Mark Hanson What are the causes and consequences of childhood - PowerPoint PPT Presentation

Institute of Developmental Sciences Mark Hanson What are the causes and consequences of childhood obesity? 1

CONSEQUENCES?

Reduced educational attainment, job prospects; Low self-esteem. Bullying; Mental health; Cardiovascular disease Diabetes; Asthma; Cancer; Joint problems; Complications associated with childhood obesity Infertility; Pregnancy complications; Birth defects; Gestational diabetes; Etc Etc Han JC, Lawlor DA, Kimm SY. Childhood obesity. The Lancet . 2010 ;375(9727):1737-48.

Mismatch concept Risk of obesity, ill health and NCDs Priming of risk from conception onwards Life course Birth Mismatch (diet, physical activity, sleep/stress, env. toxicants) amplifies risk

Testing the mismatch hypothesis in the Southampton Women’s Survey: Effect of an unhealthy diet in childhood on child’s fatness depends on prenatal growth trajectory Increasingly unhealthy childhood diet Fatter Healthy diet Thinner Late gestation fetal growth late Slower Faster 5 Crozier et al 2018

Mismatch concept Risk of obesity, ill health and Tomorrow’s NCDs parents Priming of risk from conception onwards Life course Birth Mismatch (diet, physical activity, sleep/stress, env. toxicants) amplifies risk

Annual Report of the Chief Medical Office 2014 7 The Health of the 51%: Women

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For every complex question there is usually a simple answer…….

………and it is usually wrong

But complexity is not the same as complicated. Foresight report 2007

Causes • Inherited genes?

Causes • Inherited genes account for <10% of risk at population level • Eating too much/ sedentary lifestyle?

Calories eaten Calories burnt up

Calories eaten Calories burnt up Metabolic control processes

Causes • Inherited genes account for <10% of risk at population level • Eating too much/ sedentary lifestyle are not the whole story • What else?

Modifiable Risk Factors for Childhood Obesity Gillman MW and Ludwig DS. Perspective: How Early Should Obesity Prevention Start? NEJM Nov 2013

Diet in pregnancy and child’s adiposity (ponderal index) at birth (538 term Southampton pregnancies) Dairy protein intake in late pregnancy (g/day) Carbohydrate intake in Carbohydrate P=0.01 early pregnancy Dairy protein P=0.03 (g/day) Godfrey et al BJOG 1997;104:663-7

Southampton Women’s Survey. Following Southampton families. Young women with a lower level of educational attainment are more likely to eat an unbalanced diet 60% 54.7% 48.5% 50% 40% 33.5% 30% 19.4% 20% 12.9% 10% 3.5% 0% 21 Robinson et al EJCN 2004; 58:1174-80

Obesity (BMI ≥ 95 th percentile) at age 4 years according to maternal first-trimester BMI. Effect graded across the normal range 35 30 Obesity (% of children) 25 20 15 10 5 0 <18.5 18.5-24.9 25-29.9 30-39.9 >40 Maternal BMI 22 From Whitaker, Pediatrics. 2004 Jul;114(1):e29-36.