Double burden of undernutrition and obesity in Uruguay

BACKGROUND

Uruguay is at an advanced stage of the epidemiologic transition; like other Latin American countries, it bears a nutritional double burden composed of undernutrition and overweight or obesity.

OBJECTIVES

The aim was to estimate whether a double burden of nutritional problems exists in Uruguay and to identify if governmental programs and policies for nutrition take this double burden into account.

DESIGN

Existing studies were reviewed, and other data were processed specifically for the purpose of this article. Several data sources were used to include a broad, comprehensive population range.

RESULTS

The prevalence of stunting in children aged <2 y is 10.9%. There is a high frequency of obesity, which increases with age (9.5% in children <2 y old, 18.8% in those aged 6 y, 20.4% in those aged 11 y, 26.6% in those aged 13-15 y, and 35.3% in adults). In addition, 13.8% of women start pregnancy underweight and the rate of obesity increases during pregnancy from 36.7% at the beginning to 46.5% at the end. Anemia is very frequent in the selected population we examined, as follows: 31% of children <2 y old and 20.9% of pregnant women in their third trimester. An obese mother with a stunted child are present in 6.3% of households; 1.9% of stunted children are obese at age 6 y and 3.1% are obese at the age of 11. Multiple logistic analysis applied to children <2 y showed an association between stunting and obesity (OR: 2.0; 95% CI: 1.2, 3.6).

CONCLUSIONS

The data suggest that there is a nutritional double burden in Uruguay. This nutritional burden is similar to that of other countries in the region. This important public issue should be tackled, and it should be addressed in early infancy.

Human growth and chronic disease: a memorial to Jim Tanner

CONTEXT

Memorial to Jim Tanner.

OBJECTIVE

To examine the links between early growth and chronic disease in later life.

METHODS

Literature review.

RESULTS

There is now a developmental model for the origins of chronic disease in which the causes to be identified are linked to normal variations in feto-placental, infant and childhood growth and development. These variations lead to variations in the supply of nutrients to the baby that permanently alters gene expression, a process known as 'programming'.

CONCLUSIONS

Variations in the processes of development programme the function of a few key systems that are linked to chronic disease-the immune system, anti-oxidant defences, inflammatory responses, the number and quality of stem cells, neuro-endocrine settings and the balance of the autonomic nervous system. There is not a separate cause for each different disease. Which chronic disease originates during development may depend more on timing than on qualitative differences in exposures to external influences.

Resource allocation in utero and health in later life

The way that a fetus obtains and allocates nutritional resources has profound consequences for its life-long health. Under the new developmental model for the origins of chronic disease, the causes to be identified are linked to normal variations in the processes of feto-placental development, that are associated with differences in the supply of nutrients to the baby. These differences programme the function of a few key systems that are linked to chronic disease, including the immune system, anti-oxidant defences, inflammation, and the number and quality of stem cells. There is not a separate cause for each different disease. Which chronic disease originates during development may depend more on timing than on qualitative differences in experience.

Mother's body size and placental size predict coronary heart disease in men

AIMS

People whose birthweights were towards the lower end of the normal range are at increased risk of coronary heart disease. This is attributed to foetal programming through malnutrition, but the cause of the malnutrition is unknown.

METHODS AND RESULTS

We studied 6975 men born in Helsinki during 1934-44. Their size at birth was recorded. Babies who later developed coronary heart disease tended to have a low ponderal index (birthweight/length(3)). Three different placental phenotypes predicted the disease. In primiparous mothers who were short, having below median height, the hazard ratio for the disease was 1.14 (95% confidence interval 1.08-1.21, P< 0.0001) for each centimetre increase in the difference between the length and breadth of the placental surface. In tall mothers whose body mass index was above the median, the hazard ratio was 1.25 (1.10-1.42, P= 0.0007) per 40 cm(2) decrease in the surface area. In tall mothers whose body mass index was below the median, the hazard ratio was 1.07 (1.02-1.13, P= 0.01) per 1% increase in the placental weight/birthweight ratio.

CONCLUSIONS

Three different combinations of maternal and placental size predicted coronary heart disease. The mother's body size determines the availability of nutrients and is linked to the development and function of the placenta, reflected in its shape and size. We speculate that variations in three processes of normal placental development lead to foetal malnutrition. The processes are (i) implantation and spiral artery invasion, (ii) growth of the chorionic surface, and (iii) compensatory expansion of the chorionic surface.

