Abstract-Data on the early life origins of adult hypertension have been widely reported: however, recent research shows that the strength of association between small size at birth and higher blood pressure weakens as study size increases.In this article, we retest the association between birth weight and systolic blood pressure in a large cohort, examine whether age interacts with birth weight to predict blood pressure, and explore reasons why birth weight-blood pressure associations tend to weaken with increasing study size. Key Words: blood pressure Ⅲ epidemiology Ⅲ infant nutrition Ⅲ blood pressure determination T he "fetal origins" hypothesis suggests that "insults" at critical periods during fetal development can lead to permanent metabolic and structural changes in the fetus increasing the risk of many diseases in adulthood. 1 One key finding in support of this hypothesis is the observation, now replicated in many populations, that lower birth weight is associated with higher adult systolic blood pressure (SBP) 1,2 : an association observed independently of socioeconomic position. 3 Surprisingly, despite the wealth of literature in this field, the precise nature of the association between birth weight and blood pressure remains contentious.One important area of recent debate has focused on the strength of association between birth weight and blood pressure. In the most recent systematic review, Huxley et al 4 concluded that birth weight had little relevance in determining blood pressure levels in later life. This finding was at odds with previous systematic reviews, which have suggested that SBP decreases by between 2 and 4 mm Hg for each 1-kg increase in birth weight. 5,6 Central to the argument put forward by Huxley et al 4 was that after ordering studies by statistical size (derived from the inverse of the variance of the regression coefficient), a clear trend (PϽ0.0001) was observed toward weaker associations between birth weight and blood pressure in the larger studies. In small studies (typically with Ͻ1000 participants), a 1-kg increase in birth weight was associated with a 1.9 mm Hg decrease in SBP, whereas in large studies (typically with Ͼ3000 participants), SBP was reduced by only 0.6 mm Hg/kg. Huxley et al 4 suggested that this was evidence of publication bias, with smaller studies being more likely to be published if they found strong inverse birth weight-blood pressure associations. 7 The authors argued that because larger studies are known to be less prone to publication bias, a decrease of 0.6 mm Hg/kg was nearer to the true association. An additional contentious area in the literature has been the actual nature of the association between birth weight and blood pressure. Even within the large studies reviewed by Huxley et al, 4 the association was inconsistent, with some large studies reporting a perfectly linear association across the birth weight continuum 8 and others reporting a reverse J-shape pattern, whereby those individuals with the highest birth weight also tended toward slightly...