Maternal obesity can negatively impact fetal growth and development and increase health risks for offspring. A study found that offspring of obese mothers are at increased risk for various birth defects as well as issues like stillbirth, needing treatment in the NICU, and poorer neonatal outcomes. Children of obese mothers also have an increased risk of becoming obese themselves and developing poorer metabolic health and higher blood pressure. While genes play a role, factors like shared behaviors, fetal growth patterns, gestational diabetes, breastfeeding, and early life diet also contribute to associations between maternal weight and child outcomes.
Austin Journal of Obesity & Metabolic Syndrome is an international scholarly peer reviewed Open Access journal, aims to promote the research in all the related fields of Metabolic Syndrome.
Austin Journal of Obesity & Metabolic Syndrome is a comprehensive Open Access peer reviewed scientific Journal that covers multidisciplinary fields. We provide limitless access towards accessing our literature hub with colossal range of articles. The journal aims to publish high quality varied article types such as Research, Review, Short Communications, Case Reports, Perspectives (Editorials), Clinical Images.
Austin Journal of Obesity & Metabolic Syndrome supports the scientific modernization and enrichment in Metabolic Syndromes research community by magnifying access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed member journals under one roof thereby promoting knowledge sharing, collaborative and promotion of multidisciplinary science.
Organised once every four years, the 12th FENS European Nutrition Conference is being held this year in Berlin, from 20th to 23rd October. On this occasion, YINI is delighted to be part of the programme, hosting a symposium on a very topical subject: "Yogurt consumption benefits: global findings & perspectives". This insightful session, chaired by Prof Dr Raanan Shamir (Israel) and Andrew Prentice (UK), took place on Thursday 22th October, at 16.30 and was led by renowned experts in the fields of obesity, nutrition and diabetes!
Dr Richard Atkinson
He has worked in obesity research and treatment for over 40 years, is interested in obesity policy, and has advocated for young investigator programs nationally and internationally. His research
includes causes and treatments of obesity, particularly obesity drugs, obesity surgery, and virus-induced obesity. His laboratory demonstrated that human adenovirus-36 produces obesity in animals and is associated with obesity in humans.
In summary
The York Health Economics Consortium and collaborators performed a comprehensive literature search identifying papers on yogurt and weight management. Selection criteria were studies of classical yogurt only, probiotic bacteria were excluded, as were studies on individuals with various diseases. From 13,000 potential papers, 69 met potential criteria and 22 were selected, including 7 cross-sectional, 6 cohort, 2 crossover, and 7 controlled trials. All cross-sectional and cohort trials showed a beneficial association of yogurt and one or more body weight/composition measures. Limitations were that all dietary data were self-reported, confounding variables not completely controlled, and correlation is not causation. Two crossover studies were small, short duration, and uninterpretable. Five of seven controlled trials had major limitations including self-report of intake, inadequate or irrelevant research design, few subjects, inadequate description, etc. One well controlled, randomized study had clear results showing a beneficial effect of yogurt, but improper design to address effects of yogurt alone. Five of six RCT showed a beneficial effect of yogurt, but only one was significant. Yogurt is a “health food” accepted by most people and has potential for prevention and treatment of overweight/obesity. Previous studies give optimism for yogurt for weight management, but future well-designed randomized, controlled trials for proof of principle and large population studies for feasibility are needed.
Primary Maternal Care: Assessment of fetal growth and condition during pregnancySaide OER Africa
Primary Maternal Care addresses the needs of healthcare workers in level 1 district hospitals and clinics who provide antenatal and postnatal care, but do not conduct deliveries. It is adapted from theory chapters and skills workshops from Maternal Care. This book complements the national protocol of antenatal care in South Africa. It covers: booking for antenatal care, assesing fetal growth and wellbeing, hypertensive disorders of pregnancy, antepartum haemorrhage, preterm labour, important medical conditions
Austin Journal of Obesity & Metabolic Syndrome is an international scholarly peer reviewed Open Access journal, aims to promote the research in all the related fields of Metabolic Syndrome.
