2. Session expectations
By the end of the session participants should be
able to
• Describe the life course approach
• Critically analyze evidence supporting the life
course approach
• Explain the importance of preconception care
and nutrition
3. Introduction
• The importance of nutrition throughout the life
cycle cannot be refuted. However, the
significance of nutrition during specific times of
growth, development, and aging is becoming
increasingly appreciated.
• Health professionals have recognized for quite
some time the effects of proper nutrition
during pregnancy on the health of the infant
and mother, even after her childbearing years
5. The life course approach
• A life course approach to adult health is not a new concept,
the idea that experiences in earlier life shape adult health,
was the prevailing model of public health in the first half of
the twentieth century.
• A life course approach looks back across an individual’s life
experiences or across generations for clues to current
patterns of health and disease.
NOTE: Past and present experiences are shaped by the wider
social, economic and cultural context. However, caution is
required in extrapolating from the past to the present.
6. Cont...
• The approach incorporates, but is broader than, ‘the
foetal origins hypothesis’ (programming) which links
conditions in the intrauterine environment to the later
development of adult chronic disease (Barker, 1998).
• Growing evidence suggests that there are critical
periods of growth and development, not just in utero
and early infancy but also during childhood and
adolescence, when environmental exposures do more
damage to health and long-term health potential than
they would at other times of development.
7. Cont...
• There is also evidence of sensitive
developmental stages in childhood and
adolescence when social and cognitive skills,
habits, coping strategies, attitudes and values
are more easily acquired than at later ages.
• These abilities and skills strongly influence life
course trajectories with implications for health
in later life.
8. Conclusion
• A life course approach provides an essentially
optimistic approach to health and raises
questions for policy. It helps identify chains of
risk that can be broken and times of
intervention that may be especially effective.
• Discuss policy implications of understanding
and appreciating the life course approach
9. Fetal origin hypothesis
• Exposures to adverse nutritional and other
conditions during critical or sensitive periods
of growth and development (intrauterine, first
two years of life) can permanently affect body
structures and functions resulting in increased
disease risk in adulthood.
10.
11.
12. Why ?
• Undernutrition during critical periods
– Changes to tissues and to systems
– “hard-wired” for life
– Critical period for most organs and tissues occur
before birth
13. By any other name…
• Barker Theory
• Fetal Origins of Adult Disease
• Fetal Programming
• Metabolic Programming
• Nutrition Programming
• Life course Perspective
14. Examples of Diseases Related to LBW
(NOT causal!)
• Allergies
• Autoimmune diseases
• Bronchitis
• CVD
• Decreased bone mineral content
• Gestational Diabetes
• HTN
• Kidney disease
• Metabolic syndrome
• Mood disorders
• Obesity
• Ovarian cancer
• PCOS (higher birth weight)
• Schizophrenia
• Short stature
• Stroke
• T2DM
• Chronic lung disease
• Hormone related cancers (breast,
prostate, testicular) [higher birth
weight]
Prentice, Phiol Behav 2005
Wu, J Nutr 2004
Benston, Gut 2006
• http://www.bbc.co.uk/programmes/
b0139623/episodes/guide
20. Micronutrients
• Micronutrient deficiencies to cells/tissues
-Decreased nephron number in kidneys?
-Decreased myocyte cells in heart?
• Pune Maternal Nutrition Study (India)
– Fruit/green vegetables during pregnancy was
positively associated with birth size and glucose
tolerance in their offspring.
• Calcium intake during pregnancy associated
with lower blood pressure in offspring
21. Thrifty Phenotype Hypothesis
• Less than optimal growing conditions
Fetal tissues make functional adaptations to a low supply
of nutrients
– Help fetus survive and remain alive after birth
– Lowers nutrient needs to muscles
– Directs them to brain/heart
• Predictive adaptive response (PAR)
– Fetus adapts to improve chance of survival in
extrauterine life.
– Disparities between the predicted environment and
actual environment???
22. What About Genetics??
• The same egg + sperm implanted in two
different women will produce different babies.
• “Everyone is kneaded out of the same dough
but not baked in the same oven.”
Yiddish proverb
23. Cont…
• Structure of genes remains unchanged
• Nutrients modify which genes are turned on
(“expressed”) or inactive
24. Limitations of Fetal-Origins Hypothesis
• Which nutritional exposures? (weight or nutrients)
• Which genes get suppressed?
• When are the vulnerable periods?
• What energy and micronutrients are related to
optimal gene functioning?
• Research quality? And quantity?
• Many unanswered questions!!
• Offers diminished hope for vulnerable people
• Is it reversible?
• Intergenerational?
