Stroke 'Belts' Tied to Long-Ago Malnutrition

Effects of deprivation in pregnancy felt to this day, study finds

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HealthDay Reporter

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THURSDAY, June 19, 2003 (HealthDayNews) -- The ill effects of generations of malnutrition are still being felt today in the form of increases in risk of stroke and other medical problems in the United States and England, researchers say.

A new study finds "stroke belts" in both countries, regions where strokes are not only more likely to occur but also happen at early ages than elsewhere, says a report in the June 20 issue of Stroke.

Those regions -- the southeastern states of America, the northern industrial sections of England and Wales -- have long been known as places where poverty hit hard in the late 1900s and the early 20th century, with bad diet and poor living conditions all too common.

Now David J.P. Barker, an epidemiologist at the University of Southampton, and Daniel T. Lackland, a professor of epidemiology at the University of South Carolina, say that while the stark deprivation in those regions has largely been alleviated, the differences in health persist up to the latest generation.

Barker and Lackland compared data on stroke incidence between 1968 and 1978 with rates of maternal and newborn deaths between 1911 and 1925. There is a striking correlation between high maternal and newborn deaths rates then and the incidence of stroke now, they say.

Efforts to place the blame on something in the environment of those regions have largely failed, Lackland says. "They have looked at selenium in the soil, but that is not a common factor in those regions of the United States and the United Kingdom," he says.

More likely, bad health is a legacy passed on from generation to generation, he says. Mothers who were malnourished and in poor health decades ago had babies of low birth weight, a marker of medical problems ahead.

"We see a higher incidence of hypertension and diabetes," Lackland says. "There could be a developmental aspect in these problems, something in the fetus."

Strikingly, the increased risk follows children born in the stroke belt, regardless of where they move to, the study finds. "It is going to take several generations for this effect to wash out," says a statement by Barker. "The lesson here is that if you prejudice the health of a girl or a woman, you prejudice the health of the offspring. Stroke risk is not just in the genes. It is about the environment in the womb."

There are lessons for both doctors and residents of those regions, Lackland says. Doctors should understand that "you can't base your medical practice on what is true of the entire nation," he says. "You have to be more aggressive."

And people who live in the stroke belt, or whose ancestors did, need to be careful about the risk factors for stroke and heart disease, making special efforts to follow the rules about such basics as blood pressure, diet and exercise, Lackland says.

An accompanying editorial by Dr. Larry B. Goldstein, a professor of medicine at Duke University Medical Center, says the report provides "another compelling argument to ensure adequate prenatal care and maternal nutrition."

"Investment in programs aimed at optimizing maternal health and nutrition may pay dividends in reducing the incidence of stroke in their unborn babies when they reach adulthood," Goldstein writes.

More information

To learn more about stroke, visit the American Heart Association or the National Institute of Neurological Disorders and Stroke.

SOURCES: Daniel T. Lackland, Dr.P.H., professor, epidemiology, University of South Carolina, Charleston; June 20, 2003, Stroke

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