Placental programming of blood pressure in Indian children

Aim

To determine whether the size and shape of the placental surface predict blood pressure in childhood.

Methods

We studied blood pressure in 471 nine-year-old Indian children whose placental length, breadth and weight were measured in a prospective birth cohort study.

Results

In the daughters of short mothers (<median height), systolic blood pressure (SBP) rose as placental breadth increased (β = 0.69 mmHg/cm, p = 0.05) and as the ratio of placental surface area to birthweight increased (p = 0.0003). In the daughters of tall mothers, SBP rose as the difference between placental length and breadth increased (β = 1.40 mmHg/cm, p = 0.007), that is as the surface became more oval. Among boys, associations with placental size were only statistically significant after adjusting for current BMI and height. After adjustment, SBP rose as placental breadth, area and weight decreased (for breadth β = −0.68 mmHg/cm, p < 0.05 for all three measurements).

Conclusions

The size and shape of the placental surface predict childhood blood pressure. Blood pressure may be programmed by variation in the normal processes of placentation: these include implantation, expansion of the chorionic surface in mid-gestation and compensatory expansion of the chorionic surface in late gestation.

How boys grow determines how long they live

OBJECTIVES

Increase in height in modern societies has been accompanied by an in increase in lifespan. The longer lives of taller people suggest that good nutrition during childhood, together with freedom from recurrent minor infection, prolong human life. There is, however, a caveat. Tall adult stature may be the result of rapid "compensatory" growth following a setback. Compensatory growth is known to reduce the lifespan of animals, possibly because it is disorganized.

METHODS

We analyzed lifespan among 6,975 men born in Helsinki, Finland, during 1934-44. Their early growth was recorded.

RESULTS

Boys who were tallest at seven years of age had lower all cause mortality, the hazard ratio being 0.79(95%CI 0.70 to 0.89, P < 0.0001) per 10 cm increase in height. There was, however, a group of boys among whom being tall was associated with increased all cause mortality, the hazard ratio being 1.32(1.00 to 1.75, P = 0.05). These boys were taller at seven years than their birthweight and length at birth predicted. After they were excluded from the analysis, boys who were more than 126 cm in height at seven lived for eight years longer than those who were 114 cm or less. This increase in lifespan was similar to the effect of high socio-economic status in adult life.

CONCLUSIONS

Rapid growth in childhood height usually predicts a longer life. But tallness among men may be a misleading indicator of wellbeing and longer life expectancy in populations where compensatory growth is widespread. African Americans may be an example. Am. J. Hum. Biol., 2011. © 2011 Wiley-Liss, Inc.

Boys live dangerously in the womb

The growth of every human fetus is constrained by the limited capacity of the mother and placenta to deliver nutrients to it. At birth, boys tend to be longer than girls at any placental weight. Boy's placentas may therefore be more efficient than girls, but may have less reserve capacity. In the womb boys grow faster than girls and are therefore at greater risk of becoming undernourished. Fetal undernutrition leads to small size at birth and cardiovascular disorders, including hypertension, in later life. We studied 2003 men and women aged around 62 years who were born in Helsinki, Finland, of whom 644 had hypertension: we examined their body and placental size at birth. In both sexes, hypertension was associated with low birth weight. In men, hypertension was also associated with a long minor diameter of the placental surface. The dangerous growth strategy of boys may be compounded by the costs of compensatory placental enlargement in late gestation. In women, hypertension was associated with a small placental area, which may reduce nutrient delivery to the fetus. In men, hypertension was linked to the mothers' socioeconomic status, an indicator of their diets: in women it was linked to the mothers' heights, an indicator of their protein metabolism. Boys' greater dependence on their mothers' diets may enable them to capitalize on an improving food supply, but it makes them vulnerable to food shortages. The ultimate manifestation of their dangerous strategies may be that men have higher blood pressures and shorter lives than women.

Adult consequences of fetal growth restriction

Low birthweight in relation to the length of gestation, is now known to be associated with increased rates of coronary heart disease and the related disorders stroke, hypertension and type 2 diabetes. These associations extend across the whole range of birthweight, which implies that normal variations in nutrient delivery to the fetus have profound long-term effects. The associations are thought to reflect the body's plasticity during development, by which its structure and function can be permanently changed by the intra uterine and early post natal environment. Slow growth during infancy and rapid weight gain after the age of two years exacerbate the effect of slow fetal growth. Cardiovascular disease and type 2 diabetes arise through a series of interactions between environmental influences and the pathways of development that precede them.