamongmenwiththelowestannualincome(140(15700)45/7341.
000.
002111-140(15700)61/7761.
34(0.
91to1.
96)96-110(12400)41/5951.
26(0.
82to1.
92)75-95(10700)64/7471.
52(1.
03to2.
22)118(13300)1.
001.
74(1.
03to2.
94)2.
05(1.
20to3.
50)87-118(13300)0.
92(0.
39to2.
14)1.
79(1.
07to2.
99)1.
63(0.
97to2.
74)26.
0(n=2154)Hazardratio(95%CI)Unadjusted(adjusted)PvaluefortrendHazardratio(95%CI)Unadjusted(adjusted)PvaluefortrendInfancyFather'ssocialclass:Uppermiddle1.
000.
06(0.
41*)0.
76(0.
32to1.
84)0.
006(0.
02*)Lowermiddle1.
52(0.
71to3.
27)1.
05(0.
49to2.
27)Labourer1.
86(0.
94to3.
68)1.
60(0.
81to3.
16)EducationLevelofeducation:High1.
000.
0040.
60(0.
30to1.
20)0.
007Middle1.
29(0.
73to2.
27)1.
50(0.
88to2.
55)Low2.
00(1.
17to3.
42)1.
47(0.
86to2.
51)Adultlife(1980)Socialclass:Higherofficial1.
00140(15700)1.
00<0.
0001(0.
0001)1.
19(0.
65to2.
19)0.
75(0.
84)111-140(15700)1.
54(0.
83to2.
87)1.
42(0.
78to2.
57)96-110(12400)1.
07(0.
51to2.
22)1.
66(0.
90to3.
07)76-95(10700)2.
07(1.
13to3.
79)1.
44(0.
79to2.
62)<75(8400)2.
58(1.
45to4.
60)1.
37(0.
75to2.
51)*Adjustedforadultsocialclass.
Adjustedforfather'ssocialclass.
Table4Hazardratiosforcoronaryheartdiseaseinmenwithponderalindexatbirth<26kg/m3,accordingtoadultsocialclassandchangesinbodymassindex(BMI)betweenages1and12yearsSocialclassChangeinSDscoreforBMIDecrease*IncreaseHigherofficial1.
38(0.
55to3.
52)1.
00Lowerofficial1.
14(0.
38to3.
40)1.
84(0.
70to4.
85)Selfemployed0.
69(0.
09to5.
62)2.
93(0.
86to10.
01)Labourer2.
18(0.
88to5.
39)3.
78(1.
68to8.
53)*P=0.
24fortrend.
P<0.
0001fortrend.
Papers3BMJVOLUME3231DECEMBER2001bmj.
comon8November2020byguest.
Protectedbycopyright.
http://www.
bmj.
com/BMJ:firstpublishedas10.
1136/bmj.
323.
7324.
1273on1December2001.
DownloadedfromInfantgrowthandsocialclassAshaspreviouslybeenshown,wefoundthathavingafatherwithlowsocialclassincreasedtheriskofcoron-aryheartdiseaseindependentlyofaman'sownsocialclass.
10–13Growthduringinfancywasreducedinfamiliesoflowsocialclass,andpoorinfantgrowthisassociatedwithincreasedriskofdisease,possiblythroughalteredlivergrowthandconsequentre-programmingoflipidmetabolismandbloodcoagulation.
1415Theeffectsoflowsocialclassoncoronaryheartdisease,however,wereonlypartlyexplainedbytheireffectoninfantgrowth.
Itsothereffectscouldbelinkedtoitsstrongassociationwithpooreducationalattainment.
EducationWefoundthatpooreducationalattainmentwasassoci-atedwithlatercoronaryheartdisease.
Menwhoachievedonlylowlevelsofeducationhadreducedinfantgrowth,butthisexplainedonlyasmallpartoftheassociation.
OnepossibleexplanationhasbeensuggestedbyafollowupstudyofchildrenborninAberdeen,Scotland.
16Thosewhohadlowerscoresinamentalabilitytestat12yearsofagediedyounger.
WhalleyandDrearyproposedthatperformanceinintelligencetestsmightreflectgeneralaspectsofchild-hoodfitnessrelatedtolongtermhealth.
Greaterintel-ligenceandhigherlevelsofeducationcouldalsobeassociatedwithhealthierbehaviourinadultlife.
LivingstandardsinadultlifeAsexpected,lowsocialclassandlowincomewereassociatedwithincreasedratesofcoronaryheartdisease.
71718Wefound,however,thattheseeffectswerestrongerinmenwhowerethinatbirth,especiallyiftheyhadhadacceleratedweightgaininchildhood.
Taxablehouseholdincomewasstronglyrelatedtoeducationalattainment.
Wefoundthatbetteredu-cationalattainmentprotectedmenfromtheharmfuleffectsoflowincome.
Thewayinwhichlowincomemayincreasecardiovascularriskiscontroversial.
Lynchetalhaveemphasisedthematerialconsequencesoflowincomeonlivingconditions.
