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

BMA Board of ScienceTaking a multigenerational perspective also focuses attention on the ways in which disease riskcan be transmitted during periods of nutritional transition (see Figure 7). Obesity, type 2 diabetesand altered metabolism in women resulting from poor nutrition during development can result ingreater glucose levels or gestational diabetes in pregnancy. This is likely to induce similar metabolicchanges in their offspring.Figure 7: Cycles of disease riskIntergenerational switching of pathwaysGestationaldiabetesLarge babiesWomenmalnourishedLow pregnancyweight gainSuboptimal fetaldevelopmentVery poor postnatalenvironmentStuntingEnriched postnatalenviroment due tonutritional transitionObesityInsulinresistanceMaterialmorbidityPrematuredeath andmorbidityCycles of disease risk can involve more than one generation. Women who are malnourished or who havesub-optimal body composition and weight gain in pregnancy are more likely to have offspring with stunting andpremature death and morbidity (left part of diagram). This becomes a self-perpetuating cycle. Their offspring are athigher risk of cardiovascular and metabolic disease, especially if socio-economic transition or migration gives accessto high fat and glycaemic index food and reduced physical activity. Women of this generation are more likely todevelop gestational diabetes and to have offspring which in turn are also at risk of obesity and diabetes. Thisprocess, which may involve different mechanisms from the first, nonetheless produces another cycle of disease.Source: Gluckman PD & Hanson MA (2005) Metabolic disease: evolutionary, developmental and transgenerationalinfluences. In: Hornstra G, Uauy R, Yang X (eds) The Impact of maternal nutrition on the offspring. Nestle Nutritionworkshop series: Pediatric program. Switzerland: Karger.Early life nutrition and lifelong health 23