IMPACT OF BIRTH-WEIGHT ON ADULT MINOR ILLNESS

There is now well-established evidence that low birthweight has important health implications beyond infancy and childhood as suggested by the fetal origins of disease theory1. It postulates that in utero under-nutrition leads to permanent changes to the physiology and metabolism of the body, in part explaining the higher incidence of cardiovascular illnesses,2,3 stroke,4 and type 2 diabetes5 in that population. In addition, lower birthweight is associated with higher mortality rates from all causes6 . An area where the evidence is still in early stages is that of the link between birthweight and adult minor illnesses. These conditions include common cold and viral respiratory tract infections, headache and gastrointestinal disturbances and account for between 18-40% of the general practitioner’s time7,8. Minor illnesses also have significant economic impact. They were estimated to cost the UK’s National Health Service (NHS) $2.2 billion per year7 and lead to significant workabsenteeism9 . Such disease-related economic impact led not only to an emphasis on promoting self-care measures for minor ailments,10 but also an attempt to better understand its epidemiology. Previous work by Belingham-Young11 introduced the notion that birthweight may be related to adult minor illness. Until now, such notion only garnered limited attention and the current study by the same group filled this important knowledge gap12. In this cross-sectional retrospective cohort study, the authors used a minor illness checklist completed by 258 participants (219 female, 39 male) who identify themselves as having been born at term and knew their birthweight. A median split of the total scores was used to divide the participants into low and high minor illness groups. They were also grouped based on optimal (3,500 – 4,500 grams) and suboptimal birthweight (2540 – 3490 grams). Interestingly, minor illness scores were significantly lower for those in the optimal birthweight, and there was a significant negative correlation between birthweight and minor illness score. The authors argue that their findings have significant public health implications. Health care prevention initiatives favoring individuals of suboptimal birth weights may have a positive impact on the frequency and severity of minor infection-related illnesses. As suggested by the authors, targeting influenza vaccinations towards this high risk group may be cost-effective in terms of preventing complications associated with this infection. However, they also address some of the practical challenges of broad implementation of health policies based on birthweight, as such data is often limited to the patients’ chart. An Equilibrium Model is discussed that may help public health practitioners in identifying and prioritizing local implementation. The results of this study bear particular public health importance as there is tremendous focus on curbing rising health care costs, especially as many parts of the world are faced with an increasingly aging population13. Yet, there are a few points worth considering. Although in part Journal of Human Growth and Development 2013; 23(1): 7-10 EDITORIAL