Recent research from Leicester University and the University of Cambridge’s Medical Research Council Toxicology unit in the UK, the Steno Diabetes Centre in Denmark, and the Massachusetts Institute of Technology in Cambridge, Massachusetts, suggests that having a poor diet during pregnancy will risk the chance of offspring developing diabetes in later life.

The research focused on the way diet in early life affects both the composition and behaviour of fat tissues.  While this laboratory study was conducted with rats, the research team cautiously suggests a generalisability to the human population, and identifies a mechanism through which poor early nutrition may impact the development and location of fat tissue. High levels of a newly identified molecule causes fat to be stored inappropriately in the muscle and liver, and is linked to both insulin resistance and high levels of diabetes.

The contemporary diet leads to storage of excess calories in fat cells, and when the cells become over-burdened they store calories in and around organs such as the liver, which can cause insulin resistance and render people more susceptible to type 2 diabetes in later life. This study lends even more credence to the early origins of health hypothesis that C3 has been exploring recently (click here >>).

Sources: NHS Choices, 9 January 2012; The Telegraph, 6 January 2012; Ferland-McCollough et al., ‘Programming of adipose tissue miR-483-3p and GDF-3 expression by maternal diet in type 2 diabetes’, Cell Death and Differentiation, 6 January 2012.

• In France, the Foundation is providing funding for 220 refrigeration units to French Red Cross locations across the country. This will allow for better distribution of fresh foods, including fruits, vegetables, dairy and meat, which are  Over the next three years, the units are expected to help distribute up to 50 million more meals to those in need over the next three years. A pilot programme will also be funded to implement a nutrition education workshop in 30 French Red Cross locations, to teach those attending how to cook cheap, healthy meals.
• In Germany, the Foundation is holding 800 healthy lifestyle classes 20,000 primary-school children over five years, covering nutrition, exercise, relaxation, life skills and saying no to tobacco and alcohol. Parents are also involved, and support their children with activities to do at home.
• In Italy, where nearly a quarter of children struggle with their weight, with its partners the Foundation is launching healthy living classes (including sport activities and games, as well as healthy eating workshops) are launching in 10 Italian cities to benefit at-risk communities – and the funding will also help to improve sports facilities and playgrounds. It will reach 32,000 children in three years.
• Finally, in Spain, the Alicia Foundation and Kraft Foundation will fund health education programmes and cooking workshops in schools. Children will track their food intake and physical activity, and they will analyse the data and come up with solutions to improve lifestyles. The 10 best proposals will be published online for educators across Spain to use.

Source: CSR Wire, 29 November 2011.

The study found that babies with a higher weight-to-length percentile at any point between the ages of one and 24 months were more likely to be obese later than those in a lower percentile.  Also, going up through two or more of these percentile groups in the first six months of life (something that happened to 43 per cent of the infants) was also found to be associated with higher risk of later obesity than those who do not go up so far. At age five, 11.6 per cent of the children were obese; by age 10, this rose to 16.1 per cent. However, the study found that children who had increased by two or more percentile groups had more than twice the chance of being obese at five years of age compared to those who had crossed less than two groups, and were 75 per cent more likely to be obese at 10. The authors noted that ‘efforts to curb excess weight gain in infancy may be useful in preventing later obesity’.

Source: NHS Choices, 8 November 2011.

The Clinton Global Initiative was established in 2005 to convene global leaders across sectors to develop and implement solutions to the most urgent problems facing the world. Since over half of premature deaths from NCDs are linked with lifestyle decisions that begin during childhood and adolescence, interventions that tackle the challenge of influencing choice can have a crucial impact on long term health and NCD prevention. The relationship between young people and NCDs is often overlooked. This partnership is part of a broader Young Health Programme that intends to reach 500,000 young people between ages 10-24, and was launched in Zambia last week and is already active in Brazil, India, Sweden, the United Kingdom and Canada.

The Young Health Programme also has a 2 part research component called WAVE: Well Being of Adolescents in Urban Environments which will set the stage for health interventions using cell phones and other social media to communicate with young people at risk of NCDs. AstraZeneca partners with the Urban Health Institute and the Centre for Adolescent Health for this research programme in six study sites: Baltimore, USA; Johannesburg, South Africa; Shanghai, China; Delhi, India; Rio de Janeiro in Brazil, and Ibadan in Nigeria.  WAVE, which will partner with community youth workers and young people themselves to ensure accurate survey methods, intends to collect robust data around adolescent health care access, resources and services in each survey site.

Sources: Johns Hopkins School of Public Health, Centre for Adolescent Health. AstraZeneca, news release, 21 September 2011. Young health Programme, accessed 29 September 2011

The International Journal of Epidemiology reports from a longitudinal cohort study that a strong relationship is found between the duration of an individual case of obesity and all cause mortality, establishing a clear positive link between the length of time of obesity and death.  Researchers argue that this key factor should be accounted for when researchers estimate the impact of obesity on mortality.

Tam Fry of the National Obesity Forum has warned on the BBC that due to the dramatic increase and early age of onset of obesity among youth, some young people are at risk of dying at an earlier age than their parents, due to the obesity epidemic. The English Department of Health has identified confronting the challenge of obesity as a priority for government.

Sources: BBC (Call to measure duration of obesity) 23 August 2011 and 2011 International Journal of Obesity (The number of years lived with obesity and the risk of all-cause and cause-specific mortality) 11 January 2011.

Student consumption of sugared beverages decreased from 1.71 servings per day to 1.38 servings per day, which amounts to 45 calories.  This small difference represents the equivalent of 40 per cent of the ‘excess calories’ responsible for the increasing average weight of children in the United States.

