Objective. To examine the relationship between birth weight and blood total cholesterol (TC) and to compare its strength with that of the relationship between current body mass index and TC.

Methods. 1) Cross-sectional study of adolescents, with retrospective ascertainment of birth weight from birth records or parental recall; 2) systematic review of studies examining the relations between birth weight and cholesterol at all ages.

Participants. 1) 1532 individuals (92% white, 55% male) in 10 British towns; 2) 28 studies with 32 observations showing the change in TC per 1 kg increase in birth weight—6 in infancy, 14 in adolescents, 12 in adults.

Results. In the cross-sectional study, there was a weak inverse relation between birth weight and TC level (−.061 mmol/L fall in TC per kg increase in birth weight, 95% confidence interval −.131 to .008 mmol/L per kg) which was little affected by adjustment for current body size. The difference in TC corresponding to an interquartile range increase in birth weight (−.03 mmol/L) was approximately a quarter of that for an equivalent increase in body mass index (.11 mmol/L). In the systematic review, an inverse association between birth weight and TC of a similar size to that in the cross-sectional study was observed (−.048 mmol/L per kg, 95% confidence interval −.078 to −.018 mmol/L per kg) similar in strength at all ages.

Conclusion. The relation of fetal nutrition to TC appears to be weak and is probably of limited public health importance when compared with the effects of childhood obesity.

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