Austin Journal of Obesity & Metabolic Syndrome is a comprehensive Open Access peer reviewed scientific Journal that covers multidisciplinary fields. We provide limitless access towards accessing our literature hub with colossal range of articles. The journal aims to publish high quality varied article types such as Research, Review, Short Communications, Case Reports, Perspectives (Editorials), Clinical Images.
Austin Journal of Obesity & Metabolic Syndrome supports the scientific modernization and enrichment in Metabolic Syndromes research community by magnifying access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed member journals under one roof thereby promoting knowledge sharing, collaborative and promotion of multidisciplinary science.
Organised once every four years, the 12th FENS European Nutrition Conference is being held this year in Berlin, from 20th to 23rd October. On this occasion, YINI is delighted to be part of the programme, hosting a symposium on a very topical subject: "Yogurt consumption benefits: global findings & perspectives". This insightful session, chaired by Prof Dr Raanan Shamir (Israel) and Andrew Prentice (UK), took place on Thursday 22th October, at 16.30 and was led by renowned experts in the fields of obesity, nutrition and diabetes!
Dr Richard Atkinson
He has worked in obesity research and treatment for over 40 years, is interested in obesity policy, and has advocated for young investigator programs nationally and internationally. His research
includes causes and treatments of obesity, particularly obesity drugs, obesity surgery, and virus-induced obesity. His laboratory demonstrated that human adenovirus-36 produces obesity in animals and is associated with obesity in humans.
In summary
The York Health Economics Consortium and collaborators performed a comprehensive literature search identifying papers on yogurt and weight management. Selection criteria were studies of classical yogurt only, probiotic bacteria were excluded, as were studies on individuals with various diseases. From 13,000 potential papers, 69 met potential criteria and 22 were selected, including 7 cross-sectional, 6 cohort, 2 crossover, and 7 controlled trials. All cross-sectional and cohort trials showed a beneficial association of yogurt and one or more body weight/composition measures. Limitations were that all dietary data were self-reported, confounding variables not completely controlled, and correlation is not causation. Two crossover studies were small, short duration, and uninterpretable. Five of seven controlled trials had major limitations including self-report of intake, inadequate or irrelevant research design, few subjects, inadequate description, etc. One well controlled, randomized study had clear results showing a beneficial effect of yogurt, but improper design to address effects of yogurt alone. Five of six RCT showed a beneficial effect of yogurt, but only one was significant. Yogurt is a “health food” accepted by most people and has potential for prevention and treatment of overweight/obesity. Previous studies give optimism for yogurt for weight management, but future well-designed randomized, controlled trials for proof of principle and large population studies for feasibility are needed.
Primary Maternal Care: Assessment of fetal growth and condition during pregnancySaide OER Africa
Primary Maternal Care addresses the needs of healthcare workers in level 1 district hospitals and clinics who provide antenatal and postnatal care, but do not conduct deliveries. It is adapted from theory chapters and skills workshops from Maternal Care. This book complements the national protocol of antenatal care in South Africa. It covers: booking for antenatal care, assesing fetal growth and wellbeing, hypertensive disorders of pregnancy, antepartum haemorrhage, preterm labour, important medical conditions
to download this presentation from this link
https://mohmmed-ink.blogspot.com/2020/12/obesity.html
obesity, causes, diagnosis, complications, treatment, prevention.
The journey of low birth weight infant Khaled Saad
Previously known as ‘failure to thrive’ (FTT), also known as weight faltering
Infant or children whose current weight or rate of weight gain is significantly below that expected of similar children of the same age, sex and ethnicity
Can occur in both infants (< 1 year of age) and in children (> 1 year of age)
What is the epidemiological evidence linking early life events and cancer risk and what are the potential critical windows for cancer prevention?
