Early Nutrition and Adult Non- communicable diseases: A ... · (Developmental Origins of Adult Health and Disease (DOHAD) In the last 15 years new information suggest the nutritional

Early Nutrition and Adult Non-communicable diseases: A vital link

that must be broken

Commonwealth Health Ministers’ MeetingWHO, Geneva May 14, 2011

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Anna Lartey (Associate Professor)Department of Nutrition & Food Science

University of Ghana

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“…NCD deaths are projected to increase by 15% globally between 2010 and 2020. The greatest increases will be in Africa, the Eastern Mediterranean, and South-East Asia, where they will increase by over 20%”

Global status report on non-communicable disease (WHO, April 2010)

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Total deaths by broad cause group by WHORegion and by sex

Source: Global status report on non-communicable disease (WHO, April 2010)

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Age standardized prevalence of diabetes by WHORegion and by sex


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Age standardized prevalence of Hypertension in adults ages 25+ years by WHO Region and by sex


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Age standardized prevalence of overweight in adults ages 20+ years by WHO Region and by sex


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Nutrition Transition

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Early Nutritional influences on NCDs (Developmental Origins of Adult Health and Disease (DOHAD)

In the last 15 years new information suggest the nutritional influences encountered earlier in life may be of equal importance in determining CVD risk

Maternal nutrition, fetal nutrition and disease in later life (Barker D;1992)

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Adverse environmental conditions

Fetus

Dies Adaptation to survive

Metabolic/Nutritional Programming

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Fetal under-nutrition

Brain sparing

Impaired development:Blood vessels, liver, kidney and pancreas

Down regulation of growth

Reduced insulin secretion and sensitivity

Altered Body composition

Reduced Muscle

HyperlipidemiaHypertension

Central Obesity Insulin Resistance

Type 2 Diabetes and CHD in Adult life

Metabolic Programming

Source: C. Fall 2009

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Evidence in support of Developmentalorigins of disease from animal studies

In rats, maternal diet (protein) restriction in pregnancy

High blood pressureImpaired glucose toleranceInsulin resistanceAltered hepatic function

in the adult offspring

(Woodall et al 1996; Langley et al 1994; Pickard et al 1996)

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Evidence in support of Developmental origins of disease from Humans

Indian children: study examined that association between LBW and CVD risk factors (Bavdekar, et al 2000)

At 4 years: LBW was associated with higher plasma concglucose after an oral glucose load

At 8 years:LBW children had high LDL cholesterol, higher systolic pressure and insulin resistance

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0 10 20 30 40 50 600

10

20

30

40

50

60

70

Regions

South America

Middle America / Caribbean

South East Asia

South Asia

Near East / North Africa

Sub-Saharan Africa

China

Prevalence of Low Birth Weight (%)

Prev

alen

ce o

f stu

ntin

g (%

)

Extracted from: ACC/SCN, 1997

The prevalence of Low Birth Weight and Stunting

Source of slide: R Uauy

Low Birth Weight and Stunting are Related

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Maternal Underweight & LBW are Related

UN/SCN 6th WNR 2010Source of slide: R Uauy

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Proportion of babies born low birth weight by region

0

5

10

15

20

25

30

SSA MENA S. ASIA L. America All developing Countries

Pe

rce

nta

ge

Regions

SSA= Sub Saharan Africa; MENA= Middle East and North Africa

Source of data: UNICEF State of the World’s Children, 2009

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Implications of Developmental origins of adult disease for Developing countries

Identification of critical periods during which conditions can be programmed (-9 to 24mo) raisesconcern about the potential for huge increase in the prevalence of NCDs in low income countries, especially countries going through the nutrition transition.

Good news: We have knowledge on what to do to avoid disease programming in utero and during early infancy.

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Window of opportunity to break link on nutrition programming (-9 to 24 mo)

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Early nutrition matters

•Improve maternal nutrition before and during pregnancy (diet is nutrient dense, adequate micronutrients). Adequate maternal diet is

important to break the intergenerational effect of low birth weight

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Promote Exclusive Breastfeeding


Risk of Overweight in Adolescence by Duration of Breastfeeding in Infancy

1.4

1.2

1.0

0.8

0.6

0.4

1 1- 3 4 - 6 7 - 9 >9

Duration of Breastfeeding (mo)

Odd

s R

atio

(95

% C

I)

Source: Gillman et al., 2001

Protective effect of breastfeeding on obesity

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Early nutrition matters:Promote adequate complementary feeding

0

5

10

15

20

25

30

35

40

45

Kenya Ghana Zimbabwe Morocco

% o

f chi

ldre

n un

der

5 y

stun

ted

<6 mo 6-<12 mo 12-36 mo >36 mo

Stunting prevalence by age categories (Source of data: Country DHS data)

90% of All Stunted Children Live in Just 36 Countries

PAPER 1

Consequences of stunting

Short termy Increased infant morbidityy Increased perinatal mortalityy Increased risk of maternal

mortalityy Delayed motor developmenty Adverse cognitive

development

Long termy Reduced adult staturey Lower educational attainmenty Lower adult productivity and

income earningsy Increased risk of obesityy Processes leading to stunting

(poor maternal diet) are associated with insulin resistance, diabetes and CVD in offspring later in life

y Inter-generational effects of stunting in girls

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Early nutrition matters:Promote adequate complementary feeding

*Improve the nutritional quality of complementaryfoods (feeding a variety of foods to improve dietary diversity).

*Micronutrient fortified complementary foods may be needed where local complementary food qualityis poor.

y Promotion of Breastfeedingy Complementary feedingy Improved hygienic practicesy Vitamin A supplementationy Zinc supplements for diarrhea

managementy Multiple micronutrient

powdersy De-worming y Iron-folic acid supplements for

pregnant womeny Iodized oil capsules

y Salt iodizationy Iron fortification of staple

foodsy Prevention and treatment of

moderate undernutrition with special foods

y Treatment of severe undernutrition with ready-to-use therapeutic foods (RUTF)

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Thirteen evidence-based interventions that when scaled up will make a difference(Lancet series 2008)

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What will it cost to scale up these 13 interventions in high malnutrition burden countries?

Annually: 10.3 billion USD

Benefit: Prevent annually1.1 million deaths,

30 million cases of stunting,Avert the loss of 30 million disability adjusted life years ;Substantial economic gains

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Scaling Up Nutrition movement

SUN: Scaling Up Nutrition Documents

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Scaling Up Nutrition (SUN) is a framework that lays out a new approach to improving nutrition for mothers and children during the window of opportunity from pregnancy to age two. SUN focuses on 13 key direct nutrition interventions.

SUN is led by a cross-sector, multi-partner Transition Team, chaired by Dr. David Nabarro, Special Representative of the UN Secretary General for Food Security and Nutrition

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SUN works with donors, development agencies, civil society and others within countries and at an international level, to align programs and investments with national plans.

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Early Riser countries:

These are early adopters of the SUN framework. These countries have committed to establishing national nutrition priorities and developing plans that align with the SUN approach of scaling up Nutrition

Countries must apply with a formal letter of request from a high-ranking government official (e.g. Headof Government or Minister of health) to

David Nabarro: [email protected]


mailto:[email protected]

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Early Riser countries:

Ethiopia, Guatemala, Ghana, Laos, Malawi, Mali, Niger, Peru, Uganda, Zambia

Others: Bangladesh, Nepal, Senegal, Tanzania


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Take Home Messages:

Early nutrition matters when addressing NCDs

Take advantage of the window of opportunity (-9-

24 mo) to break the link

As Ministers of Health: take advantage of the SUN

activities and make nutrition a priority