19Whilebettereduca-tionmayenablepeopletoreducetheeffectsoflowincomeontheirlivingstandards,itissurprisingthatwefoundnoeffectofincomeonceeducationwastakenintoaccount.
MarmotandWilkinsonhaveemphasisedthepsychosocialconsequencesofalowpositioninthesocialhierarchy,asindicatedbylowincome,andsuggestedthatperceptionsoflowsocialstatusandlackofsuccessleadtochangesinneuroendocrinepathwaysandhencetodisease.
20Ourfindingsseemconsistentwiththishypothesis,althoughtheypointtotheimportanceofahierarchydefinedbyeducationratherthanincome.
Thehypothesiscouldalsoexplainwhy,inourstudy,lowincomewasassociatedwithcoronaryheartdiseaseonlyinavulnerablegroupdefinedbylowratesofintrauterinegrowth.
Peoplewhoaresmallatbirthareknowntohavepersistingalterationsinresponsestostress,includingraisedserumcortisolconcentrations.
21Rapidchildhoodweightgainmayexacerbatetheadverseeffectsofsmallsizeatbirth.
22ConclusionOurresultsshowthatstudiesofthedevelopmentalori-ginsofcoronaryheartdiseasemayrevealnewbiologi-calpathwaysthroughwhichsocialinfluencesaffecttheriskofdisease.
23Peoplewhoserateofgrowthinfetallife,infancy,andchildhooddiffersfromthenormremainbiologicallydifferentandareatincreasedriskofcoronaryheartdisease.
Socialinfluencesthataltergrowthmaythereforealtertheriskofdisease.
Conversely,alteredearlygrowthmayincreasevulner-abilitytotheeffectsofpoorlivingstandardsinadultlife.
Therefore,improvementsinfetal,infant,andchildgrowthmaypreventcoronaryheartdiseaseinthenextgenerationbyimprovingthebody'sfitnessandmakingitresilienttolatersocialadversity.
WethankTerttuNopanen,TiinaSaarinen,Hillevifverstrm-Anttila,ArjaPurtonen,TiinaValle,HannaPehkonen,andUllaTarvainenforabstractingthedatafromtherecords.
SigridRos-tenwasresponsiblefordatamanagement.
LiisaToivanencoor-dinateddataabstraction.
Contributors:Alltheauthorstookpartinthedesignandanalysisofthestudyandjointlywrotethepaper.
ThedataabstractionandlinkageweresupervisedbyJGEandTF.
JGE,CO,andDJPBwillactasguarantorsforthepaper.
Funding:BritishHeartFoundation,JahnssonFoundation,FinskaLkaresllskapet,NovoFoundation.
Competinginterests:Nonedeclared.
1MarmotMG,ShipleyMJ,RoseG.
Inequalitiesindeath—specificexplana-tionsofageneralpatternLancet1984;i:1003-6.
2WaalerHT.
Height,weightandmortality.
TheNorwegianexperience.
ActaMedScandSuppl1984;679:1-56.
3BarkerDJP,WinterPD,OsmondC,MargettsB,SimmondsSJ.
Weightininfancyanddeathfromischaemicheartdisease.
Lancet1989;ii:577-80.
4LeonDA,LithellHO,VageroD,KoupilovaI,MohsenR,BerglundL,etal.
Reducedfetalgrowthrateandincreasedriskofdeathfromischaemicheartdisease:cohortstudyof15000Swedishmenandwomenborn1915-29.
BMJ1998;317:241-5.
5ErikssonJG,ForsenT,TuomilehtoJ,WinterPD,OsmondC,BarkerDJP.
Catch-upgrowthinchildhoodanddeathfromcoronaryheartdisease:longitudinalstudy.
BMJ1999;318:427-31.
6ErikssonJG,ForsenT,TuomilehtoJ,OsmondC,BarkerDJP.
Earlygrowthandcoronaryheartdiseaseinlaterlife:longitudinalstudy.
BMJ2001;322:949-53.
7AchesonD.
Independentinquiryintoinequalitiesinhealth.
London:HMStationeryOffice,1998.
8HavenH.
EducationinFinland.
Helsinki:PainoCenterrOy,1998(OfficialStatisticsofFinland).
9CoxDR.
Regressionmodelsandlife-tables.
JRStatSoc[SerB]1972;34:187-220.
10ForsdahlA.
ArepoorlivingconditionsinchildhoodandadolescenceanimportantriskfactorforarterioscleroticheartdiseaseBrJPrevSocMed1977;31:91-5.
11LynchJW,KaplanGA,CohenRD,KauhanenJ,WilsonTW,SmithNL,etal.
ChildhoodandadultsocioeconomicstatusaspredictorsofmortalityinFinland.
Lancet1994;343:524-7.
12WannametheeSG,WhincupPH,ShaperG,WalkerM.
Influenceoffathers'socialclassoncardiovasculardiseaseinmiddle-agedmen.
Lancet1996;348:1259-63.
13DaveySmithG,HartC,BlaneD,HoleD.
Adversesocioeconomiccondi-tionsinchildhoodandcausespecificadultmortality:prospectiveobser-vationalstudy.
