nore likely to develop coronary heart disease in adulthood. These ob- mechanisms, which may determine fetal nutrition and growth, and ovations can even be made in individuals who do have maintained normal body weight later in life. Similar findings were reported for the insulin resistance syndrome, a condition which leads to ept of programming does not dismiss the influences and impor- non-insulin dependent diabetes(Figure 2. 2). More recently, impaired tance of risk factors operating later in life, such as smoking, excessive early growth has been linked with accelerated ageing. a decline in alcohol consumption, inadequate exercise, and obesity, all of which muscular strength(as indicated, for example, by reduced grip strength of contribute to the development of chronic diseases. Instead it proposes the hand) is a marker of ageing, and was found to be more pronounced that these environmental factors amplify the disadvantages that may have among men and w who had low weight at birth. A specific occurred in fetal life. This has important implications for countries where nutritional deficiency is maternal iodine deficiency, which leads to fetal growth retardation is common and rates of smoking, obesity and a hypothyroidism(and subsequently cretinism)in the newborn, if it remaIns sedentary life style are increasing ving fetal development by Figure 2. 2: Prevalence of insulin resistance syndrome in British men aged 64 years according to birthweight targeting health promotion activities at improvement of health and nutrition of girls, young women, and mothers during pregnancy and lactation, especially social groups where fetal growth retar promoting the adoption and maintenance of a healthy life style (chapter 4), with special emphasis on people undernourished while the womb =5.56.5-7.5 2.2 Congenital disorders rthmwe ight (pound s Permanent physical or mental defects in the newborn can be caused by (Source: Barker DIP. Mothers, Babies and Health in Later Life. Churchill Livingston, 1998) genetic disorders, by exposure to toxins, or through infections during pregnancy. Examples of genetic diseases are pheny ketonuria(a metabolic disorder that, if left untreated, can lead to mental retardation), or familial Moreover, the effects of our own fetal development may be carried into hypercholesterolaemia (high cholesterol levels predisposing to the following generation. It has been shown that the two main cardiovascular disease in adult life determinants of a baby's weight are the mother's weight before she conceives and her own birthweight. It may therefore take several Exposure to toxins, such as smoking, drug misuse and excessive alcohol generations before nutrition in the womb can be optimised. Further in- consumption during pregnancy may cause growth impairment and mental tensive research is needed to establish the cellular and molecular retardation in the newborn. Common infections, which may cause long
6 more likely to develop coronary heart disease in adulthood. These observations can even be made in individuals who do not smoke and who have maintained normal body weight later in life. Similar findings were reported for the insulin resistance syndrome, a condition which leads to non-insulin dependent diabetes (Figure 2.2). More recently, impaired early growth has been linked with accelerated ageing. A decline in muscular strength (as indicated, for example, by reduced grip strength of the hand) is a marker of ageing, and was found to be more pronounced among men and women who had low weight at birth. A specific nutritional deficiency is maternal iodine deficiency, which leads to hypothyroidism (and subsequently cretinism) in the newborn, if it remains untreated. mechanisms, which may determine fetal nutrition and growth, and therefore guide interventions. The concept of programming does not dismiss the influences and importance of risk factors operating later in life, such as smoking, excessive alcohol consumption, inadequate exercise, and obesity, all of which contribute to the development of chronic diseases. Instead it proposes that these environmental factors amplify the disadvantages that may have occurred in fetal life. This has important implications for countries where fetal growth retardation is common and rates of smoking, obesity and a sedentary life style are increasing. Improving fetal development by l targeting health promotion activities at improvement of health and nutrition of girls, young women, and mothers during pregnancy and lactation, especially in countries and/or social groups where fetal growth retardation prevails l promoting the adoption and maintenance of a healthy life style (chapter 4), with special emphasis on people undernourished while in the womb 2.2 Congenital disorders Permanent physical or mental defects in the newborn can be caused by genetic disorders, by exposure to toxins, or through infections during pregnancy. Examples of genetic diseases are phenylketonuria (a metabolic disorder that, if left untreated, can lead to mental retardation), or familial hypercholesterolaemia (high cholesterol levels predisposing to cardiovascular disease in adult life). Exposure to toxins, such as smoking, drug misuse and excessive alcohol consumption during pregnancy may cause growth impairment and mental retardation in the newborn. Common infections, which may cause long- (Source: Barker DJP. Mothers, Babies and Health in Later Life. Churchill Livingston, 1998) Figure 2.2: Prevalence of insulin resistance syndrome in British men aged 64 years according to birthweight ! %LUWKZHLJKW SRXQGV 2GGVUDWLRIRULQVXOLQUHVLVWDQFHV\QGURPH DGMXVWHGIRU%0, Moreover, the effects of our own fetal development may be carried into the following generation. It has been shown that the two main determinants of a babys weight are the mothers weight before she conceives and her own birthweight. It may therefore take several generations before nutrition in the womb can be optimised. Further intensive research is needed to establish the cellular and molecular