By Professor Ricardo Uauy, University of Chile, London School of Hygiene and Tropical Medicine
World Cancer Congress, Saturday 6 December 2014
The association between an unhealthy childhood diet and body composition depe...CLOSER
This presentation, from Dr Sarah Crozier, focused on research exploring how the association between an unhealthy childhood diet and body composition depends on prenatal experience. The developmental mismatch hypothesis proposes that risk of diseases such as obesity is increased when impaired prenatal nutrition and growth, is followed by an unhealthy childhood diet. This project used data from the Southampton Women’s Survey (SWS) to investigate whether there was an interaction between conditional growth in fetal abdominal circumference (AC) in late pregnancy and diet at age 6 years on body composition at age 9 years.
Ethnic differences, obesity and cancer,
stages of the obesity epidemic and cancer prevention
Professor TH Lam, JP, BBS
MD, FFPH, FFOM, Hon FHKCCM, FHKAM, FRCP
Sir Robert Kotewall Professor in Public Health, School of Public Health, The University of Hong Kong
UICC World Cancer Congress Melbourne, Australia 3-6 December 2014
Intermittent Fasting: How it Can Reduce the Risk of Breast Cancer Recurrencebkling
Breast cancer recurrence is the greatest fear for those with breast cancer. While many survivors know that being overweight can contribute to recurrence of their cancer, the thought of dieting and how to go about it can be overwhelming. Dr. Nicholas Webster, Professor of Medicine, Chief of the Division of Endocrinology and Metabolism, and Associate Director for Shared Resources, Moores Cancer Center discusses his study that suggests a path that is easy to follow and produces the type of results that can be a matter of life and death for some breast cancer patients.
O número de cirurgias bariátricas aumentou dramaticamente nos últimos anos devido ao aumento taxas de obesidade nos Estados Unidos. Muitos desses procedimentos são em mulheres de em idade fértil, a perda de peso não só proporciona melhores resultados de saúde na gravidez, mas também apresenta desafios. Diretrizes são necessárias para mulheres em idade fértil considerando especialmente a gravidez e que desejam amamentar seus bebês.
Resultados de este estudo retrospectivo sugere que as mulheres pós-bariátricas grávidas se beneficiariam de consultas clínicas pré-natais para atender às necessidades suplementares. Consultas pré-natais com consultores de lactação e nutricionistas certificados podem contribuir com o estado nutricional e o aconselhamento da amamentação podem melhorar os resultados da amamentação para a díade. Encaminhamentos para nutricionistas e consultores de lactação
para dar continuidade à assistência durante todo o período fértil, incluindo a parte inicial do vida do bebê.
(Tradução livre de Marcus Renato de Carvalho)
Gloria Folson and Futoshi Yamauchi
Side Event: How Japan’s know-how can help address food and nutrition challenges in the developing world
Tokyo Nutrition for Growth (N4G) Summit 2021
NOV 30, 2021
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
1. Effects of maternal obesity on fetal growth
and metabolic health of the offspring
Emily Oken, MD, MPH
Obesity Prevention Program
Department of Population Medicine
Harvard Medical School and Harvard Pilgrim Health Care Institute
15. Oken, Ob Gyn Clinics of N. America, 2009 Jun;36(2):361-77.
Odds of child obesity for obese vs.
normal weight mothers
3.1
4.1 4.3
5.1
4.3
1
10
Whitaker 2004
(age 4)
Li 2005 (ages
2-14)
Reilly 2005
(age 7)
Li 2007 (Ages
2-12, early
onset)
Salsberry 2007
(ages 12-13)
Author, year, child age
Oddsratioforchildobesity
16. Offspring of obese mothers have
poorer cardio-metabolic status
At birth, higher body fat, reduced
energy expenditure, and more
atherogenic lipid profiles
In childhood, higher blood
pressure, risk for metabolic
syndrome - even after
adjustment for attained BMI
In adulthood, increased risk of
death from coronary heart disease
Oken, Ob Gyn Clinics of N. America, 2009 Jun;36(2):361-77.
18. Schultz et al. Diabetes Care 2006;29(8):1866-71
Environment matters, too
7%
38%
13%
70%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Type 2 Diabetes Obesity
Mexico
United States
20. Genes
Shared behaviors
Parents and children tend to share
diet, physical activity habits (Oliveria et
al, AJCN, 1992)
What accounts for associations of
maternal weight with child weight?
