United Nations Standing Committee on Nutrition 13
Download
Report
Transcript United Nations Standing Committee on Nutrition 13
Death rates from
Coronary Heart Disease
in men 1968-78
Gardner MJ et al. 1984 Atlas of mortality from selected diseases in England and Wales, 1968-78. John Wiley, Chichester.
Mortality from coronary heart disease in
CORONARY HEART DISEASE
15726 men
andratios
women
Hertfordshire
Standardised
mortality
in 10141in
men
& 5585 women
120
B irthweig h t (p ou n ds)
>9.5
20
-9.5
20
-8.5
40
-7.5
40
-6.5
60
>9.5
60
-9.5
80
-8.5
80
-7.5
100
-6.5
100
W omen
5.5
Men
5.5
Standardised Mortality Ratio
120
B irthweig h t (p ou n ds)
Hazard ratios for coronary heart disease in men
3
Hazard ratio
2.5
2
1.5
1
0.5
0
16 17 18 19 20 21 22 23 24 25 26 27 >27
Weight at one year (pounds)
Developmental plasticity
“The ability of a single genotype to produce more than
one alternative form of structure, physiological state and
behaviour in response to environmental conditions”
Adaptation
Developmental plasticity
Constraint
The fetal origins theory
Coronary heart disease, stroke, type 2 diabetes,
hypertension and osteoporosis, originate through
developmental plasticity, in response to
malnutrition during fetal life and infancy.
Certain cancers,including breast cancer,also
originate in fetal life.
Before I got married I had six theories about
bringing up children: now I have six children
and no theories.
John Wilmot, Earl of Rochester
Undernutrition,
stress, hypoxia
Gene defect
Critical window
of development
Fewer cells,
altered structure
Altered gene expression
Adaptation
DISEASE
Phenotypic plasticity and the adult
environment
Gene-environment interactions during development
alter responses to the environment in adult life
Hazard ratios for coronary heart disease
(hospital admission or death) in 3676 men
3.0
2.5
Ponderal index
<26 kg/m3
Ponderal index
>26 kg/m3
2.0
Hazard
ratio
1.5
1.0
0.5
Household income (pounds sterling,1980)
p for interaction=0.005
Weight gain in childhood and later disease
z score
Normotensive
Severe hypertension
or CHD
Mild hypertension
or stroke
Prevalence of hypertension
80
60
%
40
-3.0
-3.5
20
-4.0
0
>4.0
M -74.8
F -62.6
-81.5
-68.7
-88.0
-75.2
-96.5
-83.9
Fifths of current weight (kg)
>96.5 M
>83.9 F
Birth
-weight
(kg)
Associations between early growth and later
disease extend across the range of fetal and
infant growth. This implies that what are
regarded as normal variations in the supply
of nutrients to the baby have important
long–term effects.
Pelvic diameters
The external conjugate diameter is the
distance between the spine of the fifth lumbar
vertebra and the front of the pubic bone. A
diameter of less than 18 centimetres (7 inches)
was used as a marker of a “flat” pelvis, the
result of rickets or lesser degrees of
malnutrition in early childhood.
Odds ratios (95% confidence intervals) for stroke
and hypertension
Stroke
Mother’s
pelvic
external
conjugate
diameter
(cm)
-18
>19
Hypertension
1.62
1.89
(1.30 to 2.02) (1.30 to 2.76)
1.0
1.0
In a simultaneous regression of the effects of
height and external conjugate on newly
diagnosed hypertension, only the trend with
external conjugate remained statistically
significant (p=0.009)
32 percent of mothers born during December
and January had external conjugate diameters
of less than 18 centimetres compared with 20
percent among mothers born in the remaining
months (p=0.0005)
Conclusion
Malnutrition during infancy, including lack of
Vitamin D, leads to persisting changes in
protein metabolism which prejudice the early
nutrition and growth of the next generation and
lead, in adult life, to an atherogenic lipid
profile, hypertension and stroke.
The intercristal diameter is the maximal distance between
the iliac crests, while the interspinous diameter is the distance
between the anterior superior iliac spines. The intercristal is
usually 2.5 cm (one inch) longer than the interspinous. The
more the intercristal diameter exceeds the interspinous, the
rounder the iliac crest.
The pubertal growth of girls is characterized
by a disproportionate increase in the
intercristal diameter and rounding of the iliac
crests. This female pattern of hip growth is
under the control of estrogens, though other
hormones including growth hormone also play
a role.
Hazard ratio
Hazard ratios for breast cancer
8
8
7
7
6
6
5
5
4
4
3
3
2
2
1
1
0
0
All mothers
<40 <40
40 >40
Multiparous mothers
40
<40 <40
Length of gestation (weeks)
Mothers’ intercristal diameter (cm)
-28
-30
>30
Conclusion
Breast cancer is initiated by hormonal events
during the mother’s puberty which lead to
round, wide hips. The daughters of mothers
with such hips are at increased risk of breast
cancer because their mothers have an estrogen
profile that adversely affects early mammary
development.
Ovarian Cancer
The hazard ratio for ovarian cancer was 3.3
(95% CI 1.6 to 7.0, p=0.004) in the daughters
of mothers whose interspinous diameter was
greater than 27 cm
Hazard ratios for ovarian cancer according to
mothers’ interspinous diameter and age at menarche
Menarche at age
14 years or less
p for trend 0.002
10
8
6
4
Menarche at age
15 years or more
p for trend 0.63
2
0
25
25.1-26.0
26.1-27.0
Interspinous diameter (cm)
>27.0
Hazard ratios (95% CI) for ovarian cancer among
women whose mother’s age at menarche was 14
years or less
Mother’s height (cm)
Interspinous diameter
>26cm
160
>160
9.7
(1.9 to 49)
1.5
(0.3 to 6.8)
p = 0.001
p = 0.25
www. Barker.org
Mother
unbalanced/unvaried diet
metabolic incompetence
Embryo
Fetus
slow growth
functional incapacity
metabolic incompetence
Infant
slow growth
poor cognitive development
metabolic incompetence
Child
fat accumulation
Adult
Men
Women
cardiovascular disease
type 2 diabetes
osteoporosis
poor living
conditions
excess calories
unbalanced/
unvaried diet
The
Cycle of
Inequality