From fatalism to mitigation: A conceptual framework for mitigating fetal programming of chronic disease by maternal obesity

Prenatal exposure to gestational diabetes is associated with anxiety and physical inactivity in children during COVID-19

BACKGROUND

The coronavirus disease 2019 (COVID-19) is associated with adverse child mental health outcomes and reduced physical activity. Moreover, prenatal exposure to gestational diabetes (GDM) is associated with increased risk for adverse psychological outcomes in children.

OBJECTIVES

Assess prenatal exposure to GDM on anxiety levels and physical activity in children during the COVID-19 pandemic.

METHODS

Sixty-five children age 9 to 15 reported their physical activity and anxiety levels using the 24-hours physical activity recall and the State-Trait Anxiety Inventory for Children via phone or video meetings. Prenatal exposure to GDM was obtained from maternal electronic medical records.

RESULTS

The 38 GDM-exposed children reported significantly higher anxiety levels and were less likely to engage in any vigorous physical activity (VPA) (5% vs 30%) compared to the 27 GDM-unexposed children. Lower levels of physical activity were significantly associated with higher levels of anxiety. Less engagement in VPA explained 75% of the association between GDM exposure and anxiety levels.

CONCLUSIONS

Engaging in physical activity during the COVID-19 pandemic may be beneficial for reducing anxiety, particularly amongst GDM-exposed children.

Starting strong: Dietary, behavioral, and environmental factors that promote "strength" from conception to age 2 years

Beginning with conception and continuing through childhood and adolescence, the word "strength" connotes the totality of optimal early bone and tissue growth; neural wiring of the brain; and acquisition of fine motor, gross motor, language, and socioemotional skills. The robustness of each of these attributes depend on 3 critical epigenetic (external) factors: the quality of nutrition; positive adult nurturing; and experiences acquired within a stimulating, safe environment that affords free exploration. This review highlights the relationship between the epigenetic factors in the period of conception to age 2 years and a child's future health, cognitive capacity, and social aptitude, which collectively comprise their "strength". This paper was presented as part of the 2018 Strength Summit conference entitled, The Role of Strength in Optimal Health and Well-being. Novelty Strength in infants signifies the totality of optimal early growth and neural wiring of the brain. Strength at this life stage also includes the acquisition of motor, language, and socioemotional skills. Three epigenetic factors are critical during birth to 24 months: nutrition, nurturing, and free exploration.

Prenatal Development and Adolescent Obesity: Two Distinct Pathways to Diabetes in Adulthood

OBJECTIVE

Higher body-mass index (BMI) and lower birth weight (BW) are associated with elevated risk of diabetes in adulthood, but the extent to which they compose two distinct pathways is unclear.

METHODS

We used data from the National Longitudinal Study of Adolescent to Adult Health, a cohort of adolescents (1994-1995) followed for 14 years over four waves into adulthood (n = 13,413). Sex-stratified path analysis was used to examine pathways from BW [kg; linear (BW) and quadratic (BW2)] to latent trajectories in BMI from adolescence to adulthood to prevalent diabetes or prediabetes (pre/diabetes) in adulthood, adjusting for sociodemographic characteristics.

RESULTS

Two pathways from BW to pre/diabetes were characterized: one from higher BW to elevated BMI and pre/diabetes and a second from lower BW, independent of BMI. In the BMI-independent pathway, greater BW was associated with marginally lower odds of pre/diabetes in women, but not men. Girls born at lower and higher BW exhibited elevated BMI in adolescence [coeff (95% CI): BW: -2.1 (-4.1, -0.05); BW2: 0.43 (0.09, 0.76)]; higher BW predicted marginally faster BMI gain and higher adolescent BMI and faster BMI gain were associated with pre/diabetes [coeff (95% CI): BMI intercept: 0.09 (0.06, 0.11); BMI slope: 0.11 (0.07, 0.15)]. In boys, BW was weakly associated with BMI intercept and slope; BMI slope, but not BMI intercept, was positively associated with pre/diabetes [coeff (95% CI): 0.29 (0.19, 0.39)].

CONCLUSIONS

Findings suggest that in girls, slowing BMI gain is critical for diabetes prevention, yet it may not address distinct pathology stemming from early life.