21. Genes
Shared behaviors
Mediators
Fetal growth
GDM
Breastfeeding
Infant diet quality and feeding
interactions
What accounts for associations of
maternal weight with child weight?
22. 0.29
-0.25
-0.6
-0.4
-0.2
0.0
0.2
0.4
0.6
<10 10-14 15-19 20-24 25-29 30-34 35-39 40-44 >=45
Gestational weight gain (pounds)
ChangeinchildBMIz-score
Without adjustment for maternal BMI
With adjustment for maternal BMI
IOM 2009;Oken et al., AJOG 2008
Gestational weight gain
Distribution of GWG relative to 1990 guid
by prepregnancy BMI category (PRAMS, 2
Body mass index category (IOM criteri
Under- Normal- Over- Obese
Proportion(%)ofwomen
0
20
40
60
80
100
120
weight weight weight
< IOM Within IOM > IOM
19.5
49.9
30.6
38.4
41.1
20.5
63
26.8
10.3
36.3
30.2
23.5
(25-35 lb)
(15-25 lb)
(12-20 lb)
(28-40 lb)
23. Genes
Shared behaviors
Mediators
Confounders
SES
Smoking
What accounts for associations of
maternal weight with child weight?
24. Maternal prenatal smoking and
child overweight – meta-analysis
Odds Ratio
.5 1 5
Combined
von Kries, 2002
Wideroe, 2003
Whitaker, 2004
Toschke, 2003
Toschke, 2002
Salsberry, 2005
Reilly, 2005
Power, 2002 M
Power, 2002 F
Oken, 2005
Dubois, 2006
Chen, 2006 M
Chen, 2006 F
Bergmann, 2003
Al Mamun, 2006
Adams, 2005
OR 1.50, 95% CI: 1.36, 1.65
Oken, et al. Int J Obes (Lond) 2008; 32(2):201-10
25. Genes
Shared behaviors
Mediators
Confounders
Direct effect of “obese” intrauterine
environment
What accounts for associations of
maternal weight with child weight?
26. Maternal diet
0.1
1
10
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
OddsRatio
Maternal prenatal diet and child ow/obesity at age 5
% Saturated Fat % Sugar
Murrin et al. EJCN 2013
Donahue et al. AJCN 2011
27. Obesity disproportionately affects
racial/ethnic minority children
• In 2010: 14% of white, 24.3% of Black, and
21.2% of Hispanic children 2-19 years
were obese
• Overall rates are stubbornly high;
racial/ethnic disparities are starting early
and appear to be widening
Ogden et al. JAMA 2012.
Weden et al. AJPH 2012.
0
5
10
15
20
25
Non-Hispanic
White
Non-Hispanic
Black
Hispanic
1.59
1.46
1.18
Odds of obesity for black vs. white children in the US
Adjusted for
sociodemographic
characteristics
Adjusted for
prenatal &
perinatal
factors
• Pre- and peri-natal
factors explain
most of the
disparity in obesity
28. Weights of children born before (BMS, n=45)
and after (AMS, n=172) maternal weight-loss surgery
0%
10%
20%
30%
40%
50%
60%
Underweight Normal weight Overweight Obese
BMS
AMS
Kral JG, et al. Pediatrics. 2006 Dec;118(6):e1644-9
30. Animal studies suggested early
energy intake can permanently
program body size
75 days: Weights 86g, 230g
21 days: Weights 14g, 60g
Widdowson and McCance, 1960
31. Weight(g)
Age (weeks)
Food restriction during weeks 0-3
results in sustained lower body weight
(and food excess in higher weight)
21 day period of food restriction
weaning
32. Timing is important
weaning
Weight(g)
Later food restriction
(weeks 9-12) - rats
quickly regain and
perhaps overshoot
body weight
Age (weeks)
Widdowson and McCance, 1963
21 day period of food restriction
33. Offspring of overfed mother rats have
higher body weight …
Samuelsson, A.-M. et al. Hypertension 2008;51:383-392
Male offspring Female offspring
Offspring of obese dams
Offspring of control dams
Offspring of obese dams
Offspring of control dams
34. …higher fat mass…
Samuelsson, A.-M. et al. Hypertension 2008;51:383-392