In addition to the enormous human toll of obesity and overweight, it has been estimated that the cost of obesity in the United States to business in health-related claims is $13 million each year. Since about 80% of overweight children are predicted to become obese, the human and financial burden of obesity will continue to rise without initiatives that target schools to tackle diet and exercise.

School-based ‘nudge’ strategies can be a key component in establishing behaviours that effect dietary choices.

Sources: Robert Wood Johnson Foundation (’Boston High School Students Drinking Fewer Sugary Beverages’) 19 August 2011 and Boston Globe, 13 August 2011

The importance of the ‘early origins of health’ has also been stressed in the UK’s National Institute of Clinical Excellence updated guidance on maternal and child nutrition, particularly aimed at supporting nutrition of pregnant mothers and breastfeeding women, to aid the health of infants in low-income households.  Current recommendations will be updated to align them with present World Health Organization advice. The Scientific Advisory Committee on Nutrition (SACN) has also been considering issues relevant to maternal and child health and will issue multiple reports by 2014;  at this latter point, an expert group will take on SCAN reports and issue revised clinical guidance, although the expert panel convened suggests that there is insufficient evidence to recommend policy change at this time.

NICE recommendations refer to the recently updated guidance issued by the Department of Health on infant feeding. DH guidance provides detailed recommendations around baby feeding via commercial products but emphasises: ‘Breast milk is the best form of nutrition for infants, and exclusive breastfeeding is recommended for the first six months (26 weeks) of an infant’s life.  Thereafter, breastfeeding should continue as long as the mother and baby wish, while gradually introducing the baby to a more varied diet.’

Sources: NICE review of guidance on ‘Improving the nutrition of pregnant and breastfeeding mothers and children in low-income households’ here >> and a ‘Review decision’ on ‘Maternal and child nutrition’ here >> (July 2011), and The Guardian, 3 August 2011.

England’s Chief Medical Officer Sally Davies further recommends that infants under two have access to physical activity through stretching, crawling and play and suggests that children should not spend too much time inactive in pushchairs or prams. This is the first time that governments from England, Scotland, Wales and Northern Ireland have joined forces to offer advice on exercise to under-fives.

Last week was Childhood Obesity Week in the UK (click here >> for an Alert) and advocates noted that, in addition to concerns about nutrition, children were not as physically active as they have been in the past – and that physical activity is linked to brain development.

‘The early years shape every child’s future,’ Dr Terence Stephenson, president of the Royal College of Paediatrics and Child Health said, as he welcomed the new guidance.

Sources: BBC News online, 10 July 2011; Daily Telegraph, 13 July 2011 Telegraph.

The small study was conducted in four primary schools across the UK by the University of Worcester Institute of Sport and Exercise Science for MEND and Change4Life.  The results are consistent with previous English national survey data which shows that few children get adequate amounts of daily exercise. Physical monitors as well as questionnaires were used as research tools in the study.  Children who participated engaged in just over 30 minutes of physical activity daily, which is only half the time the government estimates is needed for children to promote good health and healthy weight.

In addition, parents considerably overestimated the amount of time their children spend being physically active, believing that during the school year their children were active 4.5 hours daily and that during summer months they were even more active.  The 40 nine- and ten-year-olds spend almost two ‘screen time’ hours daily, and lifestyle changes have meant less walking and other routine physical activity, which may contribute to the moderate physical activity levels that play a role in overall health and weight management.

As C3 reported in a recent Alert >>, the June IOM report on childhood obesity urges parents and carers to educate themselves about childhood weight issues and take action to reduce childhood obesity.

Sources: The Guardian, 3 July 2011; other information from MEND and Health Survey for England (January 2009).

Although conventional wisdom has suggested that chubby babies are healthy, evidence now suggests that plump babies may grow up to be overweight children and obese adults.  Levels of both hypertension and diabetes are increasing among older children and young adults, and there are links between these illnesses and overweight in early childhood.

In the United States, 10 per cent of infants and toddlers and 20 per cent of children between two and five are currently overweight.

The report presents several bold recommendations to the US Federal government which has a lead role in programme administration, as well as recommendations to individual paediatricians, child care staff, NGOs and parents.

Key recommendations include screening for infant and child weight and height/length at every physician visit, using newly devised WHO charts (click here >>). IOM recommendations also include changing national Dietary Guidelines to include recommendations for under twos.  At present, the US dietary guidelines cover older children and adults. The recommendations will include promoting and encouraging exclusive breastfeeding for infants for six months, and combining breastfeeding with age appropriate food exposure for one year or longer.

Another component of the IOM recommendations – which presents a new aspect of infant medical recommendations – includes encouraging physical activity in young children, who have traditionally been excluded from the broader conversation around exercise. Carers for babies and young children are encouraged to keep them active and to avoid too much sedentary activity like watching television and other ‘screen time’.

Federal government, parents and day-care staff are asked to take responsibility for assisting in developing healthy dietary preferences in young children.  In low-income communities, this will mean ensuring that there is access to healthy food and promoting participation in Federal Food Assistance Programmes where there is not. There is also discussion of ensuring this is possible at the community level, given limited access to fresh foods in some settings. Another avenue parents and carers have is through ensuring children have adequate sleep.

Together, these recommendations encourage positive developments to  improve  early origins of health along the lifecourse.

Sources: Institute of Medicine, news release and report Early Childhood Obesity Prevention Policies: Consensus Report, 23 June 2011.