Developmental Origins, Epigenetics, and Equity: Moving Upstream

The Developmental Origins of Health and Disease and the related science of epigenetics redefines the meaning of what constitutes upstream approaches to significant social and public health problems. An increasingly frequent concept being expressed is "When it comes to your health, your zip code may be more important than your genetic code". Epigenetics explains how the environment-our zip code-literally gets under our skin, creates biological changes that increase our vulnerability for disease, and even children's prospects for social success, over their life course and into future generations. This science requires us to rethink where disease comes from and the best way to promote health. It identifies the most fundamental social equity issue in our society: that initial social and biological disadvantage, established even prior to birth, and linked to the social experience of prior generations, is made worse by adverse environments throughout the life course. But at the same time, it provides hope because it tells us that a concerted focus on using public policy to improve our social, physical, and economic environments can ultimately change our biology and the trajectory of health and social success into future generations.

Maternal and early life nutrition and physical activity: setting the research and intervention agenda for addressing the double burden of malnutrition in South African children

Early life is important for later health outcomes, yet there are few studies which adequately address all of the potential early life insults that may affect later life health and growth trajectories. This is particularly evident in low- to middle-income countries such as South Africa, where women of childbearing age are particularly vulnerable to high levels of physical inactivity, malnutrition, and obesity. Pregnancy may therefore be an opportune time to change behaviours and improve maternal and offspring health outcomes, and decrease the inter-generational transfer of risk. We show clear evidence that physical activity and nutrition are important target areas for intervention during pregnancy and in the early years of life, yet that current literature in Africa, and specifically South Africa, is limited. We have outlined the available literature concerning the impact of maternal and early life nutrition and physical activity on the health status of South African children, and have provided some recommendations for future research and policy.

Could post-weaning dietary chia seed mitigate the development of dyslipidemia, liver steatosis and altered glucose homeostasis in offspring exposed to a sucrose-rich diet from utero to adulthood?

The present work analyzes the effects of dietary chia seeds during postnatal life in offspring exposed to a sucrose-rich diet (SRD) from utero to adulthood. At weaning, chia seed (rich in α-linolenic acid) replaced corn oil (rich in linoleic acid) in the SRD. At 150 days of offspring life, anthropometrical parameters, blood pressure, plasma metabolites, hepatic lipid metabolism and glucose homeostasis were analyzed. Results showed that chia was able to prevent the development of hypertension, liver steatosis, hypertriglyceridemia and hypercholesterolemia. Normal triacylglycerol secretion and triacylglycerol clearance were accompanied by an improvement of de novo hepatic lipogenic and carnitine-palmitoyl transferase-1 enzymatic activities, associated with an accretion of n-3 polyunsaturated fatty acids in the total composition of liver homogenate. Glucose homeostasis and plasma free fatty acid levels were improved while visceral adiposity was slightly decreased. These results confirm that the incorporation of chia seed in the diet in postnatal life may provide a viable therapeutic option for preventing/mitigating adverse outcomes induced by an SRD from utero to adulthood.

A Framework to Address Challenges in Communicating the Developmental Origins of Health and Disease

Findings from the field of Developmental Origins of Health and Disease (DOHaD) suggest that some of the most pressing public health problems facing communities today may begin much earlier than previously understood. In particular, this body of work provides evidence that social, physical, chemical, environmental, and behavioral influences in early life play a significant role in establishing vulnerabilities for chronic disease later in life. Further, because this work points to the importance of adverse environmental exposures that cluster in population groups, it suggests that existing opportunities to intervene at a population level may need to refocus their efforts "upstream" to sufficiently combat the fundamental causes of disease. To translate these findings into improved public health, however, the distance between scientific discovery and population application will need to be bridged by conversations across a breadth of disciplines and social roles. And importantly, those involved will likely begin without a shared vocabulary or conceptual starting point. The purpose of this paper is to support and inform the translation of DOHaD findings from the bench to population-level health promotion and disease prevention, by: (1) discussing the unique communication challenges inherent to translation of DOHaD for broad audiences, (2) introducing the First-hit/Second-hit Framework with an epidemiologic planning matrix as a model for conceptualizing and structuring communication around DOHaD, and (3) discussing the ways in which patterns of communicating DOHaD findings can expand the range of solutions considered and encourage discussion of population-level solutions in relation to one another, rather than in isolation.