HEALTH ACROSS THE LIFE COURSE

Question 1

What are the 4 life course epidemiological models? [4]

Answer 1

Immediate risk: lightening strikes in early development

Cumulative risk: you overeat every day and become more and more obese

Trajectory models:any specific levels of exposure would be fine but it’s a problem if there is a change (altitude sickness). Person may change the environment they’ve adapted to and this brings about different changes

Critical/sensitive period (life latency): exposure matters most as critical developmental period (d)

Question 2

Why is parental support so important for antenatal care? [1]

Answer 2

Pre-natal environment is just as important as childhood and adulthood for creating risks for children

Question 3

How does early biological risk influence adult outcomes for:

• BP and cholesterol [1]
• Overweight [1]
• Smoking, dietary and exercise habits [1]

Answer 3

Adult blood pressure and cholesterol levels are associated to those during childhood

Overweight children are at increased risk of becoming overweight adults

Life-long smoking, dietary and exercise habits are acquired in childhood and adolescence

Question 4

Explain the Barker Hypothesis

Answer 4

In-uterine exposure affects developing phenotype:

thrifty phenotype:
* if a baby in-utero is subject to poor nutrients (because of bad maternal diet), the epigenome is programmed to expect this environment post-natally.
* Developmental changes in cellular energy metabolism: glucose handling; lipid metabolism; mitochondria biogenesis
* When born and given a nutrient rich environment: get increased risk of susceptibility to metabolic disease, such as type 2 diabetes, obesity and CHD

Question 5

What did Dutch famine experiment show? [4]

Answer 5

Those who suffered in the famine had:

• More atherogenic proflie of lipids
• CHD 9% (compared to 3% non-exposed)
• OGT: 2hr glucose was 0.5mmol/L higher in exposed
• Systolic BP increased 3 mmHg per 1kg lower birthweight

Question 6

Which 4 diseases do Barker’s Hypothesis increase the liklihood of? [4]

Answer 6

DMT2

• Hyperinsulinemia
• leptin resistance in brain: Obesity
• lipid accumulation in CV system: CVD

Question 7

What is the main mechansim of epigenetics? [1]

Answer 7

DNA methylation

Question 8

What effect does increased / decreased methylation have on genes? [2]

Answer 8

Increased methylation usually switches gene off

Decreased methylation increases gene expression

Question 9

What does IGF-2 code for?

Answer 9

IGF2 is a key factor in human growth

Question 10

Explain the link between methylation of DMD region and IGF-2 in mother and father

Answer 10

Mother:
* demethylated DMD region drives coding of H19 region

Father:
* DMD methylated (inactivated)
* Prevents coding of H19
* Causes IGF-2 to be created - drives growth of child in adolesence and middle age

Question 11

How did the Dutch Famine influence DMD

Answer 11

Demethylating of DMD still occuringl smaller babies ! (Found even 60 years later!!)

Question 12

What were differences in risk of mortaility of offspring for mothers exposed to Dutch Famine dependin on which trimester the mother was exposed tp?

(This is second generation motheres !)

Answer 12

Question 13

Effect of Nigerian Civil War: Biafra famine on:

HTN? [1]
Glucose tolerance [1]
Diabetes [1]

Answer 13

HTN: 2.5 x more likely to have
Impaired glucose tolerance
Diabetes increased

Question 14

Name two UK longitudinal studies

Answer 14

Avon Longitudinal Study of Parents and Children – ALSPAC

Born in Bradford – BiB