DOHaD in developing nations: A systematic review exploring gaps in DOHaD population studies

Abstract

Background/Aims: The developmental origins of health and disease (DOHaD) paradigm asserts that early-life environmental factors can influence later chronic disease risk. The aim of this review is to identify where these investigations take place, and whether, given the burden of non-communicable diseases (NCDs) in lower-middle income countries, this focus is appropriate and ethical. Studies must investigate on the relationship between the early nutritional environment and later non-communicable disease risk in childhood, adolescence and adulthood. Method: A systematic review was conducted covering publications up to 23 May 2018. A search for literature was conducted in three electronic databases: Medline, EMBASE (both accessed via Ovid) and Scopus. To be included, the studies must have been original, observational DOHaD studies published in academic articles that link maternal nutritional environmental exposures or birth factors to later NCD prevalence or risk. After full text reviews, 138 studies were included in the final review. Results: Of the 138 studies included in this review, 50.3% were based on data from Western Europe, 15.7% from East Asia, 12.5% from North America, 8.1% from Latin America and the Caribbean, 5% from Australasia, 3.1% from South Asia, 1.9% from both the Middle East and the Africas and 1.2% Central Asia. Additionally, this review found that only 4% of studies were based in lower-middle income countries, despite holding 80% of the non-communicable disease burden. Conclusions: There is a disconnect between the regions highly burdened by NCDs and the areas where most of the DOHaD research occurs. As it stands, majority of research and funding is focused on high income countries with little emphasis given to lower income nations or indigenous populations whom have higher rates of NCDs and poor outcomes. To improve health for vulnerable communities in both developed and developing nations, there needs to be more resources put towards these burdened populations whom may benefit most from DOHaD research and related strategies.