BMJ1998;316:1631-5.
14FallCHD,BarkerDJP,OsmondC,WinterPD,ClarkPMS,HalesCN.
Relationofinfantfeedingtoadultserumcholesterolconcentrationanddeathfromischaemicheartdisease.
BMJ1992;304:801-5.
WhatisalreadyknownonthistopicPeoplewhogrowslowlyinuteroandduringinfancyremainbiologicallydifferentthroughtheirlivesSuchpeopleareatincreasedriskofcoronaryheartdiseaseWhatthisstudyaddsAmongmenwhowerethinatbirththeriskofcoronaryheartdiseaseisfurtherincreasediftheyhavepoorlivingstandardsinadultlifeOthermentendtoberesilienttotheadverseeffectsofpoorlivingstandardsPapers4BMJVOLUME3231DECEMBER2001bmj.
comon8November2020byguest.
Protectedbycopyright.
http://www.
bmj.
com/BMJ:firstpublishedas10.
1136/bmj.
323.
7324.
1273on1December2001.
Downloadedfrom15BarkerDJP,MeadeTW,FallCHD,LeeA,OsmondC,PhippsK,etal.
RelationoffetalandinfantgrowthtoplasmafibrinogenandfactorVIIconcentrationsinadultlife.
BMJ1992;304:148-52.
16WhalleyLJ,DearyIJ.
LongitudinalcohortstudyofchildhoodIQandsur-vivaluptoage76.
BMJ2001;322:819-22.
17MarmotM,McDowellME.
Mortalitydeclineandwideningsocialinequalities.
Lancet1986;ii:274-6.
18MacintyreK,StewartS,ChalmersJ,PellJ,FinlaysonA,BoydJ,etal.
Rela-tionbetweensocioeconomicdeprivationanddeathfromafirstmyocar-dialinfarctioninScotland:populationbasedanalysis.
BMJ2001;322:1152-3.
19LynchJW,DaveySmithG,KaplanGA,HouseJS.
Incomeinequalityandmortality:importancetohealthofindividualincome,psychosocialenvi-ronment,ormaterialconditions.
BMJ2000;320:1200-4.
20MarmotM,WilkinsonRG.
Psychosocialandmaterialpathwaysintherelationbetweenincomeandhealth:aresponsetoLynchetal.
BMJ2001;322:1233-6.
21PhillipsDIW,WalkerBR,ReynoldsRM,FlanaghanDEH,WoodPJ,OsmondC,etal.
Lowbirthweightpredictselevatedplasmacortisolcon-centrationsinadultsfrom3populations.
Hypertension2000;35:1301-6.
22ForsenT,ErikssonJ,TuomilhetoJ,ReunanenA,OsmondC,BarkerDJP.
Thefetalandchildhoodgrowthofpersonswhodeveloptype2diabetes.
AnnInternMed2000;133:176-82.
23DickensP.
Linkingthesocialandnaturalsciences:iscapitalmodifyinghumanbiologyinitsownimage.
Sociology2001;35:93-110.
(Accepted29August2001)Papers5BMJVOLUME3231DECEMBER2001bmj.
comon8November2020byguest.
Protectedbycopyright.
http://www.
bmj.
com/BMJ:firstpublishedas10.
1136/bmj.
323.
7324.
1273on1December2001.
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Tudcloud(月付7.2美元),香港VPS,可选大带宽或不限流量
Tudcloud是一家新开的主机商，提供VPS和独立服务器租用，数据中心在中国香港(VPS和独立服务器)和美国洛杉矶(独立服务器)，商家VPS基于KVM架构，开设在香港机房，可以选择限制流量大带宽或者限制带宽不限流量套餐。目前提供8折优惠码，优惠后最低每月7.2美元起。虽然主机商网站为英文界面，但是支付方式仅支付宝和Stripe，可能是国人商家。下面列出部分VPS主机套餐配置信息。CPU：1cor...
易探云美国云服务器评测，主机低至33元/月,336元/年
美国服务器哪家平台好?美国服务器无需备案，即开即用，上线快。美国服务器多数带防御，且有时候项目运营的时候，防御能力是用户考虑的重点，特别是网站容易受到攻击的行业。现在有那么多美国一年服务器，哪家的美国云服务器好呢？美国服务器用哪家好?这里推荐易探云，有美国BGP、美国CN2、美国高防、美国GIA等云服务器，线路优化的不错。易探云刚好就是做香港及美国云服务器的主要商家之一，我们来看一下易探云美国云服...
paypal$10的代金券，选购美国VPS
paypal贝宝可撸$10的代金券!这两天paypal出了活动，本次并没有其他的限制，只要注册国区的paypal，使用国内的手机号和62开头的银联卡，就可以获得10美元的代金券，这个代金券购买产品需要大于10.1美元，站长给大家推荐几个方式，可以白嫖一年的VPS，有需要的朋友可以看看比较简单。PayPal送10美元活动：点击直达活动sfz与绑定卡的号码可以重复用 注册的邮箱，手机号与绑的银联卡必须...
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