OC – Offspring of control dams
OO – Offspring of obese dams
35. …higher energy intake…
Samuelsson, A.-M. et al. Hypertension 2008;51:383-392
Offspring of obese dams
Offspring of control dams
Offspring of obese dams
Offspring of control dams
36. …and adverse cardio-metabolic profiles
Samuelsson, A.-M. et al. Hypertension 2008;51:383-392
OC – Offspring of control dams
OO – Offspring of obese dams
37. Pathways linking maternal weight
with child outcomes
Maternal
pre-pregnancy
size
Gestational
weight
gain
Child
adiposity
Birth
weight
Disease
outcomes
Fetal
growth
Gestation
length
Shared genes and behaviors
Gestational
Diabetes
Infant
feeding &
growth
Oken, E. In “Influence of Pregnancy weight on maternal and child health.” IOM 2007.
38. The microbiome and obesity
Huh et al. Arch Dis Child 2012.
Dominguez-Bello et al. Proc Natl Acad
Sci USA. 2010;107[26]:11973.)
39. „Agouti‟ mice - Genetic cause for obesity
first identified >100 years ago
These
mice are
identical
twins!
How do you
get from here
back to
here?
43. Inter- and trans-generational influences
Kaati et al. European Journal of Human Genetics
(2007) 15, 784–790
Excess early
nutrition
in grandmother
(pink line)
results in shorter
lifespan in
grandchild
Innes et al,. JAMA 2002
Longevity of grandchild
44. Air pollution and obesity
Fleisch et al. Submitted.
Fleisc
h
Et
al
0.1
1
10
1 2 3 4 5
Black Carbon
Traffic Density
Quintile
Overweightat6m
46. Taveras et al. Arch Ped Adol Med 2012.
What can you do after birth?
• Watch out for
accelerated
postnatal growth
47. What can you do after birth?
• Watch out for
accelerated
postnatal growth
• Promote
postpartum
weight loss
Large for Gestational Age
0.1
1
10
<-1 -1 to <1 1 to <2 2 to <3 >= 3
Change in BMI
OddsRatio
BMI < 25
BMI >= 25
Gestational Diabetes
0.1
1
10
<-1 -1 to <1 1 to <2 2 to <3 >= 3
Change in BMI
OddsRatio
BMI < 25
BMI >= 25
48. Dabelea D, et al. Diabetes Care 2008;31(7):1422-6. 79 youth aged 10-22y with Type
2 DM and 190 nondiabetic controls
% exposed to maternal diabetes % exposed to maternal obesity
Cases
Controls
What is the impact?
Overall, 47.2% (95% CI 30.9–63.5) of type 2 diabetes in
youth could be attributed to intrauterine exposure to
maternal diabetes and obesity.
Editor's Notes
Thanks so much to the organizers for inviting me to speak here today. It is a great pleasure to be here among such an impressive group of co-speakers, and all of you.Evidence has been accumulating for several decades that risk for chronic health conditions, including obesity has its origins in very early life. As this field if inquiry has begun to pervade the popular press, including books, magazines, and the internet, it is increasingly common for our patients to come to us with questions about the strength of this evidence, and what individuals can do to optimize the health of their children.
In research, we generally measure not only height, weight, and BMI, which are indirect measures of adiposity, but also more direct measures of fat and lean mass such as a DEXA scan. This one was taken of a young girl with a BMI of 38 kg/m2. We care about excess adiposity in childhood not only because of its association with chronic disease risk in adulthood, but also because of accumulating evidence that obese kids are at higher risk of a panoply of adverse outcomes on organ systems ranging from the brain to the bones, even when they are still children.