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  • Review Article
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Birth weight, malnutrition and kidney-associated outcomes—a global concern

Nature Reviews Nephrology volume 11, pages 135–149 (2015)Cite this article

Subjects

Key Points

  • Low birth weight, prematurity, and small size for gestational age are associated with reduced nephron numbers and an increased risk of hypertension and kidney disease in later life

  • High birth weight and gestational exposure to maternal diabetes or obesity are important factors associated with an increased risk of hypertension and kidney disease in later life

  • Maternal nutrition before and during pregnancy impacts birth weight and risk of premature delivery; maternal nutrient deficiencies can affect the development of the fetal kidneys

  • Postnatal nutrition, acute kidney injury, and clinical events can further impact nephrogenesis soon after premature delivery

  • A rapid increase in weight and/or obesity during childhood or adolescence can be associated with elevated blood pressure and an increased risk of renal disease progression, independent of birth weight

  • Micronutrient supplementation during pregnancy can reduce the risk of low birth weight and prematurity; the long-term impact on the risk of hypertension and kidney disease in these offspring remains unknown

Abstract

An adverse intrauterine environment is associated with an increased risk of elevated blood pressure and kidney disease in later life. Many studies have focused on low birth weight, prematurity and growth restriction as surrogate markers of an adverse intrauterine environment; however, high birth weight, exposure to maternal diabetes and rapid growth during early childhood are also emerging as developmental risk factors for chronic diseases. Altered programming of nephron number is an important link between exposure to developmental stressors and subsequent risk of hypertension and kidney disease. Maternal, fetal, and childhood nutrition are crucial contributors to these programming effects. Resource-poor countries experience the sequential burdens of fetal and childhood undernutrition and subsequent overnutrition, which synergistically act to augment the effects of developmental programming; this observation might explain in part the disproportionate burden of chronic disease in these regions. Numerous nutritional interventions have been effective in reducing the short-term risk of low birth weight and prematurity. Understanding the potential long-term benefits of such interventions is crucial to inform policy decisions to interrupt the developmental programming cycle and stem the growing epidemics of hypertension and kidney disease worldwide.

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Figure 1: Prevalence of SGA, preterm births and LBW infants by United Nations Millennium Development Goal regions in 2010.

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Authors and Affiliations

  1. Renal Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, 02115, MA, USA

    Barry M. Brenner

  2. Institute of Biomedical Ethics, University of Zurich, 78 Lerchenbergstrasse, Erlenbach, 8703, Switzerland

    Valerie A. Luyckx

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  1. Valerie A. Luyckx
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V.A.L. researched the data for the article, contributed substantially to the discussion of content and wrote the article. V.A.L. and B.M.B. contributed equally to the review and/or editing of the manuscript before submission.

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Correspondence to Valerie A. Luyckx.

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Supplementary information

Supplementary Figure 1

Global prevalence of micronutrient deficiencies associated with low birth weight. (PDF 329 kb)

Supplementary Figure 2

Incidence of gestational hypertension by WHO geographical region. (PDF 307 kb)

Supplementary Table 1

Clinical associations with nephron number and kidney size. (PDF 72 kb)

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Luyckx, V., Brenner, B. Birth weight, malnutrition and kidney-associated outcomes—a global concern. Nat Rev Nephrol 11, 135–149 (2015). https://doi.org/10.1038/nrneph.2014.251

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