Nutritional programming of blood pressure and renal morphology

A range of epidemiological evidence from several diverse populations, supports the hypothesis that risk of essential hypertension, coronary heart disease and non-insulin dependent diabetes is, in part, programmed by intrauterine nutritional status. Animal models developed to investigate the mechanisms that are responsible for such programming are becoming more important as challenges to the epidemiological data become more robust. With strong evidence from animal studies it is now widely accepted that maternal nutritional status in pregnancy is a major programming influence upon the fetus. This paper considers the hypothesis that renal structure and function are determined by prenatal nutrition and that this is a key mechanism in the programming of hypertension. The feeding of low protein diets or other insults in pregnancy that have an impact upon the development of cardiovascular functions, also appears to impact upon nephron number. In the sheep nephron number is related to weight at birth following nutrient restriction, and in the rat low protein diets reduce nephron number by approximately 30%. However, it is possible that hypertension and reduced renal reserve merely coincide and are not causally associated. A study of rats fed low protein diets supplemented with additional nitrogen sources found that whilst only glycine could reverse the hypertensive effects of low protein diets, all supplements could normalise nephron number. The evidence thus suggests that prenatal undernutrition may programme renal structure in later life, but that renal programming is not one of the primary mechanisms leading to hypertension.