ADULT ONSET DISEASES AND MALNUTRITION IN FIRST THREE YEARS OF LIFE


Adequate Nutrition

in utero and in the first 2 years of life is essential for achieving optimum

adult health

(1). It is found that poor fetal growth or stunting in the first 2 years of life leads to irreversible damage, including shorter adult height, lower attained schooling, reduced adult income and decreased off spring birth weight (1). Also children who are undernourished in the first 2 years of life and who put on weight rapidly later in childhood and in adolescence are at high risk of chronic diseases such as metabolic syndrome (1).

The hypothesis of fetal origins of adult disease was first put forth by Dr. David J.P. Barker in early 1990's where he considered a link between perinatal

malnutrition

and
adult diseases
such as metabolic syndrome, (2) diabetes (3) and coronary heart disease (4).

Similarly, malnutrition that occurs during critical period of growth such as in first 2 years of life can have long term health effects (5).

Undernutrition
and adult height: Stunting usually occurs with intrauterine growth retardation and malnutrition during the first few years of life unless there is compensatory growth in childhood which depends on the extent of maturational delay (6, 7). Where maturational delay is less, only a small part of growth failure is compensated for (1).

Undernutrition and cognitive performance: Though birth weight may affect cognitive skills in children, it has been found that intrauterine growth restriction has little or no measurable effect on cognitive performance in adolescents and adults (8, 9). However, stunting between 12-36 months is associated with poor cognitive ability and lower school grades in middle childhood (10).

Undernutrition and birth weight in offspring: Undernourished girls tend to become short adults and thus are more likely to have small children (1). Thus, adequate nutrition during critical periods of growth in girls helps to achieve proper adult height which may in turn prevent intrauterine growth retardation in the offspring.

Nutrition and lipid profile in adults: Birth weight is not associated with unhealthy lipid profile and nutritional supplementation in early childhood also has no effect on lipid profile (1). Abnormal lipid profile may be related to specific components of the diet.

Nutrition and Type 2 diabetes: All studies from high income countries show association of lower birth weight with type 2 diabetes in adults (1). A study from India found that diabetes was associated with low weight at 1 and 2 years of age and accelerated growth later in childhood (11).

Nutrition and Coronary Heart disease: Studies in high income countries have documented that lower birth weight is associated with increased risk of coronary heart disease in adults (12). Also lower weight in infants is associated with higher risk of coronary heart disease in men (13). It has been found that stunted adults are at increased risk of cardiovascular disease (13).

Conclusion:- Undernutrition has long term effects. Prevention of undernutrition in preschoolers will have long term beneficial effects in adulthood and good outcome in adult health. Adequate nutrition in first 3 years is essential to prevent short adults, improve functional capability in adults and metabolic diseases.

References
1. Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, Sachdev HS; Maternal and Child Undernutrition Study Group. Maternal and child undernutrition: consequences for adult health and human capital. Lancet. 2008: 26; 371: 340-357.
2. Barker DJ. The fetal and infant origins of disease. Eur J Clin Invest. 1995; 25: 457-463.
3. Hales CN, Barker DJ. Type 2 (non-insulin-dependent) diabetes mellitus: the thrifty phenotype hypothesis. Diabetologia. 1992; 35: 595-601.
4. Barker DJ. Fetal origins of coronary heart disease. BMJ. 1995: 15; 311: 171-174.
5. Caballero B, Maqbool A. International Nutrition. In: Walker WA, Watkins JB, Duggan C, eds. Nutrition in Pediatrics. London: BC Decker Inc. 2003:195-204.
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7. Martorell R, Khan LK, Schroeder DG. Reversibility of stunting: epidemiological findings in children from developing countries. Eur J Clin Nutr. 1994; 48 Suppl 1: S45-S57.
8. Hack M. Effects of intrauterine growth retardation on mental performance and behavior, outcomes during adolescence and adulthood. Eur J Clin Nutr. 1998; 52 Suppl 1: S65-71.
9. Landon J, Davison M, Breier B. The developmental environment influences on subsequent cognitive function and behavior. In:Guickman P, Hanson M. (eds). Developmental origins of health and disease. Cambridge University Press; Cambridge;2006:370-378.
10. Maluccio JA, Hoddinott J, Behrman JR, Martorell R, Quisumbing AR. The impact of nutrition during early childhood on education among Guatemalan adults. Middlebury College Economics Discussion Paper number 06-14. Middleburg College, VT, 2006.
11. Krishnaswamy K, Naidu AN, Prasad MP, Reddy GA. Fetal malnutrition and adult chronic disease. Nutr Rev. 2002; 60(5 Pt 2): S35-S39.
12. Huxley R, Owen CG, Whincup PH, Cook DG, Rich-Edwards J, Smith GD, Collins R. Is birth weight a risk factor for ischemic heart disease in later life? Am J Clin Nutr. 2007; 85: 1244-1250.
13. Fall CH. Developmental origins of cardiovascular disease, type 2, diabetes and obesity in humans. In : Wintor E, Owens J (eds). Early life origins of health and disease. Springer Science. New York: 2006.
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