Two of the pathways by which evolutionary processes can influence disease risk are evolutionary mismatch, where the individual’s evolved coping mechanisms are overwhelmed by a novel or severe cue, and developmental mismatch, where the individual is exposed to an environment that is not matched to its adaptively developed phenotype. Both pathways draw on the evolutionary principle that selection operates to sustain and promote Darwinian fitness, irrespective of the impact on health during the post-reproductive age. In this chapter we will frame DOHaD phenomena within an evolutionary context, showing that human health and disease risk are dependent on our both evolutionary and developmental histories. We also discuss the contributory role of a unique human activity to not only construct a niche but also continually modify it. Using nutrition as the exemplar, we demonstrate how the DOHaD phenomenon is underpinned by both evolutionary and developmental mismatches, and discuss the evidence for how developmental anticipatory responses may confer adaptive advantage in humans.