Early Life Nutrition and Lifelong Health - Derbyshire Local Medical ...

BMA Board of ScienceOverweight and obesity in developing countriesEconomic development and improvements in agricultural production are transforming thenutritional situation for children and adults in developing countries, although rising food pricesand continued food insecurity are a concern. Undernutrition, wasting, stunting and micronutrientdeficiencies are still major problems in developing countries, 3 and occurring in early life, theycause long-term damage to human capital and health. 19 Improved availability of energy-richfoods has however, enabled large numbers of people to escape from hunger. This has broughtconsiderable benefits, but is already giving rise to obesity and obesity-related disease. Developingcountries are reporting high rates of coronary heart disease (CHD) and type 2 diabetes that haveappeared in one or two generations to become leading causes of morbidity and mortality. Theseepidemics are expected to intensify. 20 By the year 2030, the prevalence of diabetes is predicted torise by over 100 per cent in India, China, sub-Saharan Africa, Latin America, the Caribbean andthe Middle East; an increase far exceeding that in high-income countries (54%). The highestnumber of people with diabetes will be of working age (45-64 years) unlike developed countries,where the greatest numbers are in older age groups, and in addition diabetes in pregnancy willbecome a common problem. There are similar increases anticipated in hypertension, CHD andstroke. 21 By 2015, an estimated 20 million people will die from cardiovascular disease every year. 21In the context of this report on early life nutrition, obesity is important in a number of ways. Firstly,as described, obesity arising during childhood or adult life, can ‘unmask’ the effects of adaptationsinduced by undernutrition during fetal life or infancy.Secondly, there is good evidence that increased adiposity and/or an adverse distribution of body fatis itself an outcome of malnutrition (both undernutrition and excessive nutrition) in early life.Adults who had a lower birth weight have been shown to have a higher waist circumference. 22Low birth weight babies born to underweight women in India are excessively adipose relative totheir body weight. 23 In experimental animals, maternal undernutrition during pregnancy isassociated with increased adiposity in the adult offspring. 24 The mechanisms for this phenomenonare unknown, but may arise when the correct balance of nutrients required for tissue synthesis isnot available, leading to energy storage as adipose tissue. 25Maternal obesity, another form of maternal malnutrition, also increases the adiposity of the fetusand newborn baby. This phenomenon is exacerbated further if maternal obesity is complicated bygestational diabetes, an example of fetal overnutrition – in which maternal glucose, freely crossingthe placenta, stimulates fetal insulin secretion and adipose tissue deposition. It is known thatmaternal gestational diabetes is a risk factor for early-onset type 2 diabetes in the offspring, andrecent data suggest that maternal obesity alone, even in the absence of gestational diabetes,increase the risks of metabolic syndrome in the offspring. 26 A recent follow-up study of more than9,000 women with normal glucose tolerance at initial screening, found that increasing maternalglycaemia was associated with a greater risk of obesity in the children, even amongst children ofnormal birth weight. Importantly, among those who fulfilled criteria for gestational diabetes, therelationship between maternal glycaemia and offspring obesity was lost if the mother receivedtreatment. 27 Maternal obesity is an increasing problem worldwide, and it seems likely that this willcontribute increasingly to the burden of diabetes in the future. Gestational diabetes is an exampleof how susceptibility to diabetes can be transmitted non-genetically from one generation to thenext. Women who were themselves of low birth weight are at increased risk of developinggestational diabetes, especially if they become obese in adult life. 2812Early life nutrition and lifelong health