Population aging and subsequent projected large increases in chronic conditions will be important health concerns in low- and middle-income countries. Although evidence is accumulating, little is known regarding the impact of poor early-life conditions on older adult (50 years and older) health in these settings. A systematic review of 1141 empirical studies was conducted to identify population-based and community studies in low- and middle-income countries, which examined associations between early-life conditions and older adult health. The resulting review of 20 studies revealed strong associations between (1) in utero/early infancy exposures (independent of other early life and adult conditions) and adult heart disease and diabetes; (2) poor nutrition during childhood and difficulties in adult cognition and diabetes; (3) specific childhood illnesses such as rheumatic fever and malaria and adult heart disease and mortality; (4) poor childhood health and adult functionality/disability and chronic diseases; (5) poor childhood socioeconomic status (SES) and adult mortality, functionality/disability and cognition; and (6) parental survival during childhood and adult functionality/disability and cognition. In several instances, associations remained strong even after controlling for adult SES and lifestyle. Although exact mechanisms cannot be identified, these studies reinforce to some extent the importance of early-life environment on health at older ages. Given the paucity of cohort data from the developing world to examine hypotheses of early-life conditions and older adult health, population-based studies are relevant in providing a broad perspective on the origins of adult health.

Aging in Latin America and the Caribbean will not proceed along known paths already followed by more developed countries. In particular, the health profile of the future elderly population is less predictable due to factors associated with their demographic past that may haunt them for a long time and make them more vulnerable, even if economic and institutional conditions turn out to be better than what they are likely to be. This paper answers a set of questions regarding the nature and determinants of health status among the elderly in Latin America and the Caribbean using SABE (Survey on Health and Well-Being of Elders), a cross-sectional representative sample of over 10,000 elderly aged 60 and above in private homes in seven major cities in Latin America and the Caribbean. We examine health outcomes such as self-reported health, functional limitations-Activities of Daily Living (ADL's) and Instrumental Activities of Daily Living (IADL's), obesity (ratio of weight in kilograms to the square of height in centimeters), and self-reported chronic conditions (including diabetes). The findings include: (a) Countries differ in self-reported health but exhibit much less differences in terms of functional limitations. The number of chronic conditions increase with age and is higher among females than among males; (b) On average SABE countries display levels of self-reported diabetes (and obesity) that are as high if not higher than those found in the US; (c) There is evidence, albeit weaker than expected, suggesting deteriorated health and functional status in the region; (d) There is important evidence pointing toward rather strong inequalities (by education and income) in selected health outcomes. Preliminary findings from SABE confirm that Latin America and the Caribbean display peculiarities in the health profile of elderly, particularly with regard to diabetes and obesity. It is important that new policy initiatives begin to seriously target the region's elderly, especially with an emphasis on the prevention and treatment of diabetes and obesity.

Few studies have examined the effects of early life conditions on the timing of the onset of heart disease. We use the remarkable example of a representative sample of the population of older Puerto Ricans aged 60-74 who lived in the countryside during childhood (n = 1,438) to examine the effects ofseasonal exposures to poor nutrition and infectious diseases during late gestation on the timing of the onset and the probability of ever experiencing adult heart disease. Cox and log logistic hazard models controlling for childhood conditions (self-reported childhood health status and socioeconomic status [SES], rheumatic fever, and knee height) and adult risk factors (adult SES, obesity, smoking, exercise, and self-reported diabetes) showed that the risk of onset of heart disease was 65% higher among those born during high-exposure periods compared with unexposed individuals. However, there were no significant differences in median time of onset for those ever experiencing heart disease. As a comparison, we found that there were no significant seasonality effects for those who lived in urban areas during childhood. We conclude that early exposures in utero have important ramifications for adult heart disease among the older Puerto Rican population. We show, however, that while exposure is associated with the probability of ever experiencing adult heart disease, it is not associated with the timing of onset among those who do experience it.

Objectives We examined the effects of early life exposure to poor nutrition and infectious diseases on adult heart disease and diabetes using season of birth as an indicator to help disentangle the effects on health of early life exposure from effects associated with other childhood conditions. Methods Using data from 60- to 74-year-old Puerto Ricans who lived in rural areas during childhood (n = 1,457), we estimated the effects of seasonal exposure during late gestation on the probability of diabetes and heart disease, controlling for adult obesity and other childhood conditions (health, socioeconomic status, knee height). Results We found (a) strong associations between exposure and heart disease; (b) weaker associations between exposure and diabetes, although significant negative interaction effects between exposure and having a family member with diabetes suggest the possibility of either strong gene–environment or early adult–environment interactions; (c) virtually no attenuation of effects of self-reported childhood health with controls for exposure. Discussion Timing of birth may reveal conditions experienced perinatally that affect adult heart disease and diabetes. The results suggest that examination of the effects of season of birth on these chronic conditions among older Puerto Rican adults and among older adults from similar populations deserves deeper scrutiny.