term injury, include the rubella and cytomegaly virus, and especially 3. INFLUENCES IN INFANCY AND CHILDHOOD malaria infection during pregnancy, which is probably the biggest cause of low birth weight worldwid 3.1 Breast-feeding Reducing disease in the newborn through Protein-energy malnutrition in childhood is common in developing countries and in poorer communities of industrialised countries availability of adequate screening programmes, both pre- and post- Breastfeeding is an effective, low-cost intervention to reduce mainutri- natal, for all pregnant women and their families tion in infancy and childhood. Breastmilk provides ideal nourishment, and protects against infections and allergies, promotes mother/child there s long-term follow-up for those with congenital disease and bonding, and may reduce the development of malabsorpti n synario- e providing information about the risks of toxic substances and the But there is also evidence, that exclusive breast-feeding beyond the age mode of transmission of infectious diseases, which may be hazardous of 6 months may not supply adequate energy to babies, and solid foods to the unborn child. Smoking prevention and cessation programmes should be added to the baby s diet. Infants should be fed exclusively on should be particularly targeted at women breast milk from birth to 4 to 6 months of age; that is, they should be given no other liquids or solids other than breast milk, not even water, promotion of universal immunisation against rubella for girls and for during this period. Continuing to breastfeed up to two years of age or usceptible women beyond, in addition to giving adequate complementary foods, helps to maintain adequate nutritional status and prevents diarrhoea Bibliography 1. Barker DJP Mothers, Babies and Health in Later Life. Churchill Despite this knowledge breast-feeding is not sufficiently encouraged at Livingston, Edinburgh, London, New York 1998 present WHO figures indicate that only 35%of all infants worldwide are exclusively breast fed between birth and 4 months of age 2. Frankel S, Elwood P, Sweetnam P, Yarnell ], Davey Smith G Birthweight, body mass index in middle-age, and incident coronary Increasing rates of breast feeding by heart disease. Lancet 1996: 348: 1 encouraging breast feeding among mothers throughe world 3. The World Health Report 1997. World Health Organization by training health workers who take care of women and infants, on Geneva, 1997 breastfeeding counselling and lactation management sing the media to promote community support for breastfeeding Breastmilk Substitutes and enforcing compliance where adopte
7 term injury, include the rubella and cytomegaly virus, and especially malaria infection during pregnancy, which is probably the biggest cause of low birth weight worldwide. Reducing disease in the newborn through l availability of adequate screening programmes, both pre- and postnatal, for all pregnant women and their families l ensuring long-term follow-up for those with congenital disease and their families l providing information about the risks of toxic substances and the mode of transmission of infectious diseases, which may be hazardous to the unborn child. Smoking prevention and cessation programmes should be particularly targeted at women l promotion of universal immunisation against rubella for girls and for susceptible women Bibliography 1. Barker DJP. Mothers, Babies and Health in Later Life. Churchill Livingston, Edinburgh, London, New York 1998. 2. Frankel S, Elwood P, Sweetnam P, Yarnell J, Davey Smith G. Birthweight, body mass index in middle-age, and incident coronary heart disease. Lancet 1996; 348: 1478-80. 3. The World Health Report 1997. World Health Organization, Geneva, 1997. 3. INFLUENCES IN INFANCY AND CHILDHOOD 3.1 Breast-feeding Protein-energy malnutrition in childhood is common in developing countries and in poorer communities of industrialised countries. Breastfeeding is an effective, low-cost intervention to reduce malnutrition in infancy and childhood. Breastmilk provides ideal nourishment, and protects against infections and allergies, promotes mother/child bonding, and may reduce the development of malabsorption syndromes. But there is also evidence, that exclusive breast-feeding beyond the age of 6 months may not supply adequate energy to babies, and solid foods should be added to the babys diet. Infants should be fed exclusively on breast milk from birth to 4 to 6 months of age; that is, they should be given no other liquids or solids other than breast milk, not even water, during this period. Continuing to breastfeed up to two years of age or beyond, in addition to giving adequate complementary foods, helps to maintain adequate nutritional status and prevents diarrhoea. Despite this knowledge breast-feeding is not sufficiently encouraged at present. WHO figures indicate that only 35% of all infants worldwide are exclusively breast fed between birth and 4 months of age. Increasing rates of breast feeding by l encouraging breast feeding among mothers throughout the world, by training health workers who take care of women and infants, on breastfeeding counselling and lactation management l Using the media to promote community support for breastfeeding l promoting legislation compatible with the Code of Marketing of Breastmilk Substitutes and enforcing compliance where adopted