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

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Mark Hanson What are the causes and consequences of childhood

• besity?

Institute of Developmental Sciences

CONSEQUENCES?

Complications associated with childhood obesity

Han JC, Lawlor DA, Kimm SY. Childhood obesity. The Lancet. 2010 ;375(9727):1737-48.

Reduced educational attainment, job prospects; Low self-esteem. Bullying; Mental health; Cardiovascular disease Diabetes; Asthma; Cancer; Joint problems; Infertility; Pregnancy complications; Birth defects; Gestational diabetes; Etc Etc

Mismatch (diet, physical activity, sleep/stress, env. toxicants) amplifies risk

Risk of

• besity, ill

health and NCDs

Birth

Life course

Mismatch concept

Priming of risk from conception

• nwards

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

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Crozier et al 2018

late Late gestation fetal growth Slower Faster Thinner Fatter Healthy diet Increasingly unhealthy childhood diet

Mismatch (diet, physical activity, sleep/stress, env. toxicants) amplifies risk

Risk of

• besity, ill

health and NCDs

Birth

Life course

Mismatch concept

Priming of risk from conception

• nwards

Tomorrow’s parents

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Annual Report of the Chief Medical Office 2014 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

Foresight report 2007

But complexity is not the same as complicated.

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?

Gillman MW and Ludwig DS. Perspective: How Early Should Obesity Prevention Start? NEJM Nov 2013

Modifiable Risk Factors for Childhood Obesity

Diet in pregnancy and child’s adiposity (ponderal index) at birth

(538 term Southampton pregnancies)

Carbohydrate intake in early pregnancy (g/day) Dairy protein intake in late pregnancy (g/day) Carbohydrate P=0.01 Dairy protein P=0.03 Godfrey et al BJOG 1997;104:663-7

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Southampton Women’s Survey. Following Southampton families. Young women with a lower level of educational attainment are more likely to eat an unbalanced diet

Robinson et al EJCN 2004; 58:1174-80

48.5% 33.5% 19.4% 12.9% 3.5% 54.7%

0% 10% 20% 30% 40% 50% 60%

22 5 10 15 20 25 30 35 <18.5 18.5-24.9 25-29.9 30-39.9 >40 Maternal BMI Obesity (% of children)

Obesity (BMI ≥ 95th percentile) at age 4 years according to maternal first-trimester BMI. Effect graded across the normal range

From Whitaker, Pediatrics. 2004 Jul;114(